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In 2019, C.C., then an 18-year-old American citizen living on Guam, became pregnant, but knew she and her partner weren鈥檛 ready to be parents. 鈥淚 come from a very toxic family and wanted to make sure I gave my child a better life than I had,鈥� she said. C.C. also struggles with psychiatric issues including bipolar and panic disorders and wanted to be in a good position, mentally and psychologically, to have a child.

 C.C., who is not being named because she risks ostracization in Guam鈥檚 close-knit Catholic Filipino community, was early enough in her pregnancy to qualify for a medication-induced abortion, but no doctor in the U.S. territory could (or would) prescribe the pills. In Guam, all forms of legal abortions have been unavailable since 2018, when the .

That has left Guamanian women in a fix: the closest abortion providers are thousands of miles away in Hawaii and Japan, a huge economic barrier for the island territory where the average income is about 31% below the national average. And while abortion medications in theory can be shipped to Guam, that requires an appointment with a physician outside the territory, and conducting those appointments via telemedicine remains illegal in Guam, effectively imposing a de facto ban on all abortions.

A court case filed in January 2021 is trying to help others like C.C. by allowing doctors to prescribe the pill remotely, so that Guamanian women have the opportunity to end early pregnancies.  

Two Hawaii-based OB-GYNs, supported by the American Civil Liberties Union, are challenging two laws that restrict access to medication abortions delivered via telemedicine and the mail. The plaintiffs argue that as Americans, Guamanians鈥� rights are the same as those in other states, and are protected under the Roe v. Wade landmark ruling.

The plaintiffs had some limited success in March, when the Guam attorney general and the Board of Medical Examiners agreed to strike down . The court case is continuing, however, with a 2012 law at issue that requires in-person consultations at least 24 hours before an abortion procedure. The ACLU has argued those consultations can be conducted virtually, but in late April, the judge , saying the .

While winning in court would expand access to medication abortions, surgical abortions still require traveling 4,000 miles to Hawaii, or at least 1,600 miles to Japan, trips that are unaffordable to most Guamanians.

Overcoming Stigmas

On the predominantly Catholic island with a population of less than 170,000, reproductive health care often carries a strong taboo. In 2017, 239 abortions were reported to the Guam government. After the only provider鈥檚 retirement in 2018, the official .

 鈥淚t doesn鈥檛 really feel legal here on Guam; it鈥檚 really looked down upon by the culture,鈥� said C.C. 鈥淚n my situation, it was kind of hard. I didn鈥檛 have any family support or anything. No one really knows about my abortion, still to this day.鈥� 

C.C., who now studios biomedicine in college, acquired her pills through Aid Access, an international group that conducts online consultations and mails abortion medication to parts of the U.S. and other countries where it is difficult or impossible to obtain. The nonprofit also helped cover part of the cost if C.C.鈥檚 treatment because she wasn鈥檛 working at the time.

Aid Access鈥� founder Rebecca Gomperts, a physician based in Amsterdam, said in the past half-year, the organization has helped about 30 women from Guam obtain medication for abortions. (Aid Access has also faced legal challenges: In 2019, the , and also seized some of its packages. Aid Access continues to operate, and also . In October, the Supreme Court, in a separate case, that prohibited requirements that patients pick up abortion pills in person.)

Like many ethnic Filipinos on the island, C.C.鈥檚 grandparents immigrated to Guam for work opportunities. Today, Filipinos make up about 26% of the population, with the Indigenous .

Guam has some of the , , all factors connected to unwanted pregnancies, especially for Indigenous groups: A 2016 report said that receiving abortions. Abortion on Guam made headlines in 2019, when a . because she couldn鈥檛 get an abortion.

The U.S. military also has a significant presence: The Department of Defense owns about 30% of Guam鈥檚 land, and roughly live there. But women in the military or those married to service members face a separate set of barriers. Their health care only covers abortions in cases , and elective abortions are generally not performed in military hospitals.

鈥淚t is devastating. We have people who will call our office looking for abortion care, and often the conversations are less about the medical needs or the process of having an abortion, and much more about the logistics of planning and having enough money to fly,鈥� said Dr. Shandhini Raidoo, one of the Hawaii-based OB-GYN plaintiffs in the lawsuit. She regularly sees patients traveling from Guam, especially since the former abortion provider on the island retired.

Part of a Larger Battle

Alexa Kolbi-Molinas, an ACLU attorney, views the Guam case as part of the national fight to preserve abortion. 鈥淲e don鈥檛 need to wait for the Supreme Court to wonder what a post-Roe world could look like because people in Guam are already living there,鈥� she said.

The Office of the Attorney General on Guam declined to comment for this article. In a March 8, 2020, , the office stated that, 鈥渦nlike most challenges to abortion laws, which focus on recent laws or regulations, the ACLU lawsuit comes nine years after the in-person requirement became law, without any local providers suggesting that the part of the law being challenged created an undue burden on their patient鈥檚 access to abortion.鈥�

Michael Lujan Bevacqua, curator of the Guam Museum and a plaintiff鈥檚 witness in the court case, traces the island鈥檚 limited access to abortion to its history: Spain colonized Guam in 1668, and Spanish priests felt threatened by the power of Chamorro women to make decisions around land and clan. Religion became a way to subordinate women, as Spain converted the Chamorro population to Catholicism. Guam was ceded to the U.S. through the 1898 Treaty of Paris, but the Catholic tradition had been firmly cemented in island life by then.

鈥淏y the time abortion politics get radicalized in the U.S., the Church is starting to embrace that idea here in Guam,鈥� he said.

 In 1990, Guam鈥檚 Legislature enacted a law prohibiting abortions except in pregnancies posing 鈥渟ubstantial risk鈥� to life or 鈥済rave鈥� health impacts. A federal appeals court overturned the ban in 1992. Bevacqua remembers attending a pro-abortion rights candlelight vigil with his mother and grandmother, one of his earliest motivations to become a community activist.

Bevacqua鈥檚 mother, Rita Bevacqua, was the head of the Guam Nurses Association. She heard the stories of pregnant women, including many sexual assault survivors, who felt they had no options. But she also saw the influence of the Church: Guam鈥檚 archbishop was in the chamber while senators voted on the antiabortion law in 1990, 鈥渟o they could see him, basically threatening to excommunicate them,鈥� said her son.

Bevacqua said the Church now has less authority on Guam, given the impact of highly publicized sexual assault scandals by Catholic leaders. He said many Chamorros feel freer, and he places reproductive health care within the larger conversation around decolonization.

鈥淒ecolonization doesn鈥檛 mean you go back into the past or time travel or anything like that,鈥� he said. 鈥淏ut it means that if colonization suppressed something which is good, which is empowering, which is strong, then you can try to recover that.鈥�

Decolonizing the Debate

For Vanessa Williams, a Guam lawyer working with the ACLU, anti-abortion rights sentiment is less reflective of people鈥檚 beliefs and more about the relationship between younger generations and elders鈥�尘补苍氓尘办辞 in the Chamorro language.

鈥淵ou have more conservatives or strict Catholics in the older generation where, if that鈥檚 church doctrine, they鈥檙e against it,鈥� said Williams. 鈥淪o you鈥檒l see people who are pro-choice, but who will not voice that opinion out of respect for their elders.鈥�

While Williams has only received positive messages, others sharing pro-abortion rights sentiments face retribution. A small but vocal group of anti-abortion rights activists regularly hold protests around the island. Furthermore, the physician who succeeded the retired doctor has he is against providing abortions.

In stark contrast, Guam Gov. Lourdes Leon Guerrero, elected in 2018, is the first woman to hold the office, and as a former nurse, has long been pro-abortion rights. In a broader push for women鈥檚 rights, Guerrero revived Guam鈥檚 Bureau of Women鈥檚 Affairs and appointed Jayne Flores as director.

Flores was charged with finding a replacement abortion provider, but financial constraints and anti-abortion rights demonstrations proved difficult challenges, and she has been unsuccessful at recruiting a pro-abortion rights physician to the island. Flores said it鈥檚 crucial to frame abortion within the broader discussion of women鈥檚 rights.

 鈥淢y perspective, especially from the islander perspective, where you have a lot of different cultures and a lot of them are male-dominated, is to start young and build in respect for women,鈥� Flores said.

If the ACLU lawsuit is successful, there would still be large gaps in the ability of Guamanian women to get an abortion. The majority of abortions in the U.S. take place early enough in pregnancy to be conducted with medication, but the underlying lack of a local provider in Guam for later-term procedures persists.

Kolbi-Molinas of ACLU said that as a first step, not requiring people to take extreme measures, such as travel to Hawaii, for health care services 鈥渋s itself a destigmatizing act.鈥� And now, a new generation of Guam activists are striving to reach out to their anti-abortion rights friends and family to normalize abortion. 

Maria Dolojan is a New York University master鈥檚 student and the executive director of the new reproductive justice initiative . (Famalao鈥檃n means 鈥渨omen鈥� in Chamorro.) Dolojan, who is Filipino American and grew up on Guam, co-founded the group with Stephanie Lorenzo after the 2019 rape of the 11-year-old girl.

鈥淚 put myself in the shoes of what would have happened if it was me,鈥� said Dolojan. 鈥淏ecause I grew up in a family where we didn’t have the financial resources to have been able to seek abortion services in Hawaii or anywhere else in the U.S.鈥�

The group鈥檚 15-person team is expanding its social media following and advocating for abortion rights. Dolojan says they are grappling with how to compete with the anti-abortion rights faction鈥檚 ability to mobilize so quickly, which she says has a chilling impact on discussing reproductive health care. She doesn鈥檛 personally know any Guamanians who have had abortions, but she is nonetheless confident that by focusing on Guam鈥檚 cultural heritage, they can shift the narrative.

鈥淕uam is a matriarchal society that for so long has had women leaders on the island and respects women鈥檚 choices,鈥� Dolojan said. 鈥淪o why can鈥檛 we respect their choices to receive an abortion or do what鈥檚 best for their future, for themselves and their bodies?鈥�