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Guam doula project gains bipartisan support


By Jayvee Vallejera


This early, a newly introduced bill that aims to lower maternal and infant mortality on Guam by training doulas as support system for pregnant women has already gained the support of six Democrat and three Republican lawmakers.

Bill 318-37, which was authored by Sen. Tom Fisher, is being cosponsored by Sens. Joe San Agustin, Roy Quinata, Will Parkinson, Dwayne San Nicolas, Chris Duenas, Vice Speaker Tina Muna Barnes, Jesse Lujan and Amanda Shelton.

Fisher’s Bill 318-37 aims to provide $400,000 to the Bureau of Women’s Affairs to fund the Guåhan Doula Project.

 "The Guåhan Doula Project is a pivotal step toward safeguarding the health and well-being of mothers and infants in our community," Fisher said. "By providing essential funding and support, we aim to make a substantial impact in reducing these high mortality rates."

If the bill is enacted into law, the next step would be to have doula services included in Guam’s state Medicaid plans.

Therese Arriola, acting director of the Department of Public Health and Social Services, noted that 13 states are already doing that and her department will work toward that goal.

“The next step is to really, really ensure that Medicaid [can] cover the doula services. We’re looking at possibly certification, things of that nature, and we’ll definitely work with the doulas, work with the authors, the senators, Bureau of Women’s Affairs, to ensure that everything falls in line. This all ties in to making sure that the most vulnerable population has coverage,” Arriola added.

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 Guåhan Doula Project is a first-of-its-kind initiative aimed at reducing Guam’s high maternal and infant mortality rates through nonmedical support, advocacy, education, resources, and referrals for pregnant and postpartum women, their babies, and their families.

Jayne Flores, BWA director, noted that Guam Memorial Hospital officials reported to her that an average of 17-20 percent of the women who go to the hospital to give birth have had no prenatal care. Data from the DPHSS 2023 Maternal Health Summit shows that a lack of prenatal care is a contributing factor to Guam’s high fetal death rate.

The Guåhan Doula Project was initiated by BWA and the Birthworkers of Color Collective, a nonprofit organization in California and co-founded by CHamoru woman Stevie Mesa Merino, herself a trained doula for the past nine years.

Merino’s BWCC came to Guam in December 2023 to train 13 local women to become doulas, in order to educate women in our community “on being healthy, both physically, mentally, what they can do to have healthy babies, healthy births,” said Flores, adding that doulas work in collaboration with the medical community.

Merino, through a media release read in part by Flores, noted that “bringing a Pacific Islander/CHamoru centered training run and facilitated by a CHamoru trainer is valuable.” In the release, Merino added that, “While we may not be suruhanas in the traditional sense of delivering babies, many are reclaiming this age-old sacred tradition of village care, support, and åmot.”

Bill cosponsor Muña Barnes recalled the role of suruhanas “in helping our sisters give birth,” noting that “We don’t have to pit the past against the present.

“The upcoming training funded through this bill can incorporate the prenatal and postnatal care that has been offered by our Indigenous healers for millennia, so the best of the past and the present can come together, share the medicinal knowledge of our ancestors to care for expecting mothers and to shepherd a new generation of Guamanians,” said Muña Barnes.

Tia Muña Aguon, who finished doula training last December, described doulas as “really being the guardians of the sacred birth experience,” noting that doulas help expectant and birthing mothers with their concerns, their worries, acting as a person of support during pregnancy, the labor and delivery process, and even post-partum.

Another new doula, Kirsten Rosario, noted that the doula training also is “utilizing our suruhanas that have come to the plate to help us learn about the traditional medicines that we can possibly use for our birthing work.”


Fisher, the bill’s author, described Guam’s maternal mortality and infant mortality rates as shocking, “and something has to be done about it and we are doing something about it.”

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.

Bill 318-37 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 DPHSS 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.

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


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