Over the course of 2024, private doctors have raised alarms about the state of women’s health care on Guam, from primary care in the community to acute care at the hospital, characterizing it as a worsening crisis.

Women’s health care, which includes gynecologic care, prenatal care, labor and delivery and postpartum care, has been significantly impacted by a shortage of board-certified obstetricians and gynecologists (OBGYNs).

Although the island faces a shortage of OBGYNs, it has not yet been classified nationally as a maternity care desert. However, conditions like the closure of the Sagua Managu Birthing Center and the impending closure of Marianas Physicians Group in February 2025, as OBGYNs retire from the workforce, highlight growing concerns.

Local OBGYN Dr. Thomas Shieh and Family Practitioner Dr. Hoa Nguyen believe Guam is on a path toward becoming a maternity care desert. Both note that the state of health care for women and pregnant mothers today is worse than when local physicians declared a crisis two years ago.

“We are now in the worst time for pregnant patients and (gynecology) patients who might or might not have cancer,” said Nguyen, who practices at American Medical Center. “We might have to declare another crisis. This is really worse than 2022. At that time, there was COVID-19.”

Nguyen emphasized that one of the reasons Guam’s maternal and fetal mortality rates are among the highest in the nation is inadequate or nonexistent prenatal care.

“What people don’t understand is it starts when you conceive. Prenatal care is the most important thing of them all. We have a lot of high-risk patients here that have high blood pressure and diabetes, so when they get pregnant, they become high-risk,” he said.

Nguyen explained what has changed in the past two years to further strain women’s health care.

“If you look at the (landscape) now, back in 2022, we had more (obstetrics) doctors on the island. Right now, on the private side of the community, Dr. (Teresa) Underwood is an (obstetrics and gynecology specialist). She left (the) island recently. She left for good. Dr. (Annie) Bordallo, she practices a little bit on the outside, but she retires (in March 2025). Who’s left for the whole island for OB-GYN? Dr. Tom Shieh,” Nguyen said.

The severely limited number of OBGYNs has made it difficult for women to access health and prenatal care. Doctors like Shieh, who is close in age to Dr. Bordallo, are no longer accepting new patients to spend more time with their families.

According to Shieh, the average age of OBGYNs on Guam is over 65.

The Women’s and Maternal Fetal Health Care crisis, particularly the shortage of OBGYNs, has been acknowledged by the Guam Memorial Hospital (GMH) and the Leon Guerrero-Tenorio administration, which stated that proactive measures are being implemented to ensure mothers and infants receive adequate care.

“At the forefront of these efforts are our family medicine practitioners, who are leading the care for maternal and child health services on Guam. These skilled doctors, trained and certified to deliver babies, are addressing the medical needs of our community with dedication and expertise,” Gov. Lou Leon Guerrero said in November.

She noted that family medicine practitioners help fill gaps in services.

However, Nguyen stressed that family practitioners’ care is limited, as they are not trained OBGYNs and may miss complications that OBGYNs would identify.

The crisis, according to the doctors, is further exacerbated by an alleged lack of pay parity at GMH.

In December, Dr. Jennifer Linden’s leave of absence highlighted concerns about staffing. GMH’s OBGYN coverage during her absence included one full-time doctor, one retired doctor and another doctor nearing retirement.

Shieh, listed on a December coverage schedule, confirmed that while he has privileges to deliver babies at GMH, he is not employed by or on call for the hospital.

He publicly claimed on social media that GMH asked him to cover shifts but refused his request for pay parity.

“In the past, I covered shifts at no charge to the hospital,” Shieh told The Guam Daily Post. “It’s not about money because that part I was giving to charity. What is important is treating us board-certified OB-GYNs equally. Parity is important to me and should be to others as well. GMH is an institution that should have equality to all medical staff who does the same work. This shows how corrupted the government is, how they pick and choose who they reimburse, which is a shame.”

The hospital confirmed it has one OBGYN on contract for $4,800 a day to cover calls on an as-needed basis, typically once or twice a month.