To solve the problem of abortion access, Meg Autry is seeking inspiration from an unlikely source: riverboat casinos.
As access to abortion deteriorated in the past year, Autry — an obstetrician-gynecologist at the University of California San Francisco — had been toying with a years-old idea to reach areas where such medical services were already becoming highly restricted. When the U.S. Supreme Court overturned Roe v. Wade last month, her drive to turn it into reality intensified.
The project: A clinic floating in federal waters in the Gulf of Mexico that will provide abortion care to residents from neighboring states including Mississippi, Alabama, Louisiana and Texas — all of which are set to ban or severely restrict the procedure.
“We have to be creative because our bodily autonomy is under attack,” Autry said.
The Supreme Court’s decision has jeopardized abortion access for 33 million Americans and left some patients with little choice but to travel six times as far to terminate a pregnancy. In response, abortion rights advocates are coming up with more and more creative solutions to try to “mitigate the harm,” according to Andrea Miller, president of the National Institute for Reproductive Health, an advocacy group.
A nonprofit group called Protecting Reproductive Rights of Women Endangered by State Statutes — or PRROWESS, for short — is currently fundraising for the vessel, which will aim to serve around 1,800 patients every six months and will take an estimated $20 million to get off the ground, Autry said. Once funds are sufficient, it’ll take another six to nine months to retrofit a vessel to provide abortion care, she said.
The PRROWESS vessel will offer a full range of reproductive health-care services, including surgical abortions up to 14 weeks, testing for sexually transmitted infections and emergency contraception, according to the group’s website. It aims to provide care at little to no cost for patients, depending on need.
The group is banking on the idea that a vessel floating more than three nautical miles from the shores of the Gulf of Mexico — where federal waters begin — would be outside the jurisdiction of states to enforce abortion restrictions. But it’s also gearing up for a fight.
“We are expecting challenges at every point,” Autry said.
The exact logistics — whether patients will need to be ferried to the boat, or whether it will dock on the shores of an abortion-hostile state — have yet to be worked out. There are also the challenges of finding and sourcing crew, health-care providers and providing patients with enough assurances that they’re comfortable seeking the boat’s services.
One possible snag is that states give counties or municipalities the ability to restrict docking on their shores if a vessel’s purpose doesn’t comply with local laws.
“From a politics perspective, this is a quick and easy fight” for anti-abortion politicians to pick, said Nicholas Creel, assistant professor of business law at Georgia College & State University.
Another risk is that states would restrict residents from traveling elsewhere — including out to sea — to access abortion care.
The Supreme Court has upheld the right of Americans to travel from state to state, with Justice Brett Kavanaugh writing in a concurring opinion that states outlawing the procedure may not bar residents from traveling to other states to terminate their pregnancies. Yet it hasn’t stopped anti-abortion lawmakers from drafting model legislation on the issue.
“Somebody can say ‘I have an interstate right of travel,’ but an attorney general can say ‘Yes, but the Supreme Court has never recognized it in the abortion context’,” said John Paul Jones, a professor of constitutional and maritime law at the University of Richmond School of Law. “That’s a whole ‘nother bag of worms.”
There’s also the question of where a ship is registered and what laws apply to it, as stipulated in treaties for international waters that the U.S. is subject to. If a boat is registered in another country that is “friendly” to abortions and makes its way to the Gulf of Mexico while remaining in international waters, “the U.S. is handcuffed from doing anything about that,” Jones added.
It’s not the first time a floating abortion clinic has looked to provide care to patients where the procedure is restricted. In June 2001, members of a Dutch nonprofit called Women on Waves sailed to Ireland — where a near-total abortion ban was in place until 2018 — for the “world’s first floating abortion clinic,” according to a 2002 research paper from Pace International Law Review.
The group ultimately didn’t deliver services on that first trip because it had failed to secure Dutch licensing, though it has since provided abortion care in international waters.
Other advocates for abortion access are hitting the road.
Just the Pill, a nonprofit that provides telehealth appointments and medication abortion by mail, said it will deploy a “fleet of mobile clinics.” The group began operating a mobile clinic providing medication abortions in Colorado in late June, and will begin providing procedural terminations up to 12 weeks in a second mobile clinic later this summer.
"Our intention is to provide access to patients who are unable to access services in their state,” Julie Amaon, medical director of Just the Pill, wrote in an emailed response to Bloomberg News. “There is strong legal precedence that a state has no authority over commerce in another state. It is unfortunate that so many states are trying to pass laws that are clearly in violation of this precedent.”
In his executive order on abortion, President Joe Biden said the Attorney General and Secretary of Homeland Security should consider action to protect the safety of reproductive health-care providers and patients, and that applies to mobile clinics.
Despite the ingenuity, the workarounds may still leave out those who can’t travel at all because of work or child-care obligations, are minors or undocumented. Legal risks, especially for people of color who are criminalized at higher rates, are also a concern for those who live in and have to return to states that are hostile to abortion.
“There’s all these new creative solutions coming up but at the end of the day everyone who needs care should be able to get it in their community, in their state,” National Institute for Reproductive Health’s Miller said. “While it’s not, we need to strategize.”
