Sarah* found out she was five weeks pregnant earlier this year. For the mother of three, carrying on with the pregnancy was out of the question. “My current partner and I are not ready to have a child at this time,” said the 30-year-old resident of Tamuning, on the western shore of Guam. She’s long been separated from her estranged husband, but the divorce process that involves custody over their children remains unresolved in court. “Personally, I am not financially and emotionally ready to have another child,” she said. Abortion is legal in Guam but it has long been a contentious issue in the predominately Catholic community. Terminating a pregnancy has been difficult and the only doctor who provided an abortion service retired in 2018. But a recent federal court ruling will make it easier for women on the island to obtain an early-term abortion. Since 2018, Guamanian women seeking to end their pregnancies have mostly resorted to services off the island. Hawaii is the default destination. The Catholic church, however, endorses another alternative, promoting a newly formed local adoption agency that offers to assist women who are burdened with unwanted pregnancies. “Adoption was not an option for me either,” Sarah said. “Guam is a small community. Everybody knows everybody. Rumours will swirl and people will judge you unkindly.” So Sarah spent $3,000 on a two-day trip to Hawaii, which included the plane ticket, lodging, the physician’s fee and the abortive pill prescribed to her at the Planned Parenthood clinic in Honolulu. The clinic offers medication abortions for women who are up to 11 weeks pregnant. Two tablets are prescribed, taken up to 48 hours apart, to terminate the pregnancy. “By the time I travelled to Hawaii, I was already at the stage of pregnancy that qualified for medication abortion,” she said. “I took the first pill before I left Hawaii and then took the second pill when I returned to Guam.” On Friday, a federal judge issues a ruling removes the need for women like Sarah to travel to get an abortion. The decision paves the way for the practice of “tele-abortion” in Guam by striking down restrictions that bar offshore physicians from remotely prescribing abortion pills and providing medical consultation and guidance through face-to-face videoconferencing. The court ruled women no longer need “in person communication” or individual consultations “in a private room” to obtain a medication abortion. “The undisputed evidence before the court all points to the fact that a live, face-to- face video conferencing is comparable to, and may even have some benefits over, in-person communication,” the court said. The decision stemmed from a lawsuit filed by Hawaii-based physicians Dr Shandhini Raidoo and Dr Bliss Kaneshiro, who sought to remotely supply abortion pills to women in Guam. While Guam-licensed, the two doctors could not provide the service due to the “in-person communication” requirement of the law. The court noted that Guam’s “in-person” requirement “creates an extra step in the medication abortion process” that reflects the government’s interest in limiting access to abortion and imposing its moral stance on “promoting foetal life.” Lawyer Vanessa Williams, who has been involved in litigation pushing for greater abortion access in Guam, welcomed the federal court’s decision. “For people in Guam, just like across the United States, having safe, legal access to abortion means that we can make our own decisions about our lives, our families, and our futures,” she said. Jayne Flores, director of the Bureau of Women’s Affairs, said: “we encourage support for a woman’s choice in deciding what is best for her reproductive health.” While the move has been welcomed by some, abortion remains a contested issue in the US territory. The practice was a criminal offence up until 1978, when the abortion ban was struck down by Roe v Wade. In 1990, however, the Guam Legislature reinstated the abortion ban. The law did not survive a constitutional challenge. While abortion has since been legal on Guam, the local legislature continued to add layers of requirements and restrictions, including counselling prior to the procedure. From 2008 to 2017, approximately 200 to 300 abortions were performed each year in Guam. While there may be no record of abortions being performed on the island since 2018, one local physician said it was wrong to conclude that women in Guam had no option other than to travel off the island. “There are physicians on island who quietly prescribe medication abortion to women on Guam,” said the physician, who requested not to be named. “There are no records of abortion because medication abortion is not a reportable procedure.”