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  • Writer's pictureThe San Juan Daily Star

Federal appeals court further limits abortion access on Guam

An aerial view of Guam’s coast, April 27, 2023.

By David W. Chen

A federal appeals court ruled late Tuesday that women on the American territory of Guam who are seeking medication abortion must first have an in-person consultation with a doctor, which is likely to make access to the procedure on the remote island even more difficult.

Abortion-rights supporters said that since there were no doctors on Guam who provided abortions, the ruling created a significant obstacle for women seeking the procedure. The only two doctors licensed to provide abortions on the U.S. territory are based in Hawaii, an eight-hour flight away. Until now, those doctors have been prescribing pills over video calls.

But in a unanimous ruling, the 9th U.S. Circuit Court of Appeals said other doctors on the island could provide in-person consultations, even if those physicians did not want to provide abortions themselves.

“Guam has legitimate interests in requiring an in-person consultation,” the judges said. “The consultation can underscore the medical and moral gravity of an abortion and encourage a robust exchange of information.”

Why it matters

There are at least 15 states where most abortions are now banned, requiring women who seek to terminate pregnancies to travel elsewhere, sometimes at great cost and risk to their health.

But none are as isolated as the territory of Guam — making the island of 154,000 people a “litmus test” of what life would be like under a near-total ban, its attorney general, Douglas Moylan, a Republican who opposes abortion, told The New York Times this year.

Although abortion is legal in Guam up to 13 weeks of pregnancy, and later in certain cases, the last doctor who performed abortions left the island in 2018.

Central to the case decided Tuesday before the appellate court, which is based in San Francisco, was whether Guam residents could continue receiving that care via telemedicine, or whether they would have little choice but to leave the island — something that is prohibitively expensive for most residents.


Abortion has long been a taboo topic on the culturally conservative island where about 80% of the inhabitants are Catholic.

In 1990, Guam passed what was then described as among the most draconian abortion bans in the country, making it a crime to perform, undergo or seek an abortion — except in some medical emergencies — or to encourage women to have abortions. A federal court ruled that the ban was unconstitutional and blocked the territorial government from enforcing it, but the attorney general is fighting to try to revive the ban.

With the 1990 law still blocked, Guam’s Legislature has since passed additional restrictions. One such measure was the in-person consultation law, which was challenged in January 2021 by a local lawyer, Vanessa L. Williams, in conjunction with the American Civil Liberties Union, on behalf of the two doctors based in Hawaii. That law was then blocked by a federal judge, allowing the doctors to send abortion pills.

But with the momentum of the Supreme Court decision last year that overturned the national right to abortion, the Guam attorney general’s office said the injunction should be lifted. Oral arguments were heard in February in Honolulu before a three-judge panel — two appointed by President Donald Trump and the third by President George W. Bush.

What’s next

The court’s ruling takes effect in 21 days.

Alexa Kolbi-Molinas, deputy director of the ACLU Reproductive Freedom Project, said the plaintiffs were considering their options. But she said that she was “deeply disappointed” by the ruling, and that it “imposes unnecessary obstacles on people seeking abortion in Guam.”

In a WhatsApp message, Moylan applauded the decision, saying it reflected the island’s “rich cultural values.”

“Over the past 50 years since Roe v. Wade, Guam’s People have shown a clear desire to prohibit and restrict abortions,” he said.

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