Where there’s a will, there’s a way. One doctor is finding a way forward for safe reproductive health for folks living in Southern states. She’s planning to take health care off the land and out to sea with a medical vessel anchored in the Gulf Coast, in federal waters where it will be legal to offer abortion care.
Meg Autry has worked as an obstetrician and gynecologist (OB-GYN) at the University of California, San Francisco (UCSF) for more than two decades. She’s a reproductive health advocate, and she was the residency director at UCSF for 15 years.
But Autry grew up in the South. She was born in South Carolina; went to high school in Atlanta, Georgia; attended college in Tennessee; and did her medical school in North Carolina. The idea of gambling boats able to float down the Mississippi River with legal immunity was the initial spark for Reproductive Rights of Women Endangered by State Statutes (PRROWESS), a floating health care clinic, which was an idea that came at least five years before the reversal of Roe v. Wade.
“So, I’m acutely aware of kind of the deterioration of both reproductive rights and also the deterioration in the number of people being trained to provide evidence-based complete OB-GYN care,” Autry tells Daily Kos.
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After meeting with maritime attorneys and the folks at the reproductive justice nonprofit The Lawyering Project, Autry’s concept for PRROWESS changed. With some brainstorming, she came to the conclusion that the feasibility of the Mississippi River wasn’t the best. But then, she says, she landed on the idea of dropping anchor in the Gulf Coast.
“Once you think about the Gulf and you look at a map, it's incredibly impressive to see that every state on the Gulf has restrictions, and most of them have now [abortion] bans,” Autry says. “We have a really robust, motivated legal team, and we believe that it is legal to provide reproductive services in a swath of water that is federal, that is in the Gulf.”
The issues that complicate Autry’s plan are security and the legalities of anchoring a medical vessel off the southern coast.
“Right now, there aren’t any laws that are criminalizing the patients. But again, the way things have gone, that wouldn't surprise me. So we're most worried about the patient safety and anything legal for them. And then anybody helping them,” Autry says.
There is precedent for these kinds of medical vessels. During the COVID-19 pandemic, the federal government rolled out emergency Navy vessels in New York and Los Angeles, and cruise ships are almost always outfitted with clinics.
Autry was also inspired by the work of Dutch physician Rebecca Gomperts, founder and director of Women on Waves. Gomperts created the nonprofit in 1999. It sails a boat into the harbors of countries with strict abortion laws and provides medication abortions to pregnant people in international waters. In 2005, Gomperts founded Women on Web, which provides online abortion services for pregnant people in countries where safe and legal abortions aren’t available, and gives them information and access to abortion medications online.
As for how PRROWESS plans to get patients to the medical boat, for security reasons, Autry won’t give any details about the boat taxi or smaller dinghy or vessel that transports patients to the floating facility.
“The whole purpose of this is for the people in the most southern parts of these states, that this option would be quicker and closer than any other options available to them,” Autry says.
“I say this time and time again, but if you have money in our country, you can get whatever you want whenever you want. But for poor people, people of color, and marginalized communities in the southern U.S., if you can't get away from your family for two to three days or your job for two to three days, and you don't really have options, this is an option for those people.”
Autry uses the example of Brownsville, Texas. She says to get to Denver or Albuquerque and get home, the travel time alone is two days. And that’s if a patient can get an appointment. “Whereas if you live in Brownsville and you went into federal waters, you’d be back in half a day,” she says.
Despite the fact that patients will be able to get surgical terminations, it’s not strictly an “abortion boat.” The vessel will provide contraception, testing and treatment for sexually transmitted infections, and vaccinations.
But the truth is that PRROWESS is just an idea until Autry gets the philanthropic funding she needs. She says she’s hoping someone will donate a vessel, and then she could be up and running within a year after retrofitting it as needed to make it a fully working medical clinic.
Autry is obviously passionate about her work. She says without it, “people are going to die.”
“Abortion medicine will make it not as bad [as pre-Roe], but the extent to which they're going, like in Texas, providers are afraid. And so they're not even able to provide good evidence-based care for complications. It’s already in the news. You’ve seen the 10-year-old, and that's related to abortion, but we've also seen someone who had to carry a dead fetus for three days. We also saw someone with an ectopic pregnancy, and that's going to hurt patients.
“But then you've got literally half of the training programs in the country are in states that are restricted, which means you're going to have an entire generation of people trained by providers who are afraid to practice good medicine. It’s going to have implications for years to come,” Autry says.
Autry says if there’s one thing she’d like people to know about the overturn of Roe, it’s that when people are turned away for abortion, their lives are impacted. She cites UCSF’s Turnaway Study, which analyzed what happened to people who were unable to get abortions.
“Their lives are impacted. They are much more likely to be under the poverty line. Their kids are likely to be under the poverty line. They're much less likely to have a wanted pregnancy in the future. It's debilitating. And so you need to allow patients to have bodily autonomy and make decisions about their own lives so that they can have much more rewarding lives in the future.
“It's just not fair to take that away from people, and you're taking it away from the most vulnerable people in our population. So that's what keeps me energized. That's why I went into medicine. That's why I'm doing this. Because we need equity in our country, and we need inequity, misogyny, and oppression to end. I just can't believe we are where we are,” she says.
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