The Fight Over Abortion Access In Guam Has Broad Implications For Women In The Pacific

This political moment feels familiar to Anita Arriola. Thirty-two years ago, the attorney filed a lawsuit to stop what would have been the most restrictive ban on abortion in the United States from going into effect in her home island of Guam.

It was a bill sponsored by her mother, then a local senator, and unanimously approved by Guam’s unicameral Legislature. Arriola had been a public interest attorney in San Francisco before returning home to the U.S. territory. She took on the case, despite the family tension and the threat of excommunication by Guam’s archbishop.

At the time, abortion was legal throughout the U.S. due to the 1973 Supreme Court ruling Roe v. Wade. Arriola secured an injunction, winning continued abortion access in the territory.

Now, months after the overturning of Roe v. Wade, Arriola is again embroiled in the abortion debate.

Last week, Guam’s Legislature passed its version of the Texas Heartbeat Act that includes a provision allowing residents to bring private lawsuits against anyone who performs an abortion after a fetal heartbeat is detected, typically around six weeks into a pregnancy.

Guam’s first female governor, Lou Leon Guerrero, is expected to veto the measure by Dec. 28, and the voting blocs — 8 to 7 — make an override of the veto unlikely.

Other battles, however, are expected to play out in the courts next year. In February, the 9th U.S. Circuit Court of Appeals is expected to conduct oral arguments in a case that could effectively determine whether Guam patients can legally receive pills by mail to terminate their pregnancies.

The territory’s newly elected attorney general Doug Moylan also told local media that he plans to challenge the injunction on the 1990 abortion ban that Arriola stopped from going into effect, a law that also criminalized the soliciting of abortion.

It’s a critical moment for the issue in the U.S. territory home to about 170,000 people — about the same population as Maui County — with potentially broader implications. Guam is a hub for medical services in the region, often the first stop for patients from the Commonwealth of the Northern Mariana Islands, Palau and the Federated States of Micronesia seeking care before they go to Hawaii.

Arriola said she has heard anecdotally of people from the CNMI flying to Guam for the procedure; a $200-$300 and 45-minute flight. Lack of data about abortion in the Pacific is a broader problem throughout the region.

Kate Burry, a researcher at the Kirby Institute at the University of New South Wales, says Pacific island countries in Oceania have some of the most restrictive laws against abortion in the world, reflecting in part the strong influence of Christianity.

Patients with enough money to buy a plane ticket to terminate their pregnancies may go to French or U.S. territories that have more lax abortion laws, or even to New Zealand. But even as the abortion debate has ignited across the U.S. this year, in most Pacific communities it’s still a taboo subject.

“It’s a topic that’s surrounded by silence,” Burry said.

Already A Restricted Procedure

It is already difficult to get an abortion on Guam since the island’s last abortion provider left the island in 2018. About a year ago, a lawsuit by the American Civil Liberties Union and its Hawaii and Guam partners enabled two Honolulu physicians to mail abortion medication to Guam patients.

Since then, Shandhini Raidoo, physician and assistant professor at the University of Hawaii John A. Burns School of Medicine, says her practice has sent abortion pills to an average of five patients on Guam per month.

That comes out to about 60 abortions a year, far less than the average of 200  to 300 abortions reported annually on Guam when the island had an in-person provider, but far more than the zero annual abortions reported in 2019 and 2020.

“Access to abortion in this country overall is on everyone’s minds and is under attack but it is much, much harder for folks who live in America’s territories,” Raidoo said. “Their options are even more limited than folks who live on the continent and might be able to drive somewhere.”

Guam residents must first call to arrange a virtual appointment before they can get abortion pills. The pills, mifepristone and misoprostol, can be used up to the 11th week of pregnancy. The procedure isn’t covered by health insurance on Guam, Raidoo said, and that means patients often end up spending between $200 and $300 on appointments and medication.

Patients must abide by Guam’s 24-hour mandatory waiting period, review mandatory counseling materials and sign a checklist that shows they understand various aspects of having an abortion, Raidoo said. Then it may take up to a week for the medication to arrive by mail.

Jayne Flores, the director of Guam’s Bureau of Women’s Affairs, says in addition to Hawaii, she refers Guam residents who want abortions to AidAccess.org where they can order abortion medication from European doctors.

Patients whose pregnancies have progressed beyond the 11-week mark may decide to come to Hawaii for an in-person abortion which can cost about $2,000 roundtrip on United Airlines, the only direct flight between Honolulu and Guam, Raidoo said.

In Hawaii, abortions are legal up to the point of viability — which health providers define differently but may last up to 22 weeks — and available after that time in the case of a risk to the mother’s life or health.

Faith Underpins Support For Ban

The fact that abortions may become much harder to obtain is good news to Pat Perry, a Guam resident who is a member of the Guam Catholic Pro-Life Committee.

“You can’t say that killing an innocent human being is ever a right,” she said. “I truly believe that Sen. (Elizabeth) Arriola’s bill, when she first introduced it back in 1990, it was perfect.”

Perry’s conviction comes from the strength of her faith, a common perspective on Guam where an estimated 90% of residents are Catholic and the church is often intertwined with Indigenous Chamorro culture. Back in 1990, Guam’s former Archbishop Anthony Apuron threatened to excommunicate senators who opposed the abortion ban.

Four years ago, Apuron was exiled by the Vatican from Guam after an investigation into multiple child sexual abuse allegations against him, among hundreds filed against the church on Guam. But the upheaval in church leadership hasn’t shaken the faith of Guam residents like Perry and David Sablan, president of Concerned Catholics of Guam, who sees the fall of Roe v. Wade as a critical opportunity to save the lives of unborn children.

“This is a miracle,” said Sablan, who is excited that Moylan hopes to lift the injunction preventing the 1990 abortion ban from going into effect. “For 32 years, this law was waiting to come out. A lot of babies have been killed since then but there is a light shining now for the future of Guam.”

Such strong religious conviction is common throughout the Pacific according to Burry from the University of New South Wales. More so than the threat of criminal sanctions, the belief that abortion is sin plays a bigger part in whether women seek it out, Burry said.

The combination of stigma and health care staff shortages means that even though the laws in most of the 11 Pacific countries Burry studied included some exceptions for abortion, only one country — Fiji — had any abortion providers. That effectively forces women who want abortions to rely on traditional medications or seek to access via travel or telehealth, if available.

In American Samoa, the law provides exceptions for physician-assisted abortion but there are no abortion providers, according to the Center for Reproductive Rights, and distributing abortion pills is against the law. In the Commonwealth of the Northern Mariana Islands, abortion is constitutionally prohibited and there are similarly no abortion providers.

High Stakes

Since the Heartbeat Act passed on Guam last week, attorney Vanessa Williams has been getting calls from local doctors about whether they can be exposed to liability for treating miscarriages.

“I’m a Chamorro, I’m Indigenous, I’m from Guam, born and raised here; I’m a Catholic, I was baptized and raised in this community,” Williams said.

But she disagrees with the idea that the church’s stance on abortion should affect access to the procedure on Guam, so much so that she currently serves as local counsel for the ACLU lawsuit that enabled the abortion pills by post.

To Williams, the focus on abortion ignores the real crisis of Guam’s high rates of sexual assault. Arriola similarly thinks the focus should be on improving prenatal care for Guam mothers.

Raidoo from the University of Hawaii is worried that even just shortening the window during which abortion is permissible could prevent many women from accessing the procedure.

Medical professionals generally determine pregnancy length by the date of a woman’s last menstrual period. It’s a consistent way of counting pregnancy lengths but it means that for the first two weeks of a pregnancy, conception may not have even yet occurred.

Women often don’t realize they are pregnant until they have missed their next periods — and pregnancy tests may not return positive results until then — by which point they’ll be considered four weeks pregnant. Women with irregular periods may not notice their missed period until well past the six-week window, Raidoo said.

Although the Heartbeat Act isn’t expected to become law on Guam yet, Raidoo is worried about how similar measures could affect her patients, many of whom are already parents with existing caregiving responsibilities and some of whom are stationed on Guam’s U.S. military bases.

“I think the stakes are a lot higher for folks in Guam than they are for people in other parts of the country,” Raidoo said. “For us in Hawaii, we have to be that much more cognizant of what our responsibility is to our neighbors in the Pacific.”

Civil Beat’s health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation, Cooke Foundation and Papa Ola Lokahi.