Yesterday, I joined the ACLU in filing a lawsuit to restore abortion access to Guam. More than two years ago, the last known abortion provider in Guam retired, and thanks to outdated and medically unnecessary restrictions, island residents cannot use telemedicine — which over a decade of evidence and experience has shown to be a safe and effective means of providing medication abortion — to access legal abortion. In effect, these laws are operating as an abortion ban.

Unfortunately, this is not the first time advocates, like myself, have had to turn to the courts to defend access to safe and legal abortion in Guam. In 1990, Guam took the national stage when its governor, Joseph Ada, signed into law a bill banning abortions on Guam. The law was a frontal assault on our constitutional rights — in fact, the government of Guam argued that the right to abortion did not even apply to Guam at all — and was the most restrictive ban enacted in the United States since the Supreme Court had decided Roe v. Wade. The law was challenged, the government of Guam lost, and the suit cost the people of Guam millions. Guam legislators stayed away from the issue for a while but — just as we have seen throughout the United States — over the last decade they have steadily introduced laws to make abortion more and more difficult to access.

Since 2008, politicians in Guam have introduced nearly a dozen medically unnecessary and politically motivated restrictions on safe and legal abortion care. The majority of these legislative efforts were signed into law, creating a web of barriers that have pushed safe and affordable abortion care out of reach for island residents. Among other harmful and stigmatizing effects, these laws delayed access to care and forced patients to make multiple, unnecessary visits to their doctor.

These barriers are exacerbated by a unique problem that sets Guam apart from other U.S. citizens. Guam sits about 5,800 miles (12 flight hours) from the U.S. mainland, and 3,800 miles (7 flight hours) southwest of our closest U.S. neighbor, Hawai’i. Guam has also been a federally designated a Health Professional Shortage Area (HPSA) and a Medically Underserved Area (MUA) — meaning that specialized and tertiary medical services are thousands of miles away.

These barriers hurt those who are already hurting most. The most vulnerable make up a larger part of our community than anyone would like to admit. Our rates of poverty, poor health, and domestic violence and sexual assault already are among the highest in the United States. And the current lack of access to abortion only exacerbates this crisis: Research shows that women who are forced to carry a pregnancy to term after being denied a wanted abortion are four times more likely to experience subsequent poverty; are more likely to experience serious complications from the end of pregnancy; and are more likely to remain in abusive relationships.

People who are already struggling should not be denied the ability to get an abortion, continue a pregnancy, or have a safe place to raise their children — yet that is exactly what is happening in Guam. No politician should deny us our freedom to make decisions about our own health, our bodies, and our families — especially not one who claims to serve the people of Guam. It is impossible to separate our choice of whether and when to have children from every other choice in our lives. From housing to schools to jobs, virtually every major decision that influences our lives is irrevocably impacted by our decision to have a child. Any denial of the right to choose whether to have a child is a denial of all of our other choices.

It is painful to see my island’s distinction among the U.S. is yet again based on the denial of a fundamental right to our women. However, as a Chamorro woman, carrying the legacy of Chamorro activism for reproductive freedom, I know we do not take for granted our inherent right to determine our own destiny — it is something we are still fighting for collectively. As a mother, I have to believe that we will trust and respect that our women should not be individually restrained from determining what is right for our futures. Despite centuries of colonization, our pre-colonial matriarchal traditions and culture of respect endure. I hope we continue this legacy by respecting that people in Guam are capable enough to make their reproductive health choices themselves, free from unnecessary interference from the government. If we don’t, it will cost us much more than money this time.

The federal government has not been kind to transgender people over the last four years. Trans students were put at risk when the Department of Education withdrew critical guidance explaining how schools must protect transgender students. Trans people facing housing instability were left in the cold when the Department of Housing and Urban Development rolled back rules protecting trans and gender non-conforming people from discrimination at homeless shelters and other housing services receiving federal funds. Trans military members were devastated by a single tweet from the president that put their careers and livelihoods at stake. And the list of attacks goes on.

The government is supposed to support and serve all of us, but trans folks have been intentionally and cruelly cut out these last four years, along with so many other communities. Of course, we are still here, and will continue to take care of each other no matter who is in the White House. We’ve heard Biden and Harris pledge to repeal the trans military ban and pass the Equality Act, and assure us that their administration will work to undo the harms of the last four years. Now we must must hold this administration accountable and ensure that they make a meaningful difference in the day-to-day lives of trans and non-binary people around the country.

There’s one important action this administration can take right away to show transgender people that they respect and support us: give us identification that reflects who we are. That’s why one of the ACLU’s top priorities for the Biden-Harris administration is an executive order updating the process by which federal agencies change gender markers on IDs. This order will ensure that all transgender people have access to an accurate ID. Currently, to update a gender marker in the social security system, on a passport, on immigration documents, or on any other federal ID or record, an applicant must submit a letter from a medical doctor attesting to appropriate clinical treatment for gender transition. This executive order would remove those burdensome medical documentation requirements so that everyone has access to the appropriate gender marker, and add an “X” option so that non-binary, intersex, and other folks have an accurate designation.

Access to accurate IDs is personally meaningful for trans folks but also practical, ensuring we can travel, apply for jobs, and enter public establishments with less risk of harassment or harm. But this update is not just about us, it’s a sensible solution for the federal government. IDs are intended to identify people, and are useless when they don’t match the applicant. Requiring trans folks to jump through hoops with doctor’s visits and medical letters to obtain updated IDs is costly, complicated, an invasion of privacy, and entirely unnecessary — and prevents many people from getting an updated ID to move through the world.

Accurate IDs are not possible without appropriate options for non-binary folks, intersex people, and anyone else for whom an “M” or “F” is not suitable. An “X” designation is used throughout the world to indicate a sex or gender other than male or female, and must be available on our federal documents. Nearly 20 states already have self-attestation and an “X” designation on driver’s licenses and state IDs, so this update is also important to ensure that people can have consistent state and federal documents.

The ACLU is excited to encourage this important step forward. In 2021, we’ll be sharing stories from trans and non-binary folks about the importance of accurate IDs, meeting with White House officials, and pushing the administration to follow through on their promises to the trans community. With one stroke of the pen, President-elect Biden can issue this order to not only provide a common-sense solution to access accurate IDs, but send a critical message to transgender people across the country: Our government sees you as exactly who you say you are, and we want you to be supported and included in this country.

Building trust between the government and trans communities is a long and hard process, but it starts with recognition.

Last week, we marked Roe Day, the 48th anniversary of the Supreme Court decision that legalized abortion throughout the United States. We celebrate this milestone while at the same time recognizing that legality alone has never been enough to secure real access to abortion. Indeed, we don’t need to wait for the Supreme Court to act to see a post-Roe world here in the United States. Guamanians are already living it.

Yesterday, we filed a lawsuit in the federal district court in Guam, seeking to restore abortion access to the island. The lawsuit challenges two outdated and medically unnecessary laws that are preventing physicians from using telemedicine to provide medication abortion to their patients in Guam. In effect, these laws are operating as an abortion ban.

Medication abortion is an FDA-approved option for ending an early pregnancy and treating early miscarriage, which has been safely and effectively used in the United States for more than 20 years. More than a decade of research and experience show that the medications used for a medication abortion can safely and effectively be prescribed through telemedicine. Providing medication abortion by telemedicine can not only reduce barriers to abortion care — such as travel, child care, long wait times, and the costs that result from these obstacles — but, for many patients, it also allows them to receive care where they feel safest and have the most privacy, such as their own home. But the right to such care is being denied to people in Guam.

What’s happening in Guam is disturbingly familiar. The ACLU first joined forces with advocates in Guam, led by Chamorro women (the Indigenous people of Guam), to protect abortion access more than 30 years ago. At the time, it was estimated that the majority of OB-GYNs on the island provided abortion services. However, just as we have seen throughout the United States, decades of stigmatizing political rhetoric, harassment, and increasingly restrictive laws have steadily pushed abortion out of reach in Guam.

But there are real and significant ways the fight to protect abortion access in Guam differs from that fight stateside. Guam, the largest and southernmost of the Mariana Islands chain, is located nearly 4,000 miles from Hawai‘i and about 1,500 miles from the Philippines. The last 400 years of Guam’s history have been marked by colonization by Spain, Japan, and the United States. Guam’s current political status is as an unincorporated, organized territory of the United States. Guamanians are U.S. citizens and have the same constitutional right to abortion as anyone else in the United States, but cannot vote in U.S. presidential elections. As with all abortion restrictions, these laws disproportionately harm people of color and people with low incomes: In Guam, it is Chamorro women, the Indigenous people of Guam, who not only carry the unjust weight of centuries of colonialism and imperialism, but also the disproportionate burdens of laws that strip them of the ability to make the best decision for themselves and their families about their pregnancies.

Without meaningful access to abortion on the island, people in Guam are being forced to travel several thousand miles each way to Hawai‘i, for which airfare alone costs more than a thousand dollars, just to get the care they need. That is unconscionable, not to mention unconstitutional — no court has ever upheld a law that imposes such a burden on people seeking abortion care. And during the COVID-19 pandemic, this forced travel carries extra risk and burden. Travel restrictions and quarantines in both Hawai‘i and Guam make it even more difficult to access care. Every day of quarantine escalates the cost of travel, requires more time off work and away from family and children, and makes it all the more difficult to keep one’s abortion decision private. The lack of abortion access also creates unique burdens for U.S. servicemembers stationed on the island — particularly for enlisted women, who live on extremely restricted incomes and are disproportionately people of color — who are already subjected to federal laws designed to push abortion out of reach.

The fight for access to abortion is not just about legality, but also about dignity and humanity. People who live in Guam have the same right not only to constitutionally protected health care, but to that dignity, as anyone else in the United States. We are proud to stand with Chamorro women and people in Guam, and to continue to work alongside them for a world where everyone is able to receive the abortion care they need and create their families without barriers, fear, stigma, or political interference.