For a long time, the Pregnancy Control Clinic, tucked inside a squat, beige constructing across the nook from a bowling alley, dealt with many of the abortions on Guam, a tiny U.S. territory 1,600 miles south of Japan.

But the physician who ran it retired seven years in the past, and the clinic now seems deserted. An previous medical examination desk stands close to a conceit with a dislodged faucet, and a letter from Dr. Edmund A. Griley is taped to the entrance door: “My last day of seeing patients is November 18, 2016,” he wrote. “I recommend that you begin looking for a new physician as soon as possible.”

Dr. Griley has since died, and his abandoned clinic is a dusty snapshot of Guam’s previous — and a few say, its future.

Though abortion is legal in Guam up to 13 weeks of pregnancy, and later in certain cases, the final physician who carried out abortions left Guam in 2018. The closest abortion clinic on American soil is in Hawaii, an eight-hour flight away. And a pending court docket case may quickly lower off entry to abortion tablets, the final method for most ladies on Guam to get authorized abortions.

As anti-abortion activists across the nation capitalize on momentum from the overturning of Roe v. Wade, Guam, a speck of land within the Pacific, stands out.

Forces on either side of the abortion debate say that the island of 154,000 individuals is on monitor to develop into the purest instance of what life can be like underneath a near-total ban. More than a dozen states have banned most abortions, forcing ladies there who search to terminate pregnancies to journey elsewhere, generally at nice price and danger to their well being. But none is as remoted as Guam.

“Guam is a litmus test,” stated the territory’s legal professional normal, Douglas Moylan, a Republican who opposes abortion. “If anti-abortion forces were to succeed anywhere in the United States, I would say Guam would be one of them.”

There are two medical doctors who’re licensed in Guam and prepared to supply abortions, and each are based mostly in Hawaii, the place they will see sufferers by means of video calls and prescribe abortion tablets. That may change if the Ninth Circuit Court of Appeals reinstates a territorial legislation that might require ladies to see a health care provider in individual with the intention to acquire tablets.

A streak of anti-abortion sentiment runs by means of Guam, and there are different makes an attempt to additional prohibit the process. Mr. Moylan, the legal professional normal, is preventing in federal court to attempt to revive a 1990 legislation that banned almost all abortions however was blocked by a federal choose. In the meantime, the legislature handed a invoice final yr that might prohibit most abortions after six weeks of being pregnant. It was vetoed by Gov. Lou Leon Guerrero, a Democrat, a nurse and the island’s first feminine governor.

She recalled that as a pupil in California earlier than the Roe v. Wade determination, she cared for ladies who have been “hemorrhaging because either they self-aborted or they went to underground abortion clinics and they didn’t do it right.”

As the top of the Guam Nurses Association, Ms. Leon Guerrero testified in opposition to the 1990 ban, which might have made it a criminal offense to carry out, endure or search an abortion, besides in some medical emergencies, or to encourage ladies to have abortions. A federal court docket dominated that the legislation was unconstitutional and blocked the territorial authorities from implementing it, nevertheless it stays on the books.

“Everything that’s going around impacts Guam, and our women here, because we’re much more isolated in terms of access to health care,” the governor stated.

Where America’s Day Begins

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

But although they’re American residents, residents of Guam, who largely establish ethnically both as Chamorro, the Indigenous individuals of the Mariana Islands, or as Filipino, can not vote for president or ship voting representatives to Congress.

About one-third of the island is managed by the Department of Defense, whose footprint is expanding. Though abortions should not accessible on the island’s navy bases besides in emergencies, the Pentagon will pay for abortion-related travel for troops serving in locations the place the process is unlawful.

Abortion has lengthy been a taboo subject in Pacific island communities; about 80 p.c of Guam’s inhabitants are Catholic, reflecting the island’s Spanish colonial previous.

Dr. William Freeman, the final physician who carried out abortions on Guam, left the island in 2018. Dr. Freeman, who’s now 78 and dwelling in Manila, stated that when he first arrived on Guam 39 years in the past, the seven medical doctors who carried out abortions typically acquired “phone calls threatening to kill us or blow us up.”

When he retired, a companion who opposed abortion declined to proceed that a part of their apply. Dr. Freeman recommended having medical doctors go to Guam for six-week stints to supply the process, however “no group was willing to make their clinic available,” he stated.

‘Hope Is Rising’

The Guam legislation that requires ladies in search of an abortion to obtain government-mandated info from a health care provider — and solely in individual — has been blocked by a court docket order whereas a authorized problem proceeds. The two Hawaii-based medical doctors argue in their lawsuit that if the injunction is lifted, it might develop into virtually not possible for them to help ladies on Guam by means of telemedicine.

That can be a victory, so far as the island’s Catholic officers are involved. In an interview on the chancery of the Archdiocese of Agana, where Pope John Paul II stayed overnight in 1981, Father Romeo Convocar, the apostolic administrator, stated that abortion tablets obtained by telemedicine is now considered one of his greatest considerations.

Last summer season, anticipating that the Supreme Court would quickly reverse the Roe v. Wade determination, the archdiocese distributed a pastoral letter to be learn aloud in its two dozen church buildings: “Hope is rising across our country that the scourge of abortion will be significantly curtailed.”

Catholic officers pushed for the territory to undertake a six-week ban. They resumed conducting a ceremony for the burial of unclaimed fetuses from miscarriages or abortions. They applauded Mr. Moylan’s authorized endeavors to reinstate the 1990 abortion ban.

Sharon O’Mallan, chairperson of the Guam Catholic Pro-Life Committee, referred to as the Dobbs determination overturning Roe v. Wade “great — now it turns it over to us, and we now decide what we want as our laws.”

In late April, she and Agnes White, a nurse, pointed to a billboard that they’d helped to create: “Healing the pain of abortion — one weekend at a time.”

The purpose, they stated, was to recruit ladies who had abortions to attend a confidential counseling retreat sponsored by a world religious group that opposes abortion.

‘I Would Gladly Go to Jail’

Advocates of abortion rights worry what is going to occur on Guam — which has high rates of sexual assault and maternal mortality — if entry to abortion tablets is successfully blocked. The lawsuit filed by the Hawaii medical doctors, as an illustration, argues that ladies on Guam would face heightened medical dangers, in addition to daunting monetary and logistical burdens. (According to census data, the median annual family earnings, excluding navy households, was $58,000 in 2019, or about 20 p.c beneath the nationwide common.)

Famalao’an Rights, a reproductive rights nonprofit based in 2019,stepped up its organizing in 2022 when the proposed six-week ban was gaining traction. A legislative committee’s 2,200-page report on the invoice crackled with anguished emails and handwritten letters from the general public, largely opposing the ban.

Then got here the Dobbs determination and its aftermath. “It just felt like we were at the top of the hill, so close to the finish line, and then the finish line moved,” stated Kiana Joy Yabut, a pacesetter within the group.

The Dobbs determination was demoralizing for the activists, who’re bracing for extra anti-abortion payments and making ready to assist ladies acquire abortions, even when it means breaking the legislation.

“I would gladly go to jail,” Ms. Yabut stated.

Women on Guam stated they’ve already been coping with the issue and stigma of abortion for years.

Happy Tingson was working as a resort housekeeper in 2015, when she grew to become pregnant. She instructed solely two individuals: her finest buddy, Rhea Patino, and her boyfriend on the time.

“Not a single smile on his face,” stated Ms. Tingson, who was comforted by Ms. Patino and one other buddy when she grew to become emotional throughout an interview at her sister’s home. “He was pretty much saying, ‘It’s not the right time for us to have it, we’re not financially stable,’ ” Ms. Tingson stated.

Ms. Patino drove Ms. Tingson to the Pregnancy Control Clinic, which has since closed, to obtain the process, which price $500 in 2015. “When I finally got it done, I felt kind of broken,” Ms. Tingson stated.

She by no means instructed her mother and father, who at the moment are useless, she stated. She nonetheless hasn’t instructed her older brother.

Asked if any of her mates had additionally undergone an abortion, Ms. Patino interrupted: “Me.”

When Ms. Patino, a waitress, grew to become pregnant within the fall of 2020, she and her boyfriend on the time agreed that they may not afford to lift a baby.

“I felt helpless,” she stated. “Try talking to a doctor, and they’re like, ‘I’m sorry, we don’t support that.’ ”

Ms. Patino, who by then was seven weeks pregnant, determined that essentially the most dependable choice was to fly to Florida. Planned Parenthood unexpectedly waived its $500 price for her.

“They said the fact that you came from Guam, and had to fly out here — it’s so sad, because you have no clinic out there,” Ms. Pitino, now 32, recalled. “That’s so dangerous. How can they do that to you guys?”