How can patients skirt abortion bans? A clinic at sea could be the answer : NPR

The Supreme Court’s reversal of Roe v. Wade has made it harder for many pregnant people to access abortion services — at least on land. One California-based doctor and activist has an idea: Why not offer them at sea?

Dr. Meg Autry, an OB-GYN and professor at the University of California at San Francisco, has been mulling over this question since long before Dobbs decision. She says she was inspired by the casino boats she would see in the Mississippi River while growing up in the south.

As many states tightened their restrictions on abortion — and dozens now move to ban it altogether — Autry assembled a legal team to look into whether it might be possible to offer that care by boat. After assessing their options, they’re working towards the goal of providing abortion services in federal waters in the Gulf of Mexico (though not without anticipated legal challenges and safety concerns).

Autry created and runs the nonprofit PRROWESS, whose acronym stands for Protecting Reproductive Rights of Women Endangered by State Statutes. She says their planning was years in the making, since they anticipated the Supreme Court might issue such a ruling and wanted to be ready to go public as soon as that happened.

PRROWESS is now fundraising to buy and retrofit a boat that can serve as a floating health clinic. The group hopes the clinic will offer all sorts of reproductive health and wellness services, including contraception, testing and treatment for sexually transmitted diseases and surgical abortions up to 14 weeks.

But making that clinic a reality will take time, raise questions and involve risks. Autry says it’s worth it — after all, as she tells Morning Edition‘s Rachel Martin, this is her life’s work.

“It’s just not OK for people to not have bodily autonomy,” she says. “And the people in these states that are losing their rights are poor people and people of color and marginalized communities … People are stepping up and have stepped up forever. But we have to be innovative and creative in order to allow these patients to get the care that they deserve.”

How it would work — and what happens if it doesn’t

The nonprofit needs to clear significant financial and logistical hurdles before it can color in the exact details of the proposed operation.

First and foremost, they need to raise enough money to acquire a vessel, with a preliminary goal of $20 million. That vessel will need to be retrofitted to meet clinic standards, which Autry says could take 6 to 12 months. In an ideal world, she says, the vessel would be operational in a year.

And it’s still unclear what exactly that would look like, since the size of the team and number of procedures they’ll be able to perform will depend on factors like the size of the vessel, union rules and fuel costs. But Autry estimates the crew could provide for about 20 patients a day, which comes out to roughly 1,800 people in six months.

The vessel would operate in the swath of federal waters in the Gulf of Mexico, where its activities wouldn’t be restricted by state laws. The exact distance from the coastline depends on the state, but Autry says it would be between 3 and 12 miles offshore.

The nonprofit’s website says once patients complete a pre-screening process, it will make arrangements to transport them to the vessel — and promises more information about how to make appointments soon.

It anticipates primarily serving patients who reside in Texas, Louisiana and other states along the Gulf Coast, many of which had trigger laws that immediately banned abortions.

In fact, according to PRROWESS, people in the southern parts of Mississippi, Alabama, Louisiana and Texas may be closer to the coast than to facilities in bordering states where abortion and reproductive health care are accessible.

“It is often very difficult and expensive for individuals who live close to the Gulf Coast to easily access care in a short time frame, due to distance to the nearest clinics and the need for connecting flights,” its website reads. “Flying out of state often requires patients to secure child care and time off work for multiple days, and may not be an option at all for people who are undocumented.”

The nonprofit’s goal is to offer care at little to no cost to patients, depending on need. And according to an FAQ page on its website, “If at any point along this journey it appears that the floating medical clinic will not be successful, remaining funds will be distributed to other projects addressing access to abortion.”

Organizers brace for potential legal challenges and security concerns

Autry and her nonprofit are also hesitant to provide too much detail about how people will be able to access the vessel, citing safety concerns. Without elaborating, she says she anticipates that her group will be a part of the many existing networks trying to coordinate abortion care for people who can’t get it in their state.

People seeking or providing an abortion could face prosecution or, Autry fears, violence. She calls security her group’s top concern.

And she says that while their team is secure in their understanding of the law, it’s bracing for potential legal challenges “along the way, all the time.” That’s in part because of ever-changing laws and lawsuits unfolding in restrictive states.

Amanda Allen, senior counsel and director at the Lawyering Project — which represents PRROWESS — tells NPR over email that there’s no doubt about the legality of providing abortions at sea, because states don’t have jurisdiction over the care provided in federal or international waters. She compares it to the way that an abortion provider in New York would care for a patient traveling from a restrictive state.

Still, she says their team is exploring the same questions that they would look at in the case of a provider looking to open a clinic in a state where abortions are not banned.

Those include whether there are rules governing the facility where the care is provided, and what kind of licensure and staffing is required. They’re also looking at the threats that could face abortion providers — floating or otherwise — who treat patients traveling from restrictive states.

“Given the climate of abortion access post-Dobbs, nothing is zero-risk,” Allen writes. “Because of that we are concerned about the same types of extraterritorial questions that are already creating chaos and legal uncertainty onshore. While a state’s criminal laws should not reach a provider at sea, a rogue prosecutor could choose to target PRROWESS, or a hostile state authority could open an investigation.”

There’s precedent for this kind of care, and enthusiasm for this plan

Autry and her team are much less concerned about the medical aspects of it all.

Less than 1{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} of patients require emergency care from an abortion-related complication, PRROWESS says, adding that it has planned for medical emergencies and will be prepared to transport patients to land by water shuttle or helicopter depending on the urgency.

The nonprofit says the military and relief organizations have used floating clinics for years, and that its research indicates patients are willing to seek this type of care.

Autry also points to a Dutch group called Women on Waves, which sails a ship to countries where abortion is illegal, docks about 12 miles off their coasts and provides patients with abortion pills and contraceptives.

Since its founding in 1999, it has completed campaigns — not without controversy — in countries including Ireland, Spain, Morocco, Guatemala and Mexico. (Its founder, Dr. Rebecca Gomperts, created another organization several years ago that ships abortion pills to Americans from abroad.)

“Medical care on the water and surgical terminations are incredibly safe and there’s precedent for that,” Autry says. “So we have no reason to believe that providing care on the water is more dangerous than providing care on the land, other than it’s the water.”

And while the project is still in planning stages, it sounds like many volunteers are already on board.

Autry says the response to their plan has been “almost overwhelming,” with people offering donations as well as their own volunteer services. She praised the legal and medical communities for their services, and notes that she’s had many volunteer offerings from maritime crew as well.

“The most heartwarming and overwhelming is all of the offers of help from people in the restricted states,” she adds. “We know that the majority of the country doesn’t believe in what’s happening, the outpouring we’ve received really emphasizes that.”

This story was produced by Claire Murashima and David West, and edited by Simone Popperl.