Guam’s government is appealing a judge’s ruling that removed a barrier to women in the U.S. territory accessing telemedicine abortions.

American Civil Liberties Union attorneys fighting for abortion access on Guam said the appeal is alarming because it comes as the island is grappling with the deadliest wave of the pandemic.

The Guam attorney general’s office and the Guam Medical Board of Examiners filed notice in court this week they are appealing a preliminary injunction that temporarily blocked a provision of Guam law that forced patients to have an in-person visit before abortion medication can be prescribed via telemedicine.

The September ruling stemmed from a lawsuit by two Guam-licensed physicians who live in Hawaii and want to remotely supply medication abortions to Guam patients through telemedicine. They took issue with the requirement that information about the procedure be given to patients in person.

In March, both sides agreed to a settlement that made medication abortion via telemedicine accessible. The settlement cleared the way for Guam residents to access telemedicine abortion rather than leave the island and fly nearly 4,000 miles (6,437 kilometers) to Hawaii, or farther.

“If the appeal prevails, it wouldn’t change the legality of medication abortion through telemedicine on Guam,” ACLU attorney Alexa Kolbi-Molinas said today.

But it could be an obstacle on an island where abortion continues to be a contentious issue and where there’s already limited abortion resources.

Abortions carry a strong stigma in the heavily Catholic territory.

The last abortion physician on Guam retired in 2018 and no local doctor has stepped in to fill the vacancy, U.S. Judge Frances Tydingco-Gatewood noted in her ruling.

While the appeal is pending, Hawaii doctors will be able to provide telehealth abortions, Kolbi-Molinas said.

Attorneys representing Guam officials didn’t immediately respond to requests for comment.