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Doulas project: The proposed solution to inadequate maternal care on Guam

Updated: Jun 28

 By Jayvee Vallejera

Combatting maternal and infant mortality on Guam may be a step closer to reality with the planned introduction of a bill that would pave the way for the creation of a doula initiative in the territory.

Sen. Thomas J. Fisher has introduced a bill that would appropriate $400,000 for the “Guåhan Doula Project,” which was initiated in collaboration with the Guam Bureau of Women’s Affairs.

A doula is typically a woman who guides and supports pregnant women during labor. Although they usually have no formal medical training, they typically stay by the patient’s side throughout the delivery process.

The proposed bill, which has yet to be numbered, recognizes that Guam has some of the highest maternal and infant mortality rates in the United States and its five territories, with most pregnancy-related deaths being preventable.

According to the bill’s legislative findings and intent, CHamoru infants are five times as likely as the national average to die before reaching the age of one.

The bill also cites the 2023 Needs Assessment Update for Guam by the federal Health Resources and Services Administration, which states that Guam’s 10-year average maternal mortality rate, is at 29.4, which is higher than that of the U.S. mainland, which is at 23.8 in 2020. Even more concerning is that Guam’s MMR has been increasing in the past 10 years, similar to the national trend.

Also, Guam’s Department of Public Health and Social Services has reported that the territory’s fetal death rate is also markedly higher than that of the national rate, with a 13.32 fetal death rate in 2022. In contrast, the U.S. fetal death rate has not gone above 6.11 per 1,000 births since 2011.

The DPHSS noted that fetal deaths markedly decreased when pregnant women obtain prenatal care.

The bill sees doulas as a response to address and stem these distressing numbers. The Bureau of Women’s Affairs is right now working with the national nonprofit group Birthworkers of Color Collective to address the health iniquities Guam is experiencing, especially with regard to pre- and postnatal care. The BWOCC has trained almost 500 people across the United States and worldwide to provide culturally relevant doula services/support.

“Doula training and services represent a collaborative effort that can work with Guam’s medical community to address pre- and postnatal care challenges…[and as]…an additional resource for women and their babies,” states part of the bill.

The measure assures that doulas are being recognized throughout the United States as an essential tool to address the maternal and infant mortality crisis by providing new and expectant parents with educational, emotional and physical support before, during and after a baby is born.

It cites research showing that doulas can have positive impacts on birthing outcomes and decrease unnecessary interventions. “Woman who have doula support reported shorter labors, positive birth experiences and were less likely to have a caesarian birth or other interventions,” it added.

The bill describes the Guåhan Doula Project as “cultural competency in action”—a cultural birthright and reclamation because, although the concept of doulas is relatively new to the territory, supporting and caring for pregnant and postpartum women has always been a Guam tradition through the CHamoru Suruhana and Pattera.

The bill is co-sponsored by Vice Speaker Tina Muña Barnes and Sens. Joe S. San Agustin, Roy A.B. Quinata, William A. Parkinson, Dwayne San Nicolas, Christopher M. Duenas, Jesse A. Lujan and Amanda L. Shelton.

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