Abortion care on wheels

By: - June 11, 2022 3:00 am

People attend a “Fight4Her” pro-choice rally in front of the White House at Lafayette Square on March 29, 2019. (Astrid Riecken/Getty Images)

As the nation braces for a decision that could come any day from the U.S. Supreme Court ending federally protected abortion rights — and making abortion a crime from the earliest stages of pregnancy in some states — women’s health care advocates have been thinking outside the box about ways to protect abortion access.

Here’s one idea: Mobile abortion clinics in bullet-proof vehicles could patrol the borders of states where abortion remains legal, serving patients who cross over from the 26 states where abortion has been criminalized.

Sound far-fetched? The effort is already underway.

Dr. Julie Amaon is the medical director of Just the Pill, a nonprofit, online clinic based in Minnesota that dispenses pills for medication abortion, birth control and the treatment of sexually transmitted disease. Just the Pill, which has experimented with offering patient care in mobile clinics, is working on a big expansion. Through a collaborative effort with like-minded colleagues, other women’s health organizations and private donors, Just the Pill aims to get a fleet of vehicles on the road with the ultimate goal of running mobile clinics in every state where abortion remains legal, bringing patients across state lines to access both medical and surgical abortion.

Amaon grew up in Texas and managed a Planned Parenthood clinic in Austin for four years in the early 2000s. “Planned Parenthood was having to fly in providers from the coasts, because nobody wanted to work in Texas, just because of the volatility and the protests,” she says. To help fill the void, she decided she wanted to become an abortion provider herself, going back to school to become doctor at the age of 35.

“I’m a person in my life that has decided I did not want to have children,” Amaon says. Her own mother had raised two small children while working full time and studying at night. “She worked herself to the bone,” Amaon recalls. “It’s hard being a parent. It’s hard work financially and mentally. You want to be ready. That really stuck with me.”

“There are a lot of different reasons why people choose not to have kiddos,” she adds. “They have health issues; they’re not financially ready; they’re not mentally ready. There are so many reasons. And so I think it’s important to be able to control your own fertility and control your own body. That’s something that has always been super important to me.”

Perfect timing for pandemic

Just the Pill’s model — seeing patients via telehealth appointments and providing medication through the mail — was perfectly timed for the pandemic. The effort was aided when a federal district court in Maryland ruled that the Food and Drug Administration had to suspend a rule requiring patients to go in person to a hospital or clinic to pick up the FDA-approved prescription drug, mifepristone, which is used in combination with another drug, misoprostol, to safely end early pregnancies. The court found that the requirement was onerous, unnecessary and exposed patients to an unreasonable risk of contracting COVID-19 by forcing them to pick up pills in person, even though the FDA had deemed the medication safe enough that they could take it by themselves later in the privacy of their own homes.

Amaon saw patients for telehealth visits, and Just the Pill sent the drugs to them through the mail. Then, in January 2021, the U.S. Supreme Court overruled the federal district court, allowing the FDA to restore the in-person visit requirement.

“So we actually rented a mobile clinic and drove around like 1,200 miles every week distributing pills in-person for people,” Amaon recalls.

She and her executive director took turns driving the vehicle. Then, in March, the FDA made sending pills through the mail legal again.

As they drove around Minnesota, Amaon says, she noticed she was seeing a lot of patients from Wisconsin, North Dakota, South Dakota and Iowa — “people who have more restrictive legislation in their states.”

Minnesota requires a 24-hour waiting period between appointments before someone can have an abortion. But the first visit doesn’t have to be in-person. So patients would cross the border to have a 15-minute conversation with Amaon on the phone and get their pills delivered to a general delivery address at a Minnesota post office or to a UPS or FedEx dropoff location. “That’s how we were kind of serving our surrounding states that had more restrictive laws,” says Amaon.

The organization began providing services in Montana, so they could serve surrounding states. Last December, the group expanded to offer medication abortion in Wyoming. 

Overwhelmed providers

Cynthia Lin, a board member of the Women’s Medical Fund, one of the oldest abortion funds in the nation, is impressed with Just the Pill’s work. Since 1972 the organization has helped pay for abortion care for Wisconsin patients and educates and organizes for abortion access. “I think their focus on offering streamlined approaches to medication abortion, leveraging telehealth, especially with the opening of mail options that were made possible at the beginning of the pandemic and now solidified, is a really important and crucial contribution to the spectrum of options that we need,” says Lin.

Just the Pill will provide crucial backup for providers, she added, in less restrictive states that are preparing for a flood of out-of-state patients from places where abortion is outlawed after the anticipated Supreme Court decision.

In general, says Lin, abortion providers and supportive groups have been working together to figure out how to sustain abortion access and help patients overcome logistical hurdles, including funding and transportation. “There’s just a lot more partnership and connecting of dots happening,” Lin says. “Just the Pill exists at the intersection of both offering direct access as well as funding support and partnering with other funds to be able to get people access.”

Long before Justice Samuel Alito’s draft decision overturning Roe v. Wade was leaked, Amaon and her colleagues at Just the Pill were talking about what would come next.

After the Supreme Court heard arguments in Dobbs v. Jackson Women’s Health Organization, the Mississippi case that challenges the precedent set by Roe, “We knew that Roe was going to fall,” Amaon says. The group discussed which states would lose abortion access. 

An anonymous donor kicked in funding so Just the Pill could purchase two mobile clinics — one to provide surgical abortion procedures and one to dispense medication abortion pills.

Just the Pill decided to deploy its new vehicles in Colorado because of the state’s less onerous regulations on clinics and pharmacies. The first medication mobile clinic is scheduled to be on the road in June, and the procedure clinic will follow within a few months. 

The organization plans to deploy mobile clinics on all sides of Minnesota. Amaon, the only physician on staff, is currently covering Minnesota, Montana and Wyoming. Just the Pill has been recruiting new clinicians and medical assistants in Colorado.

Evolution of care

As it continues to make connections in new states, Just the Pill plans to work with local health care providers, including providers from Wisconsin, who cross the border to work with the group in Minnesota.

“Just the Pill is an interesting example of an organization that has addressed this need to expand abortion care delivery,” says Jenny Higgins, a family planning researcher at the University of Wisconsin-Madison.

She sees the organization as part of an evolving view of reproductive health care that has moved from an era when only licensed doctors are allowed to provide abortion to a research-based understanding that nurse practitioners are just as capable of providing abortion safely. “The rise of telehealth has been a huge change in the way health care is delivered for many different services, including abortion care,” Higgins says. “I think what Just the Pill is capitalizing on is not just the shift to telehealth, but also this need at times to be able to be physically mobile versus a brick and mortar clinic.”

“The delivery of medication abortion care at Just The Pill follows the same clinical guidelines and standards as any other licensed abortion provider,” says Higgins. “The main difference is that their physical place of service moves around.”

Like Lin, she sees Just the Pill as part of an increasingly collaborative reproductive health care network.

Just the Pill advertises its telehealth services through Google ads, and 85% of patients who use its telemedicine and pills-through-the-mail services find the group online, Amaon says. 

In Colorado, the group is piloting a new model, working with funders and clinics in restrictive states to refer patients and help them with travel and other logistics. “We’re kind of trying to do a group travel model where we have a group of people coming from out of state for one day,” says Amaon. Clinics in restrictive states can provide initial services like blood work and ultrasounds, making the process more efficient.

Bulletproof clinics

Just the Pill won’t announce ahead of time where the mobile clinics will be. 

“All of our mobile clinics are bulletproof,” she adds. Just the Pill is working with a network of community organizations that are comfortable having the clinic park on their property. Each location will be disclosed only to patients, and the clinics will move around, Amaon says, “and never be in the same place more than once a month.”

The vehicles are unmarked. Each mobile unit has a sink, chairs and an exam table with a curtain that can be drawn around it. 

While Just the Pill has become adept at dispensing medication abortion from vans, the group will use an RV to do surgical abortions. 

Amaon has performed early trimester abortions in bricks-and-mortar clincs. But Just the Pill would be the first group in the United States to offer them in a mobile clinic. 

In the one-room procedural clinic, the group could handle 12 abortions per day. The medication van can serve 40-50 patients per day.

Among the states on the list for expansion in the next phase are New Mexico and Illinois, along with Pennsylvania and Virginia.

“If we can prove this model of group travel and meeting once or twice a week in different areas of the state,” Amaon said, “we hope to expand to all the safe states in the future with a fleet of mobile clinics.”

This article first appeared in the Wisconsin Examiner, a sister site of the Nebraska Examiner in the States Newsroom Network.

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Ruth Conniff
Ruth Conniff

Ruth Conniff is Editor-in-chief of the Wisconsin Examiner. She formerly served as Editor-in-chief of The Progressive Magazine where she worked for many years from both Madison and Washington, DC. Shortly after Donald Trump took office she moved with her family to Oaxaca, Mexico, and covered U.S./Mexico relations, the migrant caravan, and Mexico’s efforts to grapple with Trump. Conniff is a frequent guest on MSNBC and has appeared on Good Morning America, Democracy Now!, Wisconsin Public Radio, CNN, Fox News and many other radio and television outlets. She has also written for The Nation, The New York Times, The Washington Post, and The Los Angeles Times, among other publications. She graduated from Yale University in 1990, where she ran track and edited the campus magazine The New Journal. She lives in Madison, Wisconsin with her husband and three daughters.