With island demographics changing – are prenatal services being met?

In an island community, babies being born in the ferry line or on ferries has made the news. As the population has grown and demographics changed, the lack of prenatal care has stagnated, potentially even decreased, and young families seem stressed.

“While we would love to be able to provide prenatal/OB care in the clinic, unfortunately, the island is not equipped to support the wide array of complications that can arise during pregnancy and delivery. For the safety of the baby and the mother, we recommend patients establish care with OB services off-island, such as Island Health/Island Hospital in Anacortes. That way they have the relationship and continuity with an OB provider,” Jack Estrada Chief Administrative Officer at PeaceHealth Peace Island explained. There has been a gynecologist visiting once a month to provide limited gynecological services. This provider does not offer any prenatal/maternity or obstetric care, Estrada added. There are no doctors on the island that do.

Blythe Parker is the only licensed midwife in San Juan County. “A lot of rural areas are facing [a lack of access to prenatal care],” she said. Maternity care deserts are springing up, generally in southern states. A 2022 NPR story cited a March of Dimes, a nonprofit focused on maternal and infant health, report that found 36% of counties nationwide… constitute “maternity care deserts.”

“What we know is that nationwide there are fewer and fewer people in the field. Either retiring from it or not entering in it. A lot of it has to do more recently with the economy. Also, the end of Roe v Wade really changed everything for people in the field. It affects not only people who may have termination issues but anyone who wants a baby in the first place,” Friday Harbor Family Clinic’s Dr. Mark Fishaut, M.D., F.A.A.P. said.

To get at the crux of the issues, Fishaut tried to determine how many babies were being born in San Juan County.


“[Island births] has never been a large amount,” Fishaut said, but learning if there has indeed been a significant drop in pregnancies and newborns in the county is difficult. A majority of births take place in off-island hospitals, typically in Anacortes or Bellingham. Birth certificates list the hospital’s location as opposed to the family’s home. This skews any data for births in San Juan County Washington. Only a home birth would be listed as San Juan County. But, perhaps women are returning to home births.

According to Parker, there has not been a decline in pregnancies. “I’m not seeing less babies. Our communities are really thriving with young families. There are people that grew up here and moved back and starting families. There are also people new to the islands who moved here during COVID.”

Alisha Halverson, DNP, ANRP, RN, is one of those who grew up on the island. After having a successful practice of her own, she moved back to San Juan. Halverson wasn’t sure where the disconnect was, whether more people were using off-island doctors or perhaps home-based care. “We have a ton of kids on island. I don’t know what the class sizes are these days but there are a number of young families. So it’s interesting, the disconnect between people and healthcare,” Halverson said.

According to Fishaut’s estimation, elementary class sizes depict fewer children. “There had been three kindergarten classes every year. This year there are two. So that tells you that is one-third less,” he said. “So it goes back to the biggest issue, where are the babies? They are not here.”

A rising distrust of healthcare may play a role in determining where the children are. Family physicians such as Fishaut once saw children as they became vaccinated. “From my experience, and just talking to people here, since COVID, there are a lot more people reluctant to get immunizations,” Fishaut said. “And then they think, well, if I don’t need immunizations, why do I need to go to the doctor for wellness checks and associated wellness checks?”

Breakdowns in communications between providers have also made real childbirth data murky, according to Fishaut and Heather Christensen, PA-C, also with the Friday Harbor Family Clinic. The drop in communication has also been detrimental for families.

“The staffing at Island Hospital has resulted in physician and surgeon [shortages]. It used to be that when they were better staffed, we’d get notes from them. We generally don’t anymore,” Fishaut explained. One of the primary changes Fishaut would like to see is more communication between healthcare agencies, including data on birth rates. Optimially, this would not only help doctors but help young families be more informed, know what to expect, plan and look for. This may ease some of the anxiety.


Fishaut and Christensen have noticed that the few new families they have seen is a rise in stress and anxiety. The economy and lack of housing on the island are just a couple of huge issues burning in young parents’ minds.

Other professionals have noticed it as well. Ashley Strutz, Joyce L. Soble Family Resource Center’s Family Support Specialist, also noticed increased anxiousness in parents. “We are seeing a high stress. There is a higher cost of living, and just in general a lot going on in the world. We are seeing the impact on families from that,” Strutz said. “It can be kind of isolating here anyway, especially if you are a new young family on the island.”

Often, Strutz continued, parents’ mental states, including post-partum depression, are often overlooked. There has been a push by the state to fill those gaps and increase support in those areas.

“Moms have so much pressure to be perfect,” Strutz said. “Just because you feel like it’s challenging at times, feel stressed, does not mean you’re a bad mom.”


The Family Resource Center has a number of programs for families, including a birth support program, safe care programs where a child development provider can visit the home and work with parents, programs that ease transitioning into school, have a playgroup for tots and a youth mentoring program.

Recently the Resource Center received a grant from the Department of Children, Youth and Families to partner with Perinatal Support Washington and form a task force with local medical practitioners, therapists and other stakeholders. The task force meets once a month and is still in its early stages, and has been brainstorming about where the gaps are, where the community’s strengths and weaknesses in perinatal care are. Perinatal refers to the timeframe from pregnancy to approximately two years after birth.

“Perinatal Support Washington has been an amazing group to work with,” Strutz said. The services are free and available online. To learn more, visit https://perinatalsupport.org.

Halverson has been involved with the Perinatal Task Force and has been impressed with the work the Family Resource Center does, saying “They are amazing people, we are so lucky to have them. They have native Spanish speakers which is essential for our Latin community,” Halverson said. Peer support, she continued, works really well, especially with underserved communities and those with language barriers. “Doing peer support is brilliant.”

San Juan County Health and Human Services Department launched “Growing Families” late last year. “The health department has offered services for a long time. The goal with Growing Families was to increase those services,” Jessica Nye, MPH, CPH, Community Health Services Manager said. The cost of ferries adds up, and isn’t always practical for families. Meanwhile, families may not always know where to go for assistance. While The Growing Families program does not provide medical services, it simply connects families to the resources available. Through Growing Families, public nurses can do “come visits” to meet with the families to discuss their needs.”It doesn’t have to be in a clinic, it can be at home or even at a coffee shop,” Nye explained. They will meet the family where they are most comfortable.

“It isn’t the answer, but it is a piece of the puzzle,” Nye said. For more information on Growing Families, visit https://www.sanjuancountywa.gov/1906/Growing-Families-San-Juan-Islands#:~:text=Growing%20Families%20San%20Juan%20Islands%20(or%20just%20%22Growing%20Families%22,and%20families%20with%20a%20newborn.

“If we want our community to be sustainable and grow, we have to take care of child-baring families. You can’t provide all the services people need without prenatal because people get pregnant. How people grow in utero sets people up for how they are through their lives. So you can’t be a functioning community without taking care of perinatal,” Halverson said.

Parker would love to see increased services, saying, “The more providers the better. An OBGYN would be amazing. Our island demographic is changing, and it is a real need.”