Pacific Territories: Reproductive Care and Abortion in the Northern Mariana Islands, Guam, and American Samoa

We are close to the end of our journey through the United States, looking at the laws governing abortion and related matters. Here on The Pulse, we have been going state by state, and also through US territories, looking at reproductive law, because of the Supreme Court of the United States (SCOTUS) decision last June. This decision was on Dobbs versus Jackson Women’s Health Organization, an abortion case concerning a Mississippi law prohibiting abortion after 15 weeks of pregnancy. This means 15 weeks counting from the first day of bleeding of the last menstrual period. Of the nine SCOTUS justices, six voted to uphold the Mississippi law. The law did not actually go into effect, however, because five of those six justices also joined onto a majority opinion written by Associate Justice Samuel Alito overturning the 1973 Roe v Wade decision that protected the right to choose. Being one of the most hostile US states against the right to choose, Mississippi soon replaced its 15-week ban with a complete ban on abortion and various other states have done the same. Along with Mississippi, abortion hostile states include Tennessee, Georgia, Alabama, Arizona, Texas, Louisiana, and Missouri. In such states, there also are implications for pregnancy care overall and in some cases fertility treatment is being threatened as well. Because of the state constitution, or because of the court system, some states, such as Kansas, Alaska, Montana, and Ohio, currently uphold the right to abortion, despite a dominance on those states of anti-choice politicians. Meanwhile, legal systems supporting abortion and reproductive rights for abortion seekers from inside and outside the state are in place on numerous states, including New York, Connecticut, Illinois, Oregon, New Mexico, Washington, and North Carolina.

Pro-choice systems are also present in US territories, such as Puerto Rico, but not all US territories can say the same. Today, we are looking at the three US territories, located in the Pacific Ocean: the Northern Mariana Islands, Guam, and American Samoa.

Known officially as the Commonwealth of the Northern Mariana Islands and harboring some 55,650 people (by 2022 estimates), this group of Pacific islands is not particularly friendly to abortion rights, but the situation is complicated. An old law states that abortion is illegal. However, judicial review (review by the courts) says that abortion is actually legal. This relates to the fact that the the Northern Mariana Islands Constitution states that abortion is prohibited, “except as provided by law”, meaning that laws could be made to allow abortion. The legal status of abortion has been particularly unclear since the SCOTUS issued the Dobbs decision. Practically speaking, women of these US islands who want an abortion travel to places, such as the Philippines, Hawaii, and Japan.

On the island of Guam, which is a Mariana island, but is a separate US territory from the Northern Marianas, the situation is different. Guam permits licensed physicians to perform abortions up to 13 weeks gestation. Additionally, abortion is permitted up to 26 weeks, if the pregnancy resulted from rape or incest, or if it is determined that the fetus will suffer physical or mental defects. Of course, abortion also is allowed at any point in pregnancy to save the life or health of the mother. As with many US states that do allow abortion, minors require either consent of a parent or legal guardian, or must obtain a judicial bypass, meaning that a judge must allow the abortion, despite the lack of parental or guardian consent. As with many anti-abortion US states prior to Dobbs, and some middle of the road US states at present, Guam requires that an abortion seeker wait for 24 hours before obtaining an abortion after showing up for one, and that the abortion seeker receive counseling. Despite all of this making Guam appear to enable abortion, practically speaking, you cannot actually obtain a procedural abortion on Guam at the time that I’m writing this post. That’s because the most recent abortion provider in the territory retired in 2018. On the other hand, since 2021, medication abortion has been possible, because of an injunction issued by a judge, allowing such treatment in connection with a telemedicine visit with an offshore abortion provider. You can have a medication abortion up to 77 days (11 weeks) gestation.

As for American Samoa, this territory prohibits abortion in all cases, other than to save the life, or the physical or mental health, of the mother. Anyone helping an abortion seeker with an abortion, including by providing medication, can be charged with a Class A misdemeanor.

To sum up these three US territories in the Pacific, only the territory of Guam allows abortion, and, until a new abortion provider enters practice in the territory, the only abortion available on Guam is a medication abortion.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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