Women in Guam who want an abortion are being forced to come to Hawaii or travel elsewhere for the procedure since the island’s only abortion provider left a few years ago.

But two Hawaii physicians and the American Civil Liberties Union are trying to convince a Guam court that women in the U.S. territory should be able to get abortions using medication prescribed remotely instead of having to travel for an in-person appointment. A Guam judge denied a preliminary injunction last week and the case is now pending in District Court.

Drs. Shandhini Raidoo and Bliss Kaneshiro, who live in Hawaii and are licensed to practice in Guam, are part of an ongoing TelAbortion pilot study that allows them to prescribe abortion medication by mail.

However, two Guam abortion laws that require an “in-person” consultation prior to the procedure and stipulate that the procedure should be performed in approved clinics are essentially barring them from providing abortion medications to their Guam patients, they claim in the lawsuit. The Guam laws make no reference to telemedicine.

The issue has drawn concern because the last doctor who conducted abortions on the island retired in 2018 so there are no local providers or abortion clinics. Patients instead must fly to the closest place where abortions are available: Hawaii.

Abortions are legal in Guam, but for almost four years none have been reported to the local Guam Department of Public Health and Social Services, according to Pacific Daily News.

The lawsuit, filed in January in Guam, seeks to update local laws that the doctors say prevent them from providing abortions to patients in Guam. The ACLU argues that these laws make access to an abortion impossible in Guam and are infringing upon patients’ constitutional right to health care.

The first statute they claim is outdated requires abortions be conducted in a medical clinic or hospital.

The second, which was passed by the Guam Legislature in 2012, requires doctors to provide written materials to patients in person — an extensive list of materials that includes details such as anatomical and physiological characteristics of the fetus and that “public assistance may be available” for the child if it is born, among other requirements.

“If not for these laws, people on Guam would have access to FDA approved medications that can be used to end a pregnancy,” Alexa Kolbi-Molinas told KUAM News in a January interview. Kolbi-Molinas is the senior staff attorney for the Reproductive Freedom Project at the American Civil Liberties Union Foundation.

“But because there is no access to these medications and because of these laws, people are being forced to travel several thousand miles and incur significant costs,” she said. “People are being forced to go to Hawaii or even further just to be able to exercise their constitutional right and get the care they need.”

The problem is complicated by the fact that Hawaii, in addition to being an expensive flight away, also has few abortion providers.

The Hawaii doctors also requested a preliminary injunction in February that would permit them to consult with patients and make prescriptions online.

Last week, a Guam magistrate judge recommended a preliminary injunction be denied, but a final decision is still pending from the District Court. In her recommendation, Judge Heather Kennedy wrote that the doctors have not provided sufficient evidence that Guam’s law to require written materials and information to patients in person infringes on a woman’s constitutional right to an abortion.

Kolbi-Molinas told Civil Beat by email this week that the ACLU legal team is disappointed in the court’s recommendation that the in-person counseling requirement be enforced against telemedicine patients, but “this is not a final ruling,” and they will file objections with the District Court.

The judge’s recommendation solely addressed the counseling requirement and did not prevent the use of telemedicine to provide abortion access to patients in Guam, she said.

“An earlier settlement in the case has cleared the way for telemedicine abortion access in Guam, and that is unchanged by the recommendation,” she said.

As of May, Guam still required in-person consultations for patients a day prior to any abortion, whether in a clinic or using telemedicine.

Helping Underserved Communities

Raidoo and Kaneshiro are participating in a project called TelAbortion, sponsored by the nonprofit Gynuity Health Projects. It’s a clinical study approved by the Food and Drug Administration that explores the validity of sending abortion pills by mail to patients who are medically underserved and live in remote areas.

The Guam Attorney General’s office did not respond to a request for comment.

Raidoo and Kaneshiro declined to be interviewed for this story, citing the ongoing legal proceedings.

Kaneshiro told The Guardian last month that the number of Guam patients seeking abortion services in Hawaii has increased since the last local provider in Guam left.

But Hawaii has very few abortion providers, according to Dr. Reni Soon, chair of the Hawaii Section of the American College Of Obstetricians and Gynecologists and one of the few doctors who fly to neighbor islands to provide reproductive health care to patients.

Soon is also participating in the TelAbortion project, and said the telemedicine and abortion pill option has expanded the types of care options for patients who cannot easily come to a clinic.

Medication abortion entails taking two drugs — mifepristone and misoprostol, which were approved by the FDA in 2000 to be used up to the first 10 weeks of pregnancy.

According to a women’s health policy brief by the Kaiser Family Foundation, medication abortion accounts for more than a third of all non-hospital abortions in the U.S. conducted prior to eight weeks gestation.

Their use is becoming more popular, although the total number of abortions in the U.S. has declined steadily for the past two decades, the foundation said, adding that the use of the abortion pill is safe and effective and carries a 0.4% risk of major complications.