When a flood, wildfire or other natural disaster hits, evacuating residents are much more likely to grab important documents, family photos, water and clothes than birth control, condoms or menstrual products. Worse, if they are stranded, it may be impossible to get the supplies they need during the weeks of recovery that follow a major disaster. However, prioritizing reproductive health care access remains vital, even amidst disasters.

States typically have a list of items that residents should have on hand in case of an emergency, but prioritizing reproductive health care is rarely an aspect of these checklists. According to a new 50-state scorecard released on Thursday, only one state — Maryland — does a good job of including sexual and reproductive health supplies into its preparedness checklist.

Researchers from the Center for Biological Diversity, an environmental nonprofit, named four categories of supplies that should be included on states’ checklists: menstrual products; sexual and reproductive health items, such as emergency contraception and birthing supplies; medications and personal hygiene products. Then, they analyzed the checklists to see which ones included supplies from each of these buckets.

Maryland was the only state to get a perfect score; its list includes both condoms and menstrual products, effectively prioritizing reproductive health care access. Rhode Island was the only state to include birthing supplies which could include  gloves, a sheet and surgical scissors. Forty-eight states had medication on their checklists, which could encompass birth control. A little over half of the states included menstrual products. (Seven states used the federal government’s generic checklist, which includes “feminine supplies,” but leaves out contraceptives and condoms.)

“I think as a suite of products [states] could be providing more information to people around their sexual and reproductive health needs during those times,” said Kelley Dennings, senior campaigner with the population and sustainability program at the organization.

As climate change worsens, leading to more frequent and destructive disasters, it will more significantly impact access to reproductive and sexual health care, a topic that hasn’t been heavily researched in the United States. One study after Hurricane Katrina found that out of 55 women who had been attending a family planning clinic prior to the storm, 40 percent were no longer on birth control and two had unintended pregnancies. Another, after Hurricane Ike, found that 13 percent of 975 women surveyed had difficulty obtaining contraception, with lack of access more pronounced among Black women.

Read the full article about reproductive health care during disasters by Jessica Kutz at The 19th.