In the weeks since the Supreme Court overturned Roe v. Wade, reproductive health clinics in states with abortion bans have been forced to curtail their services. This has been particularly acute in the South, where there will soon be no legal abortion services in a wide swath of the country. Some patients are now forced to travel hundreds of miles for care.
Someday soon, they may not have to. To serve patients on the Gulf Coast who may be closer to the water than an abortion clinic, Amy Autry, an OB-GYN and professor at the University of California San Francisco, is spearheading a project that would provide abortion services on a boat in federal waters a few miles off the coastline. The nonprofit is called PRROWESS, an acronym that stands for Protecting Reproductive Rights Of Women Endangered by State Statutes.
Federal laws don’t currently prohibit abortion, so a floating clinic could legally operate without running afoul of state laws. Autry, who previously worked as an abortion provider in Wisconsin, hopes the clinic will be open to patients about three weeks out of every month. I spoke to Autry about her plans, the demand for a floating clinic, and the challenges she expects to face. Our conversation has been lightly edited for length and clarity.
Christina Cauterucci: How long have you been considering opening an abortion clinic on a boat?
Amy Autry: As reproductive rights were progressively assaulted, if you will, over the last several years—3 to 5 years probably—I had this idea of, hey, what about a boat on the Mississippi River? I knew that there were casino boats there, and there had to be something different about the water that was making that legal, because it wasn’t legal on land.
And then, although I wasn’t aware of Rebecca Gomperts when I thought of the idea, once I started telling people about my idea and was really ready to investigate it, I got connected with her. She’s the founder of Women on Waves.
They provided abortions on a boat, too, off the coast of other countries that banned abortion.
She’s a visionary and this is her life’s ambition, to protect abortion access. Her operation was a little bit different: She was in international waters, and she provided medication abortions. But she was incredibly helpful and gave me a lot of ideas.
And you’re not planning to offer medication abortions?
It’s a little bit of a different time now. It is—I don’t want to say easy, but you can get medication abortion through the mail now in the U.S. [Ed. Note: Some states have banned the provision of abortion medication by mail, but such laws can be difficult to enforce.] So we won’t be providing that on this floating reproductive health clinic. If you can get something through the mail, why would you get it on a boat?
What did Rebecca Gomperts tell you? Any dos or don’ts?
Yeah, it was amazing. So I mean, the water’s a little bit rougher where she was, like off the coast of Ireland, but she gave me some tips about the type of vessel they were on, like speed, and what she would’ve done differently.
What did she have to say about the speed of the boat?
She just recommended a faster boat.
So you had this idea. How did you get started?
We started investigating with maritime lawyers about 2 to 3 years ago, and ultimately decided that the Mississippi River was not the best option. And over the last year, as things started to accelerate with changes in American politics, we also started accelerating. We started looking at the Gulf, because essentially every state on the Gulf is restrictive on abortion. There is a swath of water in the Gulf Coast that’s federal, where our legal team believes we can provide reproductive health care.
How far are you in your planning right now?
We have done an immense amount of research, and we’ve been escalating over the last year. When the Dobbs decision got leaked, we accelerated more. And when the final decision came down, we were like, we have to go. So we put up our website, we opened our ActBlue account. And then I gave an initial radio interview—because we’ve had an overwhelming amount of support, both for finances and volunteers, which is really great, but we need big donors. If we get the money that we need or, for example, we can get a vessel donated, we’re ready to move.
When you say “we,” who are you talking about?
We have a team. I’m the public face. Our legal team is robust, and the reproductive health portion of our legal team is the Lawyering Project. They just won a big case in Minnesota this week. They’re a nonprofit reproductive health attorney group. We also have maritime lawyers. We have ship consultants, security consultants, and criminal defense.
How have you funded the work thus far?
Initially it didn’t really require funding, because we were doing a lot of research and all of the legal has been gratis. But once we started hiring consultants, we sought out seed money, which we were able to get from donors, particularly in California.
What about you? Is this your full-time job now?
No, no, it’s not. Right now, I’m able to do my full-time job and do this when I’m not doing my full-time job. I mean, this is a passion of mine and I will be involved in the consulting, but I’m not going to be retrofitting the vessel. But once we’re ready to go and be on the water, I want to be there, as one of the providers.
What will you have to do to turn a boat into a medical facility?
We know the rules of what the clinic has to look like. There are clinics on the water: There’s Mercy Ships, there’s military ships, there’s cruise ships. So there are specifications for a clinic that exists on the water. They’re not that much different than clinics that exist on the land.
Will you want it to be different than, let’s say, a cruise ship clinic?
We’ve had some incredible volunteers. People just say, “I want to volunteer. Here’s my skill, which is graphic design. Here’s my skill, which is decorating.” And my hope is to not only offer reproductive health services, but maybe we have some yoga, and it’s a nice place to be, and we have social services and legal services.
One of the biggest points of this whole thing is that this is not an adventure for rich people, right? Rich people can get wherever they want, whenever they want, for whatever they want. This is for the people in the southern parts of these states that, even with the innovative and creative people that are out there trying to maintain abortion access, they can’t get to a clinic within a reasonable timeframe for their lives. And so wouldn’t it be nice, if you were that person, to be on a warm boat, and you’re getting your services, but maybe you have some yoga, and you have a massage. I think that would be lovely if we could do that.
What kinds of medical services will you offer?
It’s a comprehensive reproductive health floating clinic. So it will have contraception, testing and treatment for sexually transmitted infections, hopefully vaccination, and surgical terminations.
How far into pregnancy will you provide abortions?
We’re thinking 14 weeks at this time. I don’t know that that’s where we’ll always be, but you certainly don’t want to start something on the edge like this, and also doing more complicated procedures.
What about security? I imagine that’s a major concern.
Security and legal are probably the biggest challenges and worries. Along every part of this journey, if you will, we’re anticipating security issues and legal issues. Security is going to be a huge part of our price tag. I don’t think it’s a secret about the threat to providers and patients in our country today. Guns are everywhere. People have been killed. We are very serious about security.
Along those lines, I read somewhere that your vessel will be large enough that it would be equipped to have a helicopter land on it.
Yeah. We have vessel size specifications below which we won’t go, for reasons of stability in the water, and vessels above that size could accommodate a helicopter.
How will patients get to the clinic? Will it be by helicopter, by boat?
There’s some things that, because of security, we’re not going to be that transparent about. But they will have to get to the boat one way or another, right?
How close will you be able to get to shore?
It depends on the state. It’s a range of something like 3 to 9 miles. And we estimate in most cases, depending on what vessel you’re using, you could get out there in about 45 minutes.
What about staff members? Will they sleep on the boat, or will it come back to land every day?
A large vessel is going to constantly stay in federal water. There are rules in terms of crews, like that you have to have sleep quarters and rest times and stuff like that. The vessel will be large enough to accommodate that, and I would anticipate that providers would come out there not just for a day.
Do you know where the boat would be based out of, where it would come home to when it’s not in the water?
Its home water will be somewhere where access is legal.
Do you know about how many people live in places where a clinic in the Gulf would be closer and easier to get to than a clinic on land? The people you’re trying to serve?
If you look at, let’s just say Texas, for example, because that’s where I’ve done the most research, because of SB 8. So if you look at McAllen, Texas, or Galveston, it is difficult to get to an access state by driving. And you’d want to have an appointment, get services, and be back to your home within a day, right? So if you think of Galveston and the Houston area, that catchment area is 7 million people.
We estimate that, with the crew, and making sure that we consider the weather, and using a very conservative estimate on the size of the vessel, we could hopefully serve around 20 patients or clients a day. And so in a six month timeframe, that would be about 1,800 people. We have a lower limit in terms of the size, but we don’t really have an upper limit. So it would obviously cost more, but if we got funding for something bigger, then we could see more patients if there was a demand.
What do you know about existing demand? Are people willing to get care on a boat?
About a year ago, I had this thought like, “Oh my god, what if we come up with this great idea and people won’t do it, like they’re not interested?” So we have UCSF colleagues that do a ton of abortion research, and so we had them add onto some of their study work: “Would you pursue this option if it was available to you?” And people said they would. The majority of the people that said they would were from the South. It’s hard to know if they are more comfortable around water, or they just know that they’re in more restrictive states, it would be more challenging to get an abortion.
I know there actually are two little spots in the Gulf of Mexico that are international waters. So if there was a federal ban on abortion, it would still be possible to have a boat in the Gulf—it would just have to be much further off the coast. Is that something you’d consider if a federal ban gets passed?
We’ve definitely considered that. But the closer, the better, right?
How much funding do you need?
There are one-time costs, like acquiring the vessel and retrofitting it. And then there’s going to be ongoing costs. The patients’ services are going to be needs-based, so the patients will pay minimal to nothing. There’ll be crew costs, there’ll be medical equipment costs, there’ll be large ongoing security costs, liability. We’re estimating to get it up and going, it’ll be $20 million. And then we’ll need ongoing funding, probably around $2 million a year to keep it functional.
Do you know how that compares to a clinic on land?
Oh, I have no idea.
Well, that seems doable for a wealthy benefactor.
Yeah. Especially one that had a vessel that was kind of sitting somewhere that we could use.