Pago Pago, AMERICAN SAMOA — The American Samoa’s 2025 Women/Maternal Health Annual Report outlines several concerns regarding the rise of  Chlamydia and Gonorrhea in the territory. 

The undated report released by the US Department of Health and Human Services notes that by 2025, American Samoa will increase the percentage of women ages 18 to 44 who have had a preventive medical visit in the past year to 59%, an increase from the baseline of 47% in 2019. 

According to the report on sexually transmitted Infections, the HIV/STD/TB/Viral Hepatitis Program prepares, prevents, responds to, and controls the spread of diseases of public health concern in American Samoa through surveillance, disease reporting, and investigation in collaboration with health care providers and key responders for a healthier and safer community.  

The HIV/STD/TB/Viral Hepatitis Program offers free testing and treatment, contact tracing, HIV testing and linkage to care, contraceptives, risk-reduction counseling, health education, and community outreaches in American Samoa. As the nation’s rates of STIs are on the rise, so are American Samoa’s numbers. 

In 2023, the HIV/STD Program reported a total of 268 women who tested positive for Chlamydia and 31 who tested positive for Gonorrhea. Numbers of both STIs increased from 2022 to 2023 by 120 positive Chlamydia cases and 23 positive gonorrhea cases.

The majority of these women were pregnant women because it was mandatory to be screened for STIs once they registered for prenatal care. Sexual partners are also tested and treated if positive.

Furthermore, the report noted that leadership and stakeholders prioritized improving women's access to coordinated, comprehensive services before, during, and after pregnancy. 

Efforts to improve pregnancy outcomes and maternal and infant health should begin before conception. Establishing healthy behaviors and achieving optimal health before pregnancy is crucial, as many women may not initially be aware they are pregnant.

In 2018, only 54.8% of American Samoa’s adult population prioritized annual wellness visits, compared to the national rate of 70.4%.

Chronic conditions remain prevalent among the adult population. Various strategies have been identified to align ASMCH Title V priorities towards improving this perspective, starting with promoting wellness visits for women in the 2021-2025 Action Plan.

Collaboration with service providers, technical assistance to enhance competencies, updating standard operating procedures, and community outreach activities have shown promising outcomes in the fourth year of this five-year cycle.

WELLNESS VISIT 

In Fiscal Year 2023, all American Samoa Department of Health programs addressing the health needs of women and the maternal population continued to collaborate to promote women’s wellness through systems-building efforts. Because of these collaborative efforts, a more holistic approach is being promoted at the Community Health Centers (ASDOH clinics) to support this concept.

Whenever a woman shows up in any of the ASDOH clinics, they are further referred to all other healthcare clinics if any preventive screenings are due, including dental, medical, gynecological, behavioral, family planning, and STI screening.

Continuous quality improvement projects are set in place to improve patient care and increase encounters, which is gradually improving the rate of women accessing preventive wellness visits.

According to the MCH Jurisdictional Surveys conducted in American Samoa in 2019, 2021, and 2024 by the National Opinion Research Center at the University of Chicago, there has been a steady improvement in the number of women accessing annual wellness visits.

In 2019, the MCHJS reported a low participation rate of 47%. This improved by 8.6% to 55.6% in 2021, then increased by 2% to 58.4% in 2024.  

This progress is particularly significant given the closure of clinics during the COVID-19 pandemic between 2021 and 2022 for mass vaccinations and community outbreaks.

The success can be attributed to the tremendous efforts of health agencies and community partners in promoting access to and utilization of preventive health care services in the aftermath.

The American Samoa Community Health Centers’ 2023 annual report supports these findings. It indicates that 4,911 women accessed their clinics for medical check-ups. This represents 56.4% of the total female population aged 18 to 44, 8,714 in American Samoa. 

Chronic diseases (NCDs) continue to be prevalent among women seeking care, with major concerns including obesity, diabetes mellitus, hypertension, heart disease, and cancer. Contributing risk factors remain high, including inadequate nutrition, poor access to nutritious food, a high rate of physical inactivity, and, despite the gradual increase in women's annual visits, low annual preventive health care visits remain.  

There is a continued need to promote wellness visits through effective policy initiatives, collaborations, and improved accessibility to affordable diagnostic and specialty care.

BREAST & CERVICAL CANCER SCREENING 

The Breast and Cervical Cancer Prevention (BCCP) program is experiencing promising outcomes by expanding its services. They now provide screenings on Saturdays at village locations and church halls, as well as offer after-hours clinics on Tuesdays and Thursdays. In total, 265 women aged 18 to 44 visited the clinic for preventive care. 

Of these, 245 women (92.5%) received a clinical breast exam, 167 women (63%) underwent a mammogram, and 114 women had a pap smear.

This represents a significant increase from the 19 pap smears recorded in 2022. However, there was a decline in the number of mammograms from 404 in 2022. The BCCP continues to refer all women suspected of being pregnant to prenatal clinics. Additionally, in 2023, the program expanded its services to the Manu’a Islands.