SAN FRANCISCO — After three decades providing obstetric and gynecological care, Dr. Amy “Meg” Autry isn’t certain of what will come next for federal abortion rights, but she’s sure of one thing: Residents in half the country will need as much access as possible — by air, land or sea.
Autry’s vision has taken her to the last of those frontiers, as she thinks through how her new nonprofit could one day facilitate abortions and other reproductive health care services aboard a vessel in federal waters, off the coasts of states where the procedures are now banned following the Supreme Court’s decision to overturn Roe v. Wade and end federal abortion rights that had stood for nearly 50 years.
It’s a novel idea with all sorts of inspirations, including riverboat casinos depicted on the Netflix series Ozark, as well as Autry’s own experience delivering abortions in both Wisconsin and now at UC San Francisco.
”I’ve had the idea for a long time,” said Autry, a UCSF doctor since 1993. “This past month has been jarring — there’s just this sense of disbelief. I grew up hearing stories about self-induced abortions … a lot of poor people are going to die if they don’t have access.”
Autry’s nonprofit, PRROWESS — Protecting Reproductive Rights of Women Endangered by State Statutes — is already seeking donations, with a preliminary goal of raising $20 million.
She has yet to nail down key details about her proposal, including the type of vessel she’ll use or how pregnant patients in states such as Texas and Louisiana would travel several miles out to sea into the Gulf Coast to reach the aquatic clinic.
And although Autry believes it’s currently too expensive and time-consuming for lower-income abortion-seekers to fly into states where the practice is legal, there isn’t immediate evidence that her idea is more viable — or how providers, and pilots who ferry the women to floating clinics, would avoid arrest and prosecution. Most states have jurisdiction over waters 3 miles offshore, and Texas and Florida even farther at 9 miles, so any vessel would have to be located in federal waters, which can be rough seas.
She does have seed funding from friends, though she declined to say how much. She has also hired a team of lawyers, including those specializing in maritime law. That’s enough for Autry to begin planning how she could one day provide reproductive care safely, cheaply and legally to women and others who need it.
“There are junctures on our journey where this could fall apart at any point,” Autry said in an interview. “We’re in uncharted territory here — we could get into the (Gulf of Mexico) and be shut down immediately.”
If her plans go south, she promises to donate all the money raised to nonprofits that support abortion access. In the meantime, she hopes someone out there might be willing to gift her a boat for the cause. And while there’s no timeline yet for setting out for sea, Autry’s dream is to have a buoyant facility ready to go within the next year.
PRROWESS intends to hire a robust security team that would protect the vessel from hostile actors, including pirate ships. But the bigger threat in states with trigger laws could be law enforcement, especially if those states start cracking down on abortion providers.
How, for instance, would someone navigating a boat taxi that transports a patient out to the group’s vessel avoid criminal charges upon returning to harbor? Would the clinic’s crew members find themselves in legal hot water if they need to come to shore?
One of Autry’s lawyers declined to get into the specifics of those questions, citing attorney-client privilege, but said she is confident the operation would be legally airtight.
“We’ve been working with Dr. Autry and PRROWESS and consulting with maritime lawyers to make sure everything that’s going to be done is safe and lawful,” said Tanya Pellegrini, an attorney with the national Lawyering Project, which works to improve abortion access.
Pellegrini said the team is looking to cruise ships that offer health assistance to passengers who need it, noting that “having medical care on a boat or a mobile clinic isn’t new — that’s been going on for a long time.”
Indeed, PRROWESS’ plan has been tried elsewhere: Women on Waves, a Dutch nonprofit founded in 1999, provides abortions off the coasts of countries with restrictive abortion laws, including Mexico, where the practice wasn’t decriminalized until 2021.
Similar to Autry’s idea, Women on Waves travels to international waters about 12 miles off the coasts of these countries. Patients make a roughly two-hour journey out to the ship on sailboats, where they are given abortion pills (but not the surgical procedure) and contraceptives, according to the organization’s website. The group has drawn intense anti-abortion protests in the countries where it operates.
Rebecca Gomperts, the nonprofit’s founder, told Business Insider this week that Women on Waves won’t begin offering the procedure to people in the U.S. until there’s more data available on how new restrictions in states with trigger laws are impacting abortion access.
Autry, who is licensed to provide reproductive care in California, said she will partner with existing nonprofits that subsidize travel costs for those seeking abortions. Aquatic health clinics have been employed for years by the military and various relief organizations, the group notes in its website’s FAQ section.
These days, Autry’s patients at UCSF tend to be “privileged, because they know they can get the services they need,” she said. But as an abortion provider two decades ago in Wisconsin, she saw just how difficult it is for lower-income people in more conservative communities to receive reproductive care.
“My house was picketed, people refused to work with me … a few times, my family members were accosted at the zoo,” she said. “When you’re talking about places that are hostile to reproductive rights, it’s a real danger out there.”
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