Abortion access and funding have always been a struggle in U.S. territories

Abortion access and funding have always been a struggle in U.S. territories

Access to abortion in U.S. territories post-Dobbs is just as difficult as before, and those concerns aren’t even a discussion within the mainstream reproductive rights movement.

by Cecille Joan Avila

This article was originally published at Prism

In June, the Dobbs v. Jackson Women’s Health Organization decision overturned Roe v. Wade, effectively eliminating the federal right to abortion, but in Guam, it’s been four years since the last surgical abortion provider retired, leaving the small island territory without anyone who can perform the procedure. Pregnant people seeking an abortion can either receive abortifacients by mail, or, if they are beyond the timeframe where it’s possible to have a medication abortion, they have to travel to Hawai‘i. That is only feasible if they have the means to—and many do not.

For many in U.S. territories, getting an abortion hasn’t only depended on the procedure being legal. People have had to rely on community networks and whatever resources were available to get or pay for an abortion. The common factor is that in U.S. territories, they need to know the right people to ask for assistance, information, and resources, which is ultimately an unsustainable way to access a key component of reproductive health.

While obtaining an abortion has never been easy throughout the states and territories, the overturning of Roe has only galvanized anti-abortion activists, leaving abortion providers, advocates, and those seeking abortions in even more dire straits. In response, abortion funds in U.S. states have been flooded with donations since the Dobbs decision, enabling them to provide critical financial support and resources to address barriers to abortion care, such as arranging a means of travel and lodging, paying for child care and other caregiving responsibilities, and everything in between. However, people who reside in the U.S. territories, including Guam and Puerto Rico, haven’t felt the same outpouring of support.

This mirrors many of the struggles that the territories face: the U.S. lays claim to the land and resources but overlooks and often outright ignores the needs of the people. Institutional and systemic inequities that plague those in the states, particularly around health care access, are magnified in the territories. As communities in the states scramble to navigate the post-Dobbs landscape, it’s easy for those in the territories to feel forgotten.

Kiana Yabut, the deputy director of Famalao’an Rights, a Guam-based community organization that addresses the need for accessible reproductive health care and also education, points to the fact that even if Guam were to follow a similar path as Puerto Rico and codify the right to access abortion in their constitution, the Dobbs decision still puts them at risk because of how deeply colonialism shapes Guam’s culture and institutions.

“I think that’s definitely the biggest thing that’s different between the U.S. territories and the mainland—we’re not even at that point yet [where abortion is as accessible as it can be in the states] as a result of colonialism [and] our pro-life governments,” Yabut said.

Lingering effects of colonialism and pressures to remain silent

A similar “heartbeat” bill to the one passed in Texas was introduced in Guam earlier this year, which Yabut says spurred many people into action to prevent the bill from being passed. Opposition to the bill motivated more pro-abortion people in the territory to speak out in favor of a person’s right to choose, and many advocates discovered that there were more reproductive rights supporters than they’d initially thought.

However, the lingering effects of Spanish colonialism mean that the majority of the people in Guam are Catholic, and the anti-abortion community is strong. Yabut says that crossing them can be dangerous, especially on such a small island. The combination of familial, social, and political pressures can be a compelling reason for those who support abortion rights to stay silent.

“I know so many people here who are pro-choice and were just kind of scared to come out [about being pro-choice] because their family is Catholic,” Yabut said. “They don’t want any turmoil with their family. They’re scared of what their church community might think because everyone is involved with these people in one way or another, so it really just sets up this barricade.”

But for all that the Catholic Church does not condone abortion, there is a distinction between what the Vatican says and what many practicing Catholics actually believe. A 2018 Gallup poll showed that up to 76% of Catholics believe that abortion should be legal in all or some cases, even though many people might feel conflicted and fearful for sharing pro-abortion views. Shannon Russell, the director of policy for Catholics for Choice, an organization dedicated to elevating the voices of pro-choice Catholics, points out that being Catholic doesn’t automatically equal being anti-abortion and argues that supporting access to abortion is, in fact, part of Catholicism’s social justice aspect. However, the overturning of Roe v. Wade has still significantly boosted the power of religious fundamentalist groups politically and socially. They are now trying to pass bills that echo those in some of the most restrictive parts of the U.S.

Although local advocates and coalitions are working to promote all aspects of reproductive health across Puerto Rico, it’s still hard to access abortion services for those who live outside of the metropolitan capital of San Juan. Only four clinics provide abortion services for the archipelago, with three located close to San Juan and a fourth in the southern region of Ponce. The limited scope of Puerto Rico’s public transit system and the costs of using private transportation are effective barriers to abortion services for many Puerto Ricans.

This puts many in the position of needing assistance, but finding it still requires discretion, says Tania Rosario-Méndez, the executive director for Taller Salud, a local feminist organization dedicated to improving women’s access to health care throughout Puerto Rico. People need to be discreet about why they need time off work, or why they might need accommodations. Although Rosario-Méndez says that the stigma around abortion might have decreased over the decades, the territory remains extremely religious, and people often have to be discreet about abortion care.

Still left out of the picture

Abortion advocacy organizations in Guam and Puerto Rico are determined to do the best that they can to provide community outreach and awareness of their services despite having limited resources. More advocates are also being trained as abortion doulas so that those seeking abortions do not have to go through the process alone and without any experienced support.

Most critically, Patricia Otón, an attorney in Puerto Rico and member of the Aborto Libre coalition, says that people need to know that abortion is still legal in Puerto Rico, making it a potential safe haven for nearby states whose abortion laws are becoming more restrictive.

“Here in Puerto Rico, we do not have that problem [of unsafe abortions],” Otón said. “There is the right for women to procure an abortion, and it’s performed by doctors.”

Pro-choice groups, including Aborto Libre, have had to counter the misunderstanding that Roe v. Wade being overturned also terminated the right to an abortion. But much like in the states, legal access to abortion doesn’t automatically translate to logistical access to abortion in Puerto Rico. While Puerto Rico’s legal code enshrines the right to privacy and protections between a person and their doctor, many of the resources that exist in the states, like abortion funds, are still absent in the territories. While an informal patchwork assortment of abortion assistance networks exists, Otón says they can’t afford to help everyone.

Even fundraising can be challenging for organizations to run. The funds that organizations in U.S. territories can apply for are extremely limited because the territories aren’t officially recognized as part of the U.S., nor are they recognized as international entities. Federal funds for Medicaid do not cover abortion in Puerto Rico except in cases of rape, incest, or endangerment of the pregnant person’s life, and some funds that could assist with other sexual and reproductive health activities come with caveats, such as restrictions against mentioning abortion.

Abortion advocates in the territories continue to be frustrated, if not resigned, to their omission from the fight for reproductive justice. Much of the media coverage and discussion around what happens in the wake of Dobbs primarily focuses on how people in the states are affected. It’s a practical concern given how that spotlight has contributed to the considerable influx of funds and support that abortion funds and other organizations in the states have seen. That need also exists in the territories, which abortion advocates have no choice but to address while navigating the dearth of resources caused by a history of colonial exploitation and ongoing stateside neglect.

“We need an amount of resources not only in funding, but logistical, technical, legal, and financial resources that we don’t have,” Rosario-Mendez said. “[But] most of the time, we are not even in the picture.”

Cecille Joan Avila (she/her), MPH, is a former photojournalist who now writes about domestic health policy issues. Her areas of interest are in ethics, getting people to care about historically excluded populations, and sexual and reproductive health.

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