The maternal mortality rate in Guam (a U.S. island territory in Micronesia) is high, mainly due to the lack of obstetric care available on the island. As of 2021, the maternal mortality rate in Guam was 30.4 per 1,000 births. An extreme lack of OBGYN providers is believed to be the cause of the high mortality rates for mothers. The Guahan Doula Project seeks to rectify this gap in care by providing a program in which women can become certified as doulas and assist in pregnancy care.

Lack of Access to Hospitals Restricts Medical Care

Guam has only three hospitals, one of which is located on the Guam Naval Base, which exclusively provides care to those serving and their families. The Guam Regional Medical City, located in Dededo, is a private hospital. This leaves only one public hospital, Guam Memorial Hospital in Tamuning, where most people in Guam can obtain medical care. It is also the only hospital with a labor and delivery wing.

Those residing in the southernmost parts of the island face up to an hour-long drive to the Guam Memorial Hospital. If there are any complications during labor and delivery, the distance may increase the odds of fatality for the mother or baby.

Due to the difficulties accessing health care, the Health Resources and Services Administration deems Guam a Medically Underserved Area. Specialized care, such as obstetrics, is even harder to access. More than half of maternity-related deaths are due to hemorrhage and pregnancy-induced high blood pressure. Both are less likely to be fatal with routine, preventative doctor visits.

Provider Shortages

According to OBGYN Dr. Tom Shieh, there are only 6.5 OBGYNs left to handle the delivery of the roughly 250 babies born monthly. This shortage of medical professionals, coupled with the lack of hospitals, undoubtedly increases maternal mortality in Guam.

Guam, with a population of 167,777, has only 6.5 practicing OB-GYNs—far too few to adequately meet the needs of expecting and delivering mothers.

Guahan Doula Project

Bill 318-47 seeks to address the maternal mortality in Guam through certifying doulas. The bill proposes allocating $400,000 to the Bureau of Women’s Affairs’ Guahan Doula Project. Doulas can provide pregnancy care to help fill the gap that the lack of OBGYNs and gynecologists leaves. There are 13 doulas in Guam as of February 2025, but that number would surely increase if the bill passes.

Doulas are not licensed medical professionals in the same way that doctors are. However, they provide support and knowledge of the birthing process that has been proven to reduce maternal mortality rates, shorten labor times and reduce emergency cesarean sections.

More doulas would offer more possibilities of access to care than the Guam Memorial Hospital does alone. Practices can be set up anywhere and don’t need to be based in a hospital. This allows more women the opportunity to receive some pregnancy care before, during and after birth.

Doulas Supplement Maternal Care

Increasing access to prenatal and postnatal care will decrease the rates of maternal mortality in Guam. Medical problems that may prove fatal are more likely to be caught and treated if the expectant woman can be seen by a provider regularly.

– Sydney Uhl

Sydney is based in Vancouver, WA, USA and focuses on Good News and Technology for The Borgen Project.

Photo: Pixabay