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In Guam, the nearest domestic abortion clinic is 4,000 miles away. How will Roe’s reversal change the U.S. territory?

"People in Guam were already living in a post-Roe world," an ACLU deputy director said. "This is what we will see again if extremist politicians enact new abortion bans and force women into second-class status."
Worshippers attend Sunday Mass at Blessed Diego de San Vitores Church in Tumon, Guam, in 2017.
Worshippers attend Sunday Mass at Blessed Diego de San Vitores Church in Tumon, Guam, in 2017.Tassanee Vejpongsa / AP file

The Supreme Court’s decision to overturn Roe v. Wade, which had made abortion a constitutionally protected right, could have a chilling effect on reproductive rights in Guam.

Advocates say women have already been living under a de facto ban in the largely Catholic U.S. Pacific Island territory and fear it could get more restrictive.

No surgical abortion has been performed on the island since 2018, when the last doctor trained to provide the procedure retired, according to the ACLU and the Bureau of Women’s Affairs.

“People in Guam were already living in a post-Roe world,” Alexa Kolbi-Molinas, deputy director of the American Civil Liberties Union’s Reproductive Freedom Project, told NBC Asian America. “This is what we will see again if extremist politicians enact new abortion bans and force women into second-class status.”

The Supreme Court ruling might have ramifications for Pacific Islanders in the two other U.S. Pacific territories, the Northern Mariana Islands and American Samoa. Neither territory has legal protections for abortion, and both have laws prohibiting the practice in the absence of Roe v. Wade.

Guam, which has a population of just 165,000 people, already has some of the highest rates of poverty, sexual assault and domestic violence in the country, according to the Guam Coalition Against Sexual Assault and Family Violence. These issues disproportionately affect Indigenous Chamorro people, who comprise 40% of the island’s population but accounted for 60% of abortions performed in 2015, according to data from the Guam Department of Health and Social Services' Office of Vital Statistics. Studies show that unwanted pregnancies exacerbate poverty and perpetuate abusive relationships.

Before Guam’s lone doctor who performed surgical abortions retired in 2018, at least 200 abortions were performed on the island every year, though medication abortion wasn’t commonly used.

A Guam court cleared the way last September for telemedicine abortions, a substantially more affordable option for women who would otherwise have to travel nearly 4,000 miles to Hawaii, the closest U.S. state where the practice is legal under local law. Flights to Hawaii cost more than $800, which advocates say is prohibitive for most Chamorro women, not accounting for the added costs of accommodation and child care. Telemedicine abortion services, on the other hand, cost about $240 for the medication and appointments.

The telemedicine abortion decision stemmed from a lawsuit filed by the ACLU on behalf of two Hawaii-based doctors who are licensed in Guam but couldn’t remotely prescribe abortion pills under Guam law.

Anti-abortion sentiment remains strong on an island where 85% of the population identifies as Catholic — a legacy of 17th-century Spanish colonialism.

Jayne Flores, director of the Guam Bureau of Women’s Affairs, said she has for years tried to recruit another certified abortion provider to Guam, but the hostility from Catholic lawmakers and a lack of public funding drove away interested parties. “A lot of clinics are afraid there would be protests and harassment if they were to provide abortions,” she said.

In 1990, the Guam Legislature passed a law banning abortions except when a mother’s life was in danger. A federal court ruled the law unconstitutional in 1992 and stopped it from being enforced.

Guam Attorney General Leevin Taitano Camacho said last month that the law won’t take effect despite the Supreme Court decision because it was unconstitutional when it was passed. But that may soon change.

In April, Guam lawmakers introduced the Heartbeat Act, a bill modeled after a Texas law that would ban abortions at about six weeks, when cardiac activity can be detected. Kolbi-Molinas, of the ACLU, said the bill would “definitely restrict if not ban telemedicine abortion altogether,” given the mandatory 24-hour delay between counseling and prescription as well as the shipping time.

Therese Terlaje, chairperson of the health committee, wrote in an official statement in May that public opinion toward the Heartbeat Act has been overwhelmingly negative. Since it was introduced to the committee, the bill has received nearly 900 written testimonies against it, and only 284 in favor.

In the meantime, grassroots organizers and public health advocates are fighting to stop the bill from becoming law on multiple fronts.

Kiana Yabut, chief development officer of reproductive justice initiative Famalao’an Rights, said the group filed for nonprofit status to begin fundraising for abortion pills and contraceptives to distribute to women who don’t have the means or connections to find them. The group is also recruiting pro-abortion rights candidates to defeat the Legislature’s Catholic supermajority. 

“There’s a huge stigma against abortions because of our history of Catholicism,” Yabut said. “Our Legislature is majority pro-life. There’s no stopping them from banning abortion altogether.”  

Flores, of the Bureau of Women’s Affairs, said the agency is focused on reducing unplanned pregnancies on the island to lower the need for abortion. These efforts include introducing comprehensive sex education in schools so young girls are aware of birth control and sexually transmitted disease testing and treatment.

“History has shown us that you don’t stop abortion when you criminalize it,” Flores said. “It just becomes more dangerous. We want abortions to be safe and accessible but also rare.” 

Vanessa Williams, an independent attorney and co-counsel for the ACLU who organizes with the local coalition Guam People for Choice, said the outlook for reproductive rights on the island is grim. But the public attitudes toward abortion, fueled in part by the Supreme Court ruling, is beginning to shift.

“A lot more people are saying, ‘I’m Catholic but I’m pro-choice,’” she said. “They can recognize their faith-based beliefs but not think the government has any business regulating women’s choices. That’s the surprising trend in recent years.”