When states cracked down on gambling in the 20th century, Americans took their money offshore to casino boats in the Mississippi River and along the Pacific Coast. They reasoned that once a vessel was more than 12 nautical miles offshore, it would be outside of U.S. territorial waters—and therefore wouldn’t have to abide by gambling restrictions.
Inspired by these boats, one doctor is betting on these same legal loopholes to set up a floating health clinic in the Gulf of Mexico and offer comprehensive reproductive care, including surgical abortions. It’s not a completely new idea, and it’s not uncontroversial, either: Some wonder whether the idea is more of a performative gimmick than a feasible solution to reproductive care, and there are a slew of legal issues to take into account, too. But all agree that it is the kind of workaround that will proliferate in a post-Roe America.
Meg Autry, an obstetrician and gynecologist at the University of California, San Francisco, founded the nonprofit PRROWESS to build a floating health clinic and provide access to reproductive health care for residents of the southern portions of Mississippi, Alabama, Louisiana, and Texas.
“If you look at people in the southernmost parts of Texas and Louisiana—even if people pay for them—they cannot get to an unrestricted state in a day,” Autry told The Daily Beast. “If you’re a single parent, or a sole caregiver, or you just can’t take time away from your family, or it’s not workable for your life, then this may be the closest, quickest way for you to get care.”
Autry’s plan is to purchase a vessel and retrofit it to clinical standards so that doctors on board can provide everything from STI testing and treatment, to contraceptives, to surgical abortions. Militaries and Mercy Ships have been offering medical care for years at sea. Autry added that there’s no reason to think that procedures “would be more complicated in a clinic on water than a clinic on land.”
Once PRROWESS sources a vessel, Autry predicted it will be able to set sail within a year and provide care for up to 20 patients a day. The boat will be anchored offshore, and patients would have to find their own way of getting to the clinic, which could be up to two hours away by water taxi.
While this vessel could offer a novel way for Americans to access abortions, it’s not an entirely new concept. When Autry first started looking into the possibility of a floating clinic, she quickly learned of Women on Waves, a Dutch nonprofit created in 1999 by physician Rebecca Gomperts which sails “abortion ships” internationally to countries that restrict or ban abortions. Like with U.S. gambling ships, a country’s penal code no longer applies when you sail beyond its territorial waters, so Gomperts’ crew can legally offer abortions by giving patients medication like mifepristone and misoprostol.
Though the abortion ships have provided hundreds of medical abortions total, Gomperts told The Daily Beast that the primary goal of Women on Waves is to draw attention to countries’ abortion bans rather than provide care to as many people as possible. For one, it’s often easier to order abortion medicine and receive it in the mail or via drone than to travel to a port and board a vessel. Moreover, vessels are limited by personnel, space, and climate—it’s hard to keep a vessel afloat during hurricane season, for example, let alone perform an abortion on one.
“I think the project is very valuable in that it really makes the problem—abortion restrictions—visible,” Gomperts said. “In terms of actual abortion access, it doesn’t add a lot to what is existing.”
Still, Gomperts has accrued best practices for other offshore reproductive care ventures over the decades she has operated Women on Waves—the kind of knowledge one can only amass by being sued repeatedly and unsuccessfully by one’s opponents.
Ventures should start small, she said: The bigger the boat, the more hoops that less-than-ecstatic port officials can make it jump through when it comes into port. In her estimation, a fleet of smaller boats would be more cost-effective and harder to detain than a vessel the size of a cruise ship. And a vessel that performs surgical abortions would have to be kept steady during the medical procedures.
Lawsuits against Gomperts’ vessels have thus far not held water in court. Even so, she said that the organization keeps a lawyer on standby during every voyage in case there are problems. “And usually, even though they’re not justified, there will be legal problems,” she said.
Isaak Hurst, the founder and principal attorney at International Maritime Group, told The Daily Beast that performing abortions and providing reproductive care on an offshore vessel is a “captivating idea” but would require quite a bit of specialized legal knowledge to keep it above board.
“It’s most maritime lawyers’ dream, because it requires tremendous amounts of legal work,” he said.
The courts haven’t issued clear guidance on a string of pertinent issues, including transferring people and cargo to and from the vessel; using a middleman like a water taxi service; and engaging in a practice offshore that is legal in one state but criminalized in another.
Hurst said that a key to maritime law is the “flag” of a vessel, or what country it is legally registered in. To skirt any future federal legislation restricting abortion, an organization like PRROWESS would want to register its vessel in a country where abortion will remain unrestricted.
Another wrinkle in Autry’s plan could be the crew: U.S. citizens can be held liable for federal crimes they commit even when they are not on U.S. soil, Mary Ziegler, a University of California, Davis law professor who specializes in reproductive legal history, told The Daily Beast. Though a reproductive health clinic moored outside U.S. territorial waters is likely a safe legal wager for now, a future Republican legislative majority or presidency could criminalize abortion at the federal level. Therefore, Hurst said it would be best to employ a crew from countries where abortions are legal.
Unfortunately, there’s a Catch-22 to the plan since only vessels built and registered in the U.S. with an American crew can freely transport people and goods from port to port without being encumbered by regulations, according to U.S. maritime law. The best bet for a group like PRROWESS is to be upfront and transparent with seeking permission from the Coast Guard—or else become a pirate ship, Hurst said.
Finally, they must also consider how neutral—or biased—a country’s judicial system is, Gomperts said.
“In most of the countries where we did sail to and had court cases, we could rely on judges being neutral,” she explained. “One of the concerns I would have in the U.S. is that there’s not a lot of legal justice.”
Ultimately, the finances and potential legal liabilities don’t make the venture seem feasible to Hurst. “The expense associated with vessels is tremendous,” he said. “Respecting the idea that you want to help as many people as you can while getting a bang for your buck, this would really not be a cost-effective approach to doing good.”
But Ziegler said it might be the only option for those whom a vessel would aim to serve. Some organizations may decide that the benefits outweigh the legal risks and wait and see what consequences will meet them. At this moment, all activism is needed, no matter the risk, Gomperts added.
“I will never tell anybody what type of activism they should or shouldn’t do,” Gomperts said. “I think everybody needs to do whatever they can at the moment, considering the desperate circumstances now, and the many women who are suffering. Anything that can help people find access to health care is useful.”
In other words, it’s all-hands-on-deck.
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