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The nearest abortion provider for people living in the Pacific Island territories is Honolulu, Hawaiʻi, which is a 14 to 44-hour flight from the Northern Mariana Islands, a 17 to 36-hour flight from Guam, and a five-hour flight from American Sāmoa. And flights alone can cost anywhere from $1,000 to $6,000. Roe v. Wade was never enough for Pacific Islanders because there was often no abortion access to begin with. As we celebrate Asian American and Pacific Islander (AA/PI) Heritage Month, reproductive rights advocates must ensure our work towards a future where reproductive freedom is a reality includes all people represented under the “AA/PI” umbrella.

The inaccessibility of abortion care is part of a larger history of the United States denying health care to Pacific Islander communities since the United States expanded its borders beyond the continent. The United States has five inhabited territories: American Sāmoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands. Like states, territories enact their own laws, including abortion laws, but Congress has ultimate control over the territories. The fight for accessible reproductive healthcare across the territories is directly tied to the fight for their lands and culture under U.S. governance.

The Invisible Health Crisis on the Islands

The inadequate reproductive healthcare in the Pacific Island territories and states, and attacks on Pacific Islanders’ reproductive legal rights, are especially alarming considering the high maternal mortality rates among Pacific Islanders. There has never been an abortion provider in the Northern Mariana Islands or American Sāmoa, and the last known abortion provider in Guam retired in 2018. Additionally, Guam, the Northern Mariana Islands, and American Sāmoa all have restrictive abortion laws either in their criminal codes or constitutions. Despite abortion being legal in Hawaiʻi, access is limited as abortion providers are largely located in only three of the seven main inhabited islands.

Studies show that limited access to reproductive healthcare, including abortion care, worsens birthing people’s health outcomes. Pacific Islanders are further proof of this finding, as Pacific Islander women have one of the highest pregnancy-related mortality ratios. Native Hawaiian or Pacific Islander people are nearly five times more likely to experience pregnancy-related deaths compared to white people. Forcing Pacific Islanders to continue their pregnancies not only strips them of their power to control their reproductive health but also places their lives at risk.

Missing and Misleading Data

The Pacific Islander health crisis is a result of the invisibility of Pacific Islanders in health data and the United States’ obstruction of Indigenous Peoples’ way of living. Data that fails to accurately represent communities prevents equitable allocation of federal resources. A review of 32 commonly used federal health data systems found that American Sāmoa was missing from 84% of these systems, the Northern Mariana Islands from 75%, and Guam from 59%. The Decennial Census includes the three Pacific Island territories but not the American Community Survey, Population Estimates Program, and Current Population Survey. These four data sets provide information on the population, workforce, housing, and health care of people living in the United States. The federal government’s refusal to collect data on Pacific Islanders, given the extreme maternal mortality and morbidity rates, is a continuation of the United States’ erasure of Pacific Islanders’ experiences and struggles.

Lost Traditions

Indigenous communities have long recognized the importance of bodily autonomy, including respecting pregnancy-related decisions. Abortion care was part of many Pacific Islanders’ lives before contact with Western powers. However, with the imposition of Western thought and colonial forces prohibiting Native cultural practices, Pacific Islanders have been disconnected from many of their ancestral practices. Stigma surrounding abortion care in Pacific Islander cultures did not always exist. Abortion care was part of the lives of the Indigenous Peoples in the Mariana, Hawaiian, and Sāmoan islands before colonialism. To reclaim traditional birthing and abortion practices is to reconnect with and preserve Indigenous Peoples’ roots, histories, and cultures.

Policy Recommendations

1. U.S. policymakers must allow Indigenous Peoples to practice their birthing traditions and ways of caring for their reproductive health without fear of criminalization.
2. U.S. policymakers in American Sāmoa, Guam, and the Northern Mariana Islands to repeal their longstanding abortion restrictions and value pregnant people’s self-determination.
3. National and local data collection on the health of Pacific Islanders must fully implement the Office of Management and Budget (OMB) Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. The OMB designates that, at a minimum, Asian American populations should be disaggregated from Pacific Islanders in data collection and reporting.

Restoring Pacific Islander Bodily Sovereignty

Ending the Pacific Islander reproductive health crisis requires addressing the United States’ colonial violence against Pacific Islanders. Since the United States controlled our islands, our bodily autonomy and ancestral ways of living have been under attack. Pacific Islanders deserve self-determination over their reproductive health, lands, and existence. In closing out AA/PI Heritage Month, the National Partnership for Women & Families thanks and honors the Asian, Asian American, and Pacific Islander elders and ancestors who have fought for our communities. We hope to build upon their work towards a reality where people can live free from reproductive violence and economic injustices.

Acknowledgment: Thank you to Rosann Mariappuram and Erin Mackay for their invaluable contributions.