The maternal care crisis on Guam is highlighted by the closure of the island’s only standalone birth center in December 2022, leaving only the single hospital and one doula as maternity support options. Without access to abortion services since 2018, the island is facing significant reproductive access gaps. Medical professionals have been sounding the alarm for two years, warning of the fragility of emergency services for birthing people. U.S. territories like Guam do not have Medicaid coverage for doula care, unlike many states on the mainland. This lack of support was exemplified when Typhoon Mawar threatened to disrupt Livia Marati’s birth plans. A CHamoru women-led organization, the Birthworkers of Color Collective, is training CHamoru doulas to provide Indigenous-centered reproductive practices and rapid-response birthing support in the face of increasing climate disasters.
Founder Stevie Merino of the Birthworkers of Color Collective emphasizes that reproductive justice is about more than just the birth experience; it also encompasses climate injustice, food insecurity, and affordable housing. Guam’s reproductive access issues are exacerbated by climate change, with pregnant women at higher risk during extreme climate events. The island’s maternal and infant mortality rates are already higher than the national average, and CHamoru infants are five times more likely to die before age 1. A critical care nurse at Guam Memorial Hospital warned that another supertyphoon could shut down the hospital’s outdated facilities, leaving pregnant people stranded without care. Environmental and cultural issues, stemming from Guam’s history under Spanish, Japanese, and U.S. control, have also contributed to reproductive health challenges, with high rates of infertility, miscarriages, and birth complications due to military activity.
Traditional CHamoru healers practiced for over 4,000 years until they were suppressed by outside forces, such as the Catholic Church and U.S. military government. The loss of traditional healing practices has led to a medicalized approach to birthing in recent decades, with younger generations now seeking to reclaim this knowledge. The Birthworkers of Color Collective’s doula training aims to recenter Indigenous practices in reproductive care by teaching CHamoru women to support pregnancy and postpartum outcomes through ancestral knowledge. The training is seen as a timely response to the urgent need for culturally relevant birthing support on Guam. As the island prepares for more frequent climate disasters, such as typhoons, the collective hopes to equip the community with the tools and resources needed to navigate emergencies.
Merino’s vision for the doula training in Guam was born out of the realization of the island’s vulnerability to climate disasters, such as Typhoon Mawar. With the closure of the birth center and the lack of Medicaid coverage for doula care, the island’s pregnant individuals are left with limited support and options. The collective’s initiative to train CHamoru doulas is a step towards addressing the maternal care crisis and bridging the reproductive access gaps on the island. By empowering local women with ancestral knowledge and skills, the Birthworkers of Color Collective is working to create a more resilient and culturally grounded reproductive care system on Guam. In the face of environmental challenges and historical trauma, the reclamation of Indigenous practices in reproductive health represents a critical step towards ensuring the well-being of future generations on the island.
