Chuuk, one state of the Federated States of Micronesia (FSM), experiences significant transnational migration to the United States (U.S.), particularly to the Territory of Guam. This migration is facilitated by the Compact of Free Association (COFA), an agreement with several Micronesian countries previously under U.S. administration that allows for free movement of their citizens into the U.S. Although part of Micronesia, Guam's colonized residents resist an identity connected to rest of Micronesia. With very poor health outcomes, the Chuukese represent a political and social body of bodies that bring sickness, babies and increased costs to the Guam government without adequate compensation by their colonizer sanctioning the migration. In order to better understand why Chuukese women suffer disproportionately poor reproductive health outcomes as compared to the rest of Guam's residents, this multi-sited dissertation examines how Chuukese women's reproduction is constructed and conceptualized by women, their families, and their "home" and "host" communities, and how these meanings are mediated by transnational migrant experiences between Chuuk and Guam. Using a critical interpretive framework, this study utilized participant observation in the clinics and communities, interviews with health care workers, and in-depth life history interviews with fifteen Chuukese women. This dissertation situates Chuukese women's reproduction in the context of transnational migration through an analysis of social, economic and political processes, health and social services policies and practices, postcolonial migration and sociocultural meanings of reproduction for Chuukese women in both Chuuk and Guam.

In the United States, concerns about adolescent childbearing and its perceived corollaries – negative health outcomes for mother and child, the disintegration of the nuclear family, and “over-dependence” on public resources – began to circulate widely in policy spheres and popular media in the 1970’s, resulting in a proliferation of policies, programs, and services designed to address its prevention. Although national birth rates among adolescents are currently at their lowest since peaking in the early 1990’s, this decline masks persistent and significant disparities between groups of young people by race, ethnicity, geography, and poverty level. The concomitant existence of social and economic inequities that contribute to these differences is particularly striking in New York City; an urban center of vast extremes in health, wealth, and opportunity, but which boasts extensive reproductive health services for young people, including confidential care and availability of free or low-cost contraception. Within this setting, the promotion of hormonal and long-acting reversible contraceptive methods, specifically aimed at young women deemed at high risk of pregnancy and with less access to health care, has emerged as a key primary prevention strategy to reduce both overall adolescent pregnancy rates and disparities between adolescent groups. Using ethnographic methods, this research examined the promulgation and interpretation of this strategy by reproductive health leaders and healthcare workers as well as contextualized these perspectives with the reproductive decisions and fertility desires of female youth for whom this strategy is intended. As a result, this study elucidates broader political and socio-cultural contexts in which young women negotiate intimate relationships and contraceptive use. Recommendations are subsequently offered for clinical practices attuned to female youths’ lived experiences, educational programs for healthcare workers, and reproductive health policies reflective of the broader factors that influence contraceptive behaviors.