Dr. Meg Autry knew some women would soon face difficulty accessing abortion long before the Supreme Court’s June 24 decision officially overturned Roe v. Wade.
“I can’t pinpoint it, but sometime in the last three to five years,” she began to sense change coming.
In her work as an OB-GYN and professor at the University of California San Francisco, she’d advocated for reproductive rights for decades, and “could kind of see the writing on the wall, politically,” as those rights started getting restricted.
So she started looking into the idea that would eventually become PRROWESS.
It’s a nonprofit organization, dedicated to creating and running a floating health clinic that will eventually anchor in federal waters off the Gulf Coast — circumventing restrictive state laws by providing “reproductive health and wellness services, including contraception and surgical abortion,” for free, in federal waters.
The idea came from casino boats that float on the Mississippi River. Autry, originally from the South, was already familiar with the paddle steamers that circumvented state gambling regulations by staying on the water.
“I was kind of joking, [saying] we should do a clinic on the Mississippi River,” she recalled.
But as the situation around Roe v. Wade started becoming more clear, “I kind of like, lightly started looking into it, and then probably around two or three years ago, I actually got in touch with some maritime lawyers.”
When it became clear that every state along the Gulf Coast was moving to restrict access to abortion, Autry and the experts she was consulting with began to focus on that body of water.
The clinic’s mission, as stated on its website, is “providing a safe haven for individuals from states where reproductive rights are severely impacted by legislation limiting access to reproductive health care.”
That mission is still in the planning stages, with donations right now going toward consultants in the maritime, medical and law community to ensure the clinic works smoothly and effectively, and to the purchase and retrofitting of a ship what will serve their needs.
But the organization and those consultants are now working to get the clinic off the ground, eventually hoping to hire a base crew for the ship and find volunteers for other roles.
“In the last year that we decided, we think we can really do this, now we need to operationalize it,” Autry said.
They’ve been meeting weekly to determine what size ship they’ll work on, how to transport people who need their services to the clinic, how many people will work on the crew, and who they can rely on to work or volunteer there.
Beyond surgical abortions up to 14 weeks, the clinic will offer “contraception including emergency contraception, on site testing for sexually transmitted infections (STIs), STI treatment, and vaccination.”
There’s an “incredible amount of detail and planning” that has gone into it, she said.
Part of that planning is to create a welcoming environment, rather than a scary “dark alley,” according to Autry. “We hope it’s going to be aesthetically pleasing.”
The organization is also looking into including legal aid, social workers, and therapists in the clinic’s offerings, so that patients “feel well taken care of” from a social standpoint as well as a medical one.
Eventually, PRROWESS will offer clinical services for approximately three weeks out of every month, with the help of “a full team of licensed health care providers” and “an experienced captain and crew,” according to the website.
People are already reaching out to help with the effort, Autry said.
“I cannot undersell or overstate how amazing the outreach has been,” she said, and not just from a financial standpoint.
Grant writers, medical professionals, attorneys and others have asked if they can volunteer or work with the clinic, Autry said. A number of them are from the South themselves, in the states now affected by extreme restrictions.
In striking down Roe v. Wade, the Supreme Court cited “history and tradition.” What exactly does that history look like? To find out, LX News Storyteller Jalyn Henderson talked with Leslie Jean Reagan, who teaches Women and Gender Studies at the University of Illinois – Urbana Champagne and authored “When Abortion Was a Crime.”
The goal for the clinic is to provide care “at little to no cost to the patient, depending on need,” the website says.
That goes for all possible future patients, Autry said, but she’s moving forward with the clinic to serve the people who will be hardest hit by the new restrictions.
“I try to say this in every interview, this is truly for poor people and marginalized patients,” she told NBCLA. “I don’t know that people of money are going to choose to go on a boat to get reproductive health services.”
For people who cannot afford to take three days off work to travel inland to another state, or who cannot afford the plane ticket to do so, she hopes the PRROWESS clinic will “allow patients to get the care that they need within a day,” in a way that is legal to them.
And according to Martin J. Davies, a maritime law professor and expert at Tulane University in Louisiana, the plan will likely work.
Once ships travel more than three nautical miles — just under three and a half regular miles — from the coastline in the Gulf of Mexico, those ships leave the territory controlled by an individual state and enter federal waters, Davies explained.
“Essentially what [the clinic is] relying on, when you’re in that zone, you’re in a geographical territory that’s governed by federal law but not that state law,” Davies said in a phone call with NBC4. “And of course, there is no federal law governing abortions.”
Because states can only apply their laws to territory they control, restrictions on abortion in states like Texas and Louisiana would not apply to a clinic operating in the swath of federal waters off the Gulf Coast.
There might still be a risk of legal challenges against PRROWESS, in the form of constitutional law arguments for “extraterritorial application of legislation,” Davies said.
That would be a lawsuit where states argue that “activity beyond the geographical borders has an impact within their geographical borders,” Davies said, to try and prevent the clinic from operating.
But, with the caveat that he personally specializes in maritime law and not constitutional law, Davies suspects that argument, and the costly legal battle associated with it, would fall flat.
Staying in federal waters is less an ironclad, litigation-proof workaround than, for example, registering the boat in another country and mooring it further out in the Gulf Coast, in the international waters about 12 nautical miles out. But the legal battle over staying in federal waters isn’t likely to go in favor of the states, Davies said.
The other legal risk to PRROWESS would be if states move to criminalize the act of helping someone travel beyond state borders to get an abortion. But according to Davies, that would raise “constitutional law questions” that risk criminalizing other actions related to trade.
“I think [the clinic’s plan] is likely to work,” Davies said.
Even so, Autry and PRROWESS are prepared for any legal challenges that may pop up.
“I don’t think you can underestimate the anti-choice attempt to criminalize this at any point along the way,” she said. “I think we’re just preparing to have challenges.”
And as they prepare for those legal challenges, the people the clinic plans to serve are the priority.
“Our No. 1 goal is to protect the patients – protect their privacy, protect them physically,” Autry said. “It’s unimaginable that to just get services that you need and deserve, that you have to fear for your — anything.”