In isolated Guam, abortion is legal. And almost impossible to get.

For decades, the Pregnancy Control Clinic, tucked away in a squat, beige building around the corner from a bowling alley, handled the majority of abortions in Guam, a small U.S. territory 1,600 miles south of Japan.

But the doctor who ran it retired seven years ago and the clinic now seems abandoned. An old medical exam table stands next to a dressing table with a loose faucet, and a letter from Dr. Edmund A. Griley is taped to the front door: “My last day seeing patients is November 18, 2016,” he wrote. “I recommend that you start looking for a new doctor as soon as possible.”

Dr. Griley has since passed away, and his abandoned clinic is a dusty snapshot of Guam’s past – and some say its future.

although abortion is legal in Guam up to 13 weeks gestation, and later in certain cases, the last doctor to perform abortions left Guam in 2018. The closest abortion clinic on U.S. soil is in Hawaii, an eight-hour flight away. And a pending lawsuit could soon close access to abortion pills, the last way for most women on Guam to get legal abortions.

As anti-abortion activists across the country capitalize on the momentum of the overturn of Roe v. Wade, Guam, a sliver of land in the Pacific Ocean, stands out.

Forces on both sides of the abortion debate say the island of 154,000 is on track to become the purest example of what life would be like under a near-total ban. More than a dozen states have banned most abortions, forcing women there who want to terminate pregnancies to travel elsewhere, sometimes at great cost and risk to their health. But none are as isolated as Guam.

“Guam is a litmus test,” said the territory’s attorney general, Douglas Moylan, a Republican who opposes abortion. “If anti-abortion forces succeeded anywhere in the United States, I’d say Guam would be one of them.”

There are two doctors who are licensed in Guam and willing to perform abortions, and both are based in Hawaii where they can see patients via video calls and prescribe abortion pills. That could change if the Ninth Circuit Court of Appeals reinstates a territorial law requiring women to go to a doctor in person to get pills.

There is a wave of anti-abortion sentiment sweeping through Guam, and there are other attempts to further restrict the procedure. Mr. Moylan, the Attorney General, joins the fight federal court to try to revive a 1990 law that banned nearly all abortions but was stopped by a federal judge. Meanwhile, the legislature passed a law last year banning most abortions after six weeks of pregnancy. It was vetoed by Governor Lou Leon Guerrero, a Democrat, nurse and the island’s first female governor.

She recalled that as a college student in California before the Roe v. Wade decision, she cared for women who “bleeded from self-aborting or from going to underground abortion clinics and not doing well.”

As head of the Guam Nurses Association, Ms. Leon Guerrero testified against the 1990 banwhat would have made it a crime to perform, have, or seek an abortion, except in some medical emergencies, or to cheer on women to have abortions. A federal court ruled the law unconstitutional and blocked the territorial government from enforcing it, but it remains on the books.

“Everything that is going on affects Guam and our women here because we are much more isolated in terms of access to health care,” the governor said.

Where America’s Day begins

Guam is so far west of the continental United States that its clocks are 15 hours ahead of Eastern Standard Time, in the same time zone as Vladivostok, Russia, and Australia’s east coast. The island promotes itself as “where America’s day begins”.

But while U.S. citizens, residents of Guam, who usually identify themselves ethnically as Chamorro, the Mariana Islands indigenous people, or as Filipino, cannot vote for president or send voting representatives to Congress.

About a third of the island is controlled by the Ministry of Defense, whose footprint is growing. While abortions are not available at the island’s military bases except in emergencies, the Pentagon will pay for abortion-related travel for troops serving in places where the procedure is illegal.

Abortion has long been a taboo in Pacific island communities; about 80 percent of Guam’s residents are Catholic, reflecting the island’s Spanish colonial past.

Dr. William Freeman, the last doctor to perform abortions on Guam, left the island in 2018. Dr. Freeman, who is now 78 and lives in Manila, said when he first arrived on Guam 39 years ago, the seven doctors who performed abortions often received “calls threatening to kill us or blow us up.”

When he retired, a partner who opposed abortion refused to continue that part of their practice. Dr. Freeman suggested having doctors visit Guam for six weeks to perform the procedure, but “no group was willing to make their clinic available,” he said.

‘Hope rises’

Guam’s law requiring women seeking an abortion to receive government-mandated information from a physician — and only in person — has been blocked by a court order while a legal challenge is underway. The two Hawaii-based doctors plead in their lawsuit that if the order is lifted, it would make it virtually impossible for them to help women on Guam via telemedicine.

That would be a victory as far as the island’s Catholic officials are concerned. In an interview at the chancery of the Archdiocese of Agana, where Pope John Paul II spent the night in 1981, Father Romeo Convocar, the Apostolic Administrator, said that abortion pills obtained through telemedicine were now one of his main concerns.

Last summer, anticipating that the Supreme Court would soon overturn the Roe v. Wade decision, the archdiocese distributed a pastoral letter to read in its two dozen churches: “Hope is growing in our country that the plague of abortion will be significantly curtailed.”

Catholic officials pushed for the area to pass a six-week ban. She resumed conducting a ceremony for the burial of unclaimed fetuses miscarriages or abortions. She applauded mr. Moylan’s legal efforts to reinstate the 1990 abortion ban.

Sharon O’Mallan, President of the Guam Catholic Pro-Life Committeecalled the Dobbs decision overturning Roe v. Wade “great — now it’s handing over to us, and we’re deciding what we want as our laws now.”

In late April, she and Agnes White, a nurse, pointed to a billboard they had helped create: “Healing the Pain of Abortion — One Weekend at a Time.”

The goal, they said, was to recruit women who had had abortions to attend a confidential counseling retreat sponsored by an international religious group that opposes abortion.

‘I would like to go to prison’

Abortion rights advocates fear what will happen on Guam — and it has high rates of sexual violence And maternal mortality — if access to abortion pills is effectively blocked. For example, the lawsuit filed by the Hawaiian doctors argues that women on Guam would face increased medical risks, as well as daunting financial and logistical burdens. (According to census datamedian annual household income, excluding military families, was $58,000 in 2019, or about 20 percent below the national average.)

Famalao’an Rights, a reproductive rights nonprofit founded in 2019, ramped up its organization in 2022 as the proposed six-week ban gained traction. A 2,200-page legislative committee report the account crackled with anguished emails and handwritten letters from the public, mostly against the ban.

Then came the Dobbs decision and its aftermath. “It just felt like we were on top of the hill, so close to the finish line, and then the finish line moved,” said Kiana Joy Yabut, a leader in the group.

The Dobbs decision was demoralizing for activists, who are bracing for more anti-abortion laws and preparing to help women get abortions, even if it means breaking the law.

“I would like to go to prison,” said Ms. Yabut.

Women on Guam said they have been dealing with the difficulty and stigma of abortion for years.

Happy Tingson was working as a hotel housekeeper in 2015 when she became pregnant. She only told two people: her best friend, Rhea Patino, and her boyfriend at the time.

“Not a single smile on his face,” said Ms Tingson, who was comforted by Ms Patino and another friend when she got emotional during an interview at her sister’s home. “He pretty much said, ‘It’s not the right time for us to have it, we’re not financially stable,'” Ms Tingson said.

Ms. Patino drove Ms. Tingson to the Pregnancy Control Clinic, which has since closed, to undergo the procedure, which cost $500 in 2015. “When I finally got it done I felt a little broken,” said Ms Tingson.

She never told her parents, who are now dead, she said. She still hasn’t told her older brother.

Asked if any of her friends had had abortions, Mrs. Patino interrupted: “Me.”

When Mrs. Patino, a waitress, became pregnant in the fall of 2020, she and her then-boyfriend agreed that they couldn’t afford to raise a child.

“I felt powerless,” she said. “Try talking to a doctor and they say, ‘I’m sorry, we don’t support that.’ ”

Mrs. Patino, who was already seven weeks pregnant at the time, decided that flying to Florida was the most reliable option. Planned Parenthood unexpectedly waived the $500 allowance for her.

“They said you came from Guam and had to fly here – it’s so sad, because you don’t have a clinic there,” recalls Ms. Pitino, now 32, himself. ‘That’s so dangerous. How can they do that to you?”