Doctors Push to Bring Reproductive Health Care Back to Guam

The U.S. territory has not had any abortion suppliers since 2018, and antiquated legal guidelines are stopping girls from acquiring these companies.

In 2019, C.C., then an 18-year-old American citizen residing on Guam, grew to become pregnant, however knew she and her accomplice weren’t able to be mother and father. “I come from a really poisonous household and needed to ensure I gave my baby a greater life than I had,” she mentioned. C.C. additionally struggles with psychiatric points together with bipolar and panic problems and needed to be in an excellent place, mentally and psychologically, to have a toddler.

 C.C., who shouldn’t be being named as a result of she dangers ostracization in Guam’s close-knit Catholic Filipino group, was early sufficient in her being pregnant to qualify for a medication-induced abortion, however no physician within the U.S. territory might (or would) prescribe the drugs. In Guam, all types of authorized abortions have been unavailable since 2018, when the only medical practitioner who performed the procedure retired.

That has left Guamanian girls in a repair: the closest abortion suppliers are hundreds of miles away in Hawaii and Japan, an enormous financial barrier for the island territory the place the common revenue is about 31% beneath the nationwide common. And whereas abortion medicines in idea will be shipped to Guam, that requires an appointment with a doctor outdoors the territory, and conducting these appointments by way of telemedicine stays unlawful in Guam, successfully imposing a de facto ban on all abortions.

A courtroom case filed in January 2021 is attempting to assist others like C.C. by permitting docs to prescribe the capsule remotely, in order that Guamanian girls have the chance to finish early pregnancies.  

Two Hawaii-based OB-GYNs, supported by the American Civil Liberties Union, are difficult two legal guidelines that limit entry to medicine abortions delivered by way of telemedicine and the mail. The plaintiffs argue that as People, Guamanians’ rights are the identical as these in different states, and are protected beneath the Roe v. Wade landmark ruling.

The plaintiffs had some restricted success in March, when the Guam legal professional basic and the Board of Medical Examiners agreed to strike down one 1978 law requiring abortions be performed in medical clinics or hospitals. The courtroom case is constant, nevertheless, with a 2012 legislation at challenge that requires in-person consultations not less than 24 hours earlier than an abortion process. The ACLU has argued these consultations will be performed nearly, however in late April, the choose denied a request for a preliminary injunction, saying the plaintiffs haven’t shown Guam’s laws place an undue burden on the right to abortions.

Whereas profitable in courtroom would broaden entry to medicine abortions, surgical abortions nonetheless require touring 4,000 miles to Hawaii, or not less than 1,600 miles to Japan, journeys which can be unaffordable to most Guamanians.

Overcoming Stigmas

On the predominantly Catholic island with a inhabitants of lower than 170,000, reproductive well being care typically carries a robust taboo. In 2017, 239 abortions had been reported to the Guam authorities. After the one supplier’s retirement in 2018, the official number dropped to zero.

 “It doesn’t actually really feel authorized right here on Guam; it’s actually regarded down upon by the tradition,” mentioned C.C. “In my scenario, it was type of arduous. I didn’t have any household help or something. Nobody actually is aware of about my abortion, nonetheless to at the present time.” 

C.C., who now studios biomedicine in school, acquired her drugs by means of Assist Entry, a global group that conducts on-line consultations and mails abortion medicine to components of the U.S. and different international locations the place it’s tough or unattainable to acquire. The nonprofit additionally helped cowl a part of the fee if C.C.’s therapy as a result of she wasn’t working on the time.

Assist Entry’ founder Rebecca Gomperts, a doctor primarily based in Amsterdam, mentioned up to now half-year, the group has helped about 30 girls from Guam get hold of medicine for abortions. (Assist Entry has additionally confronted authorized challenges: In 2019, the U.S. Food and Drug Administration sent a warning letter to the group to stop its work, and likewise seized a few of its packages. Assist Entry continues to function, and likewise has filed suit against the FDA. In October, the Supreme Courtroom, in a separate case, refused to overturn a lower court ruling that prohibited necessities that sufferers choose up abortion drugs in individual.)

Like many ethnic Filipinos on the island, C.C.’s grandparents immigrated to Guam for work alternatives. In the present day, Filipinos make up about 26% of the inhabitants, with the Indigenous Chamorro people accounting for around 37%.

Guam has a number of the highest rates of poverty, sexual assault, and domestic violence in the U.S., all elements linked to undesirable pregnancies, particularly for Indigenous teams: A 2016 report mentioned that Chamorro people account for 61% of Guamanians receiving abortions. Abortion on Guam made headlines in 2019, when a 38-year-old man raped an 11-year-old girl. She had to carry the baby to term as a result of she couldn’t get an abortion.

The U.S. navy additionally has a big presence: The Division of Protection owns about 30% of Guam’s land, and roughly 21,700 military members and their families reside there. However girls within the navy or these married to service members face a separate set of limitations. Their well being care solely covers abortions in instances of incest, life endangerment, and rape, and elective abortions are typically not carried out in navy hospitals.

“It’s devastating. We’ve individuals who will name our workplace in search of abortion care, and infrequently the conversations are much less concerning the medical wants or the method of getting an abortion, and way more concerning the logistics of planning and having sufficient cash to fly,” mentioned Dr. Shandhini Raidoo, one of many Hawaii-based OB-GYN plaintiffs within the lawsuit. She frequently sees sufferers touring from Guam, particularly for the reason that former abortion supplier on the island retired.

A part of a Bigger Battle

Alexa Kolbi-Molinas, an ACLU legal professional, views the Guam case as a part of the nationwide struggle to protect abortion. “We don’t want to attend for the Supreme Courtroom to marvel what a post-Roe world might appear to be as a result of individuals in Guam are already residing there,” she mentioned.

The Workplace of the Lawyer Normal on Guam declined to remark for this text. In a March 8, 2020, news release, the workplace said that, “not like most challenges to abortion legal guidelines, which concentrate on latest legal guidelines or rules, the ACLU lawsuit comes 9 years after the in-person requirement grew to become legislation, with none native suppliers suggesting that the a part of the legislation being challenged created an undue burden on their affected person’s entry to abortion.”

Michael Lujan Bevacqua, curator of the Guam Museum and a plaintiff’s witness within the courtroom case, traces the island’s restricted entry to abortion to its historical past: Spain colonized Guam in 1668, and Spanish clergymen felt threatened by the ability of Chamorro girls to make choices round land and clan. Faith grew to become a technique to subordinate girls, as Spain transformed the Chamorro inhabitants to Catholicism. Guam was ceded to the U.S. by means of the 1898 Treaty of Paris, however the Catholic custom had been firmly cemented in island life by then.

“By the point abortion politics get radicalized within the U.S., the Church is beginning to embrace that concept right here in Guam,” he mentioned.

 In 1990, Guam’s Legislature enacted a legislation prohibiting abortions besides in pregnancies posing “substantial threat” to life or “grave” well being impacts. A federal appeals courtroom overturned the ban in 1992. Bevacqua remembers attending a pro-abortion rights candlelight vigil along with his mom and grandmother, one among his earliest motivations to turn out to be a group activist.

Bevacqua’s mom, Rita Bevacqua, was the top of the Guam Nurses Affiliation. She heard the tales of pregnant girls, together with many sexual assault survivors, who felt they’d no choices. However she additionally noticed the affect of the Church: Guam’s archbishop was within the chamber whereas senators voted on the antiabortion legislation in 1990, “so they might see him, mainly threatening to excommunicate them,” mentioned her son.

Bevacqua mentioned the Church now has much less authority on Guam, given the affect of extremely publicized sexual assault scandals by Catholic leaders. He mentioned many Chamorros really feel freer, and he locations reproductive well being care inside the bigger dialog round decolonization.

“Decolonization doesn’t imply you return into the previous or time journey or something like that,” he mentioned. “However it implies that if colonization suppressed one thing which is nice, which is empowering, which is powerful, then you’ll be able to attempt to get better that.”

Decolonizing the Debate

For Vanessa Williams, a Guam lawyer working with the ACLU, anti-abortion rights sentiment is much less reflective of individuals’s beliefs and extra concerning the relationship between youthful generations and elders—manåmko within the Chamorro language.

“You’ve got extra conservatives or strict Catholics within the older era the place, if that’s church doctrine, they’re in opposition to it,” mentioned Williams. “So that you’ll see people who find themselves pro-choice, however who is not going to voice that opinion out of respect for his or her elders.”

Whereas Williams has solely obtained optimistic messages, others sharing pro-abortion rights sentiments face retribution. A small however vocal group of anti-abortion rights activists frequently maintain protests across the island. Moreover, the doctor who succeeded the retired physician has told Pacific Daily News he’s in opposition to offering abortions.

In stark distinction, Guam Gov. Lourdes Leon Guerrero, elected in 2018, is the primary lady to carry the workplace, and as a former nurse, has lengthy been pro-abortion rights. In a broader push for girls’s rights, Guerrero revived Guam’s Bureau of Ladies’s Affairs and appointed Jayne Flores as director.

Flores was charged with discovering a substitute abortion supplier, however monetary constraints and anti-abortion rights demonstrations proved tough challenges, and she or he has been unsuccessful at recruiting a pro-abortion rights doctor to the island. Flores mentioned it’s essential to border abortion inside the broader dialogue of ladies’s rights.

 “My perspective, particularly from the islander perspective, the place you’ve plenty of completely different cultures and plenty of them are male-dominated, is to begin younger and construct in respect for girls,” Flores mentioned.

If the ACLU lawsuit is profitable, there would nonetheless be massive gaps within the skill of Guamanian girls to get an abortion. The vast majority of abortions within the U.S. happen early sufficient in being pregnant to be performed with medicine, however the underlying lack of a neighborhood supplier in Guam for later-term procedures persists.

Kolbi-Molinas of ACLU mentioned that as a primary step, not requiring individuals to take excessive measures, comparable to journey to Hawaii, for well being care companies “is itself a destigmatizing act.” And now, a brand new era of Guam activists are striving to achieve out to their anti-abortion rights family and friends to normalize abortion. 

Maria Dolojan is a New York College grasp’s scholar and the manager director of the brand new reproductive justice initiative Famalao’an Rights. (Famalao’an means “girls” in Chamorro.) Dolojan, who’s Filipino American and grew up on Guam, co-founded the group with Stephanie Lorenzo after the 2019 rape of the 11-year-old lady.

“I put myself within the footwear of what would have occurred if it was me,” mentioned Dolojan. “As a result of I grew up in a household the place we didn’t have the monetary assets to have been capable of search abortion companies in Hawaii or wherever else within the U.S.”

The group’s 15-person workforce is increasing its social media following and advocating for abortion rights. Dolojan says they’re grappling with how one can compete with the anti-abortion rights faction’s skill to mobilize so shortly, which she says has a chilling affect on discussing reproductive well being care. She doesn’t personally know any Guamanians who’ve had abortions, however she is nonetheless assured that by specializing in Guam’s cultural heritage, they will shift the narrative.

“Guam is a matriarchal society that for thus lengthy has had girls leaders on the island and respects girls’s selections,” Dolojan mentioned. “So why can’t we respect their selections to obtain an abortion or do what’s finest for his or her future, for themselves and their our bodies?”


Hannah Steinkopf-Frank
is a contract author and photographer specializing in girls’s and LGBTQ rights. She focuses on France and Europe. She has been printed in shops together with the New York Occasions, Lit Hub, JSTOR Each day, In These Occasions, Teen Vogue, Them and Wired UK. She relies in Paris, France, and speaks English and French. She will be reached at

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