There were 40 maternal deaths in the U.S. Territory of Guam from 1968 to 2021, resulting invery high maternal mortality ratios (MMR) during the years when there are maternal deaths.The MMR during the past fifty years ranged from a low of 22.6 in 1996 to a high of 30.4 in2021; using a 10-year average MMR from the most recent ten-year period, 2008-2017, at 27.0is still higher than the U.S. MMR of 20.7. Chamorro and Chuukese women on Guam have both disproportionately higher maternal mortality and extremely low birth weight (ELBW)infants. Approximately one-fourth of Guam women are at risk for unintentional pregnancy due to not using any contraception or any reliable methods of contraception. The percent of pregnant women who receive prenatal care beginning in the 1st trimester on Guam remained relatively unchanged since 2015 at 60.9%, and the percent of women whose prenatal care initiation was late or received no prenatal care also remained unchanged at 13.4%. A study which examined reasons for the lack of prenatal care among women of reproductive age on Guam showed that lack of medical insurance (24.3%) and lack of transportation (22.6%) were the main reasons given by respondents. Risk factors for maternal death are also high on Guam and reflect disparities in access to health and coverage whereby women with lower education and lower household income were less likely to either have health insurance coverage or have had a routine check-up in the past year. The estimated proportion of current smokers, and the proportions overweight or obese, or with diabetes or gestational diabetes in Guam’s female population all follow income and educational gradients.
The Guam Department of Public Health and Social services (DPHSS) proposes to implement several strategies to address high maternal mortality: (1) improve the quality and availability of death records on Guam through a consistent process to enable thorough maternal death review, (2) implement a standardized process for selecting maternal deaths for review, and for obtaining additional information from medical and other records, and interviews, and (3) establish a Maternal Mortality Review Committee to conduct population level review of possible pregnancy-related deaths and relevant data, and to make recommendations for the prevention of maternal deaths.
There are three main outcomes for this proposed project: (1) improvement of State-Level Maternal Health Data and Surveillance through enhancing the quality and availability of death records on Guam, through a consistent process to enable thorough maternal death review; (2) implementation of a standardized process for selecting maternal deaths for review, and for obtaining additional information from medical and other records, and interviews and (3) establishment of a Guam Maternal Mortality Review Committee (MMRC).