In this excerpt from her book Access: Inside the Abortion Underground and the Sixty-Year Battle for Reproductive Freedom, author Rebecca Grant details the many ways activists moved to protect abortion access in the months immediately after Roe v. Wade was overturned on June 24, 2022.
One hundred days out from Dobbs, at least 66 clinics across 15 states had closed or stopped offering abortion services. Patients were panicked, as were clinic staff, who simultaneously had to balance their grief, reroute existing appointments, and face the existential dread of the future in a country where they couldn’t do their work because half the population had been reduced to second-class citizens. Some providers had anticipated what was coming and adapted by opening new locations in “haven” states that bordered ones with bans. Whole Woman’s Health and Jackson Women’s Health Organization, the clinic at the center of the Dobbs case, had been in the process of opening new locations in New Mexico when the decision was issued, knowing their Texas and Mississippi clinics would be closed. Planned Parenthood opened a new location in Carbondale, Illinois, to service surrounding areas under bans, as did CHOICES, an independent clinic based in Tennessee. Carbondale had become an oasis of sorts because it was situated in the vicinity of Missouri, Arkansas, Mississippi, Tennessee, Indiana, and Kentucky, and three-quarters of patients who sought care there came from out of state. Trust Women in Wichita, Kansas, which before Dobbs had also provided abortion care at a clinic in Oklahoma, increased the amount of aid it distributed to patients from $30,000 to $40,000 per month in the spring of 2022 to more than six times that — $250,000 each month — by the end of the year.
This level of financing was necessary not only because clinics were seeing a higher volume of patients, but also because the limitations to access enforced by Dobbs were pushing people later into pregnancy before they could get to appointments. This meant procedures were even more expensive and time-consuming, putting a strain on patients, clinics, and abortion funds alike. (Aid programs like Trust Women’s and abortion funds were also instrumental in interrupting this cycle by helping people access care earlier on.) The clinic staff also noticed that more patients were opting for surgical procedures — which only took 15 to 20 minutes, not including travel, wait, and recovery time — even if they were eligible for the medication, out of concern that completing the medication abortion process — which could take a few days — in their home state would put them in legal jeopardy.
To bridge gaps in the new geography, other providers got creative with how they delivered care. The founder of Just The Pill, Julie Amaon, who had launched the telemedicine service in 2020, set up mobile abortion clinics that traveled around rural areas to reduce the distances people had to travel to pick up pills. (Planned Parenthood also established a mobile clinic program.) “We can go wherever the need is greatest, so that means less traveling for our patients, it means that we can quickly adapt to the courts, to state legislatures and the markets,” Amaon told NPR. “I think that having these mobile and pop-up clinics — whatever the next iteration is — is just a thing that we’re going to do . . . to help expand access.”
In an echo of Rebecca Gomperts’s strategy, one American doctor even announced her intention to establish a mobile clinic aboard a ship. Dr. Amy “Meg” Autry had been mulling the idea for years as attacks on reproductive rights had escalated, particularly in the South, where she had grown up. In parts of the country with the strictest gambling laws, there was a long tradition of casino boats that allowed gambling on the water where it wasn’t legal on land, and she wondered if the same principle could apply to abortion care. Autry had not been familiar with Women on Waves at the time, but when she started sharing her idea, people told her to reach out to Gomperts, who herself had once looked into providing care on the Mississippi River and concluded it wasn’t feasible. After conversations with maritime lawyers, Autry arrived at the same conclusion and redirected her attention toward the Gulf of Mexico, which included swaths of federal waters where state law did not apply.
Related: Why I'm Letting Go of Roe v. Wade on What Would Be Its 50th Anniversary
Although she had planned to “creatively” use international maritime law to skirt abortion bans, Autry’s strategy was different from Gomperts’s. Her ambition was not for a short-term campaign, but rather for a vessel that would travel along the Gulf as a permanent option for people in the southern parts of Mississippi, Alabama, Louisiana, Florida, and Texas. Those states had all moved to ban or restrict abortion, and many of their residents lived closer to the Gulf Coast than to the clinics in places like Wichita and Carbondale. Autry began pulling the pieces together she’d need to carry out her vision, and right after Dobbs came down, she announced the formation of PRROWESS — Protecting Reproductive Rights of Women Endangered by State Statutes. Since medication abortion had become so accessible through the mail, she planned to focus PRROWESS’s resources on surgical procedures. The effort would require fundraising to the tune of tens of millions of dollars, but Autry believed it would be worth it by estimating PRROWESS would be able to see 1,800 patients in six months.
In addition to land and sea, the skies, too, were enlisted in the response effort, with an organization called Elevated Access, which offered patients free flights to appointments for abortion and gender-affirming care, on private planes flown by volunteer pilots. People were also trying to lend their support online: across social media, there were offers to host people who traveled for abortion; membership of the “Auntie Network” subreddit exploded, a forum where people seeking abortions could post and connect with assistance from others; and TikTok was awash in content creators discussing the use of various herbal ingredients and oils and teas to end early pregnancies.
Kamyon Conner [the Executive Director of the Texas Equal Access Fund, an abortion fund based in the Dallas area] was glad that people were galvanized about abortion and willing to devote time and money, but at the same time, the frenzy was frustrating. She and her colleagues had been doing this work for years, and although well-intentioned, she found that people who were new to the fight were often unaware of resources that already existed and threw out unworkable and inadvisable suggestions, which sowed additional chaos and confusion. She didn’t want to quell people’s enthusiasm, but it also felt important to explain why she had concerns about the prospect of abortion seekers staying in the homes of random, unvetted internet strangers or why she wasn’t immediately elated when random pilots reached out with offers to transport people on their personal planes to abortion appointments.
It wasn’t that those inventive ideas had no potential to help, but people didn’t need to reinvent the wheel. Rather, she thought they should invest in the existing infrastructure that activists had painstakingly built, year after year, volunteer hour by volunteer hour, dollar by dollar, to connect people with the care they needed. On her podcast “The A-Files,” WeTestify founder [Renee] Bracey Sherman likened it to inexperienced boaters freaking out on board a canoe as it went through rough water: if they kept flailing, the canoe would capsize, when what they really needed to do was sit down, take a breather, and listen to the people who already had a plan so the boat would stay steady.
One way the movement responded was by sharing information about medication abortion as widely as possible: all over the Internet as well as on billboards, the sides of trucks, T-shirts, stickers, banners, TV ads, and more. In the wake of Dobbs, there were a lot of discussions about “not going back” and protestors holding up signs with coat hangers, but the reality was that self-managed abortion looked a lot different than it had in the days before Roe, and thanks to the pills, did not need to be treated as scary and unsafe. In July, just a few weeks after the decision, Bracey Sherman gave testimony in Congress, explaining how abortion pills could be used outside of medical settings — the first time this information had been shared before the legislature:
“It is one mifepristone pill followed by four misoprostol[s], dissolved under the tongue, 24−48 hours later, or a series of 12 misoprostol pills, four at a time, dissolved under the tongue every three hours,” she said. “There’s no way to test it in the blood stream and a person doesn’t need to tell the police what they took. . . . I share that to exercise my right to free speech, because there are organizations and legislators who want to make what I just said a crime.”
