When the decades-long campaign to restrict abortion access in the US started ramping up, Meg Autry, knowing a full assault on abortion rights was inevitable, began thinking about the gambling boats she’d seen growing up on the Mississippi River.
The huge vessels looked like regular casinos on the inside. Despite the fact that gambling was steadily being prohibited in the US in the 1950s, the boats were a creative solution: Because the river’s waters were regulated differently from land, the casinos weren’t illegal.
What if Autry, an obstetrician-gynecologist, could use that same logic to skirt abortion laws, she wondered? For the last five years, Autry has pursued the idea of setting up an abortion clinic on the seas.
She has now raised millions of dollars towards that effort. She hopes to launch the boat by the summer of 2024 in the Gulf of Mexico, providing surgical abortions to people traveling from a swath of states where the procedure is now banned.
That is just one of the creative solutions to preserve abortion access since Roe fell – ending legal abortion in 13 states. In some areas, patients now must travel over 500 miles to obtain a legal abortion.
To deal with the gap in care, organizations like Autry’s are springing up around the country, offering abortion care in international waters, on wheels and through abortion pills mailed from overseas.
Reducing travel times
After Roe fell, Planned Parenthood of the St Louis Region and Southwest Missouri saw the number of out-of-state patients increase by 435%. With Illinois now surrounded by bans in neighboring Arkansas, Indiana, Wisconsin, Tennessee and Kentucky, the wait time for an abortion through Planned Parenthood went from four days to two and a half weeks.
“We estimated that in the first year after Roe was overturned, we would see 14,000 additional patients coming from outside of the state. And that has all come true,” explains Bonyen Lee-Gilmore, vice-president of strategy for Planned Parenthood’s St Louis and south-west Missouri region.
Patients have also started coming in with more complex needs: making appointments later in pregnancy, and in need of more resources, like travel assistance, lodging and childcare. With only two other clinics in southern Illinois, the strain has been huge.
“It reaffirms what we’ve always known, which is when you try and ban abortion, you push people later into pregnancy. It doesn’t eliminate the need for abortion, but it complicates their care,” says Lee-Gilmore.
By the end of the year, Planned Parenthood will launch a new initiative in Illinois: a traveling abortion clinic which will drive to meet patients near the borders of restrictive states. Housed in a 37ft RV, with two exam rooms, a lab, a little waiting room and ultrasound machines, the mobile clinic will provide gynecological care and medication abortions, also know as abortion pills.
“[We hope it will] relieve the burden on the brick-and-mortar health centers at a time when capacity is so short for providers,” says Lee-Gilmore.
“If you could reduce 60 to 100 or 200 miles for a patient, you are reducing travel times, you are reducing gas costs for them,” she adds.
The clinic won’t be a silver bullet. Although nurses and physician’s assistants in many other states can provide abortion care, in Illinois they can’t, putting further strain on a limited pool of medical professionals.
And Planned Parenthood’s mobile clinic won’t currently be able to assist with the surge in demand for procedural abortions, sometimes called surgical abortions, at a time when more patients are coming to them for abortions after 14 weeks of pregnancy – at which point medication abortion is no longer recommended.
“Is one mobile abortion clinic going to solve a problem for the entire state of Illinois? Absolutely not,” says Lee-Gilmore.
“There is no substitute for abortion care that is near somebody’s home,” explains Elizabeth Nash, principal policy associate for state issues at the Guttmacher Institute.
“Access close to home is critical, because there are huge financial and logistical hurdles people have to overcome to get an abortion, including travel, taking time off from work, and arranging childcare. Low-income people and people of color make up a disproportionate share of abortion patients, and for many of them overcoming those barriers to get an abortion will be extremely difficult, if not impossible,” says Nash.
‘Doing what it takes’
Just the Pill has been providing abortion support on wheels for years. Initially that was to help patients in rural areas, because even before Roe was overturned, abortion access was largely dependent on geography – with hundreds of thousands of people traveling hundreds of miles to get to a clinic.
Just the Pill’s project, called Abortion Delivered, operated mobile clinics in Montana, Minnesota and Wyoming until 2021, and after Roe fell, they set up a new mobile clinic in Colorado to address the influx of patients coming from states like Texas.
They plan to open a mobile procedural clinic this fall, which would be the first in the country. That clinic will allow them to provide first trimester vacuum removals, and deal with any complications that arise from medication abortions.
Julie Amaon, Just the Pill’s medical director, also emphasizes that such provisions can’t replace legal abortion access across states.
She mentions patients who have booked appointments and even purchased plane tickets, only to have to cancel because their babysitter didn’t show up or they didn’t have the right documents.
“It’s been pretty eye-opening,” she says. “Even knowing the hoops that people had to jump through before – now, it’s expanded twentyfold.”
“But we want to push the envelope because we think this is essential medical care that everybody should be able to access,” says Amaon.
Autry, who is setting up the abortion boat hopes to provide a wide range of care at a larger scale than a mobile clinic on wheels. Her boat will be big enough to house a helipad in case of emergencies, and she hopes it will ease the needs of patients in the south, with states like Alabama, Georgia, Louisiana and Texas all bordering the Gulf.
“My proposal increases access to a different group of people because it’s surgical terminations past the point where you can get medication abortion,” says Autry.
“A lot of people that live in these areas are very poor. And for them to take time off for work or time away from their family, it’s too burdensome. So to have an option where they could go on a boat in half a day, or a day at most, is a benefit,” she says.
She has identified a vessel which she plans to retrofit to meet clinic specifications. Their services are going to be free or on a sliding scale. Hiring a crew and covering maintenance, fuel and medical supplies will cost another five to 10 million dollars (£4.4m to £8.8m) – which she says is not as much as it sounds, when it comes to big philanthropic funders. She did not disclose information about donors who have already signed on.
She hopes that providing abortions at sea isn’t a long-term solution for America.
“People need to understand that patients and physicians and the medical community are going to do what it takes to make things right until our country comes around. But I hope they do come around,” she says.
