Meeting abortion patients where they are: providers turn to mobile units

LaQuetta Cooper is standing in front of a big, blue RV parked in an industrial lot, across the Mississippi River from St. Louis. It looks much like any other RV out on the road — except for the lettering on the side that reads, “Mobile Health Clinic.”

Cooper, health care operations director for Planned Parenthood of the St. Louis Region and Southwest Missouri, says the vehicle soon will offer abortion pills to patients in Illinois, cutting down their travel times by driving closer to them.

"The biggest needs that we are seeing is the fact that they have to travel so far to get the care that they need," Cooper says. "This will be helpful so they don't have to travel three to five hours."

The RV was delivered this week in preparation for launching in the coming months. Planned Parenthood first announced its plan to develop the unit about a month ago.

Meeting patients closer to where they live

Since the U.S. Supreme Court decision in June overturning the abortion-rights precedent Roe v. Wade, Cooper says thousands of patients have been flocking to the organization's clinic in southern Illinois after their states enacted prohibitions on the procedure.

"I didn't think that other states' [abortion rights] would be overturned so quickly," she says. "Because of that we've seen a huge uptick, quicker than we thought we were going to see, in the last few months."

As a result, Planned Parenthood officials say they wanted to find a way to expand capacity and make it easier for patients in states with abortion bans to reach them. Many struggle to get time off work, find child care, and cover the costs of traveling long distances for appointments.

Planned Parenthood's new clinic on wheels will have to operate within Illinois, where abortion remains legal, but will be able to travel closer to other state lines.

Inside, the clinic is equipped with two examination rooms - including small exam tables and ultrasound machines. It's one of just a few such units nationwide that are set up to provide abortions.

Around the time of the Supreme Court decision, the nonprofit organization Just the Pill quietly began offering abortion pills out of a similar setup in Colorado. Since then, Dr. Julie Amaon, the medical director, says more than 100 patients have received abortion pills from that clinic. She says the ability to move around offers several advantages - particularly in the current legal and political climate.

"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 says." 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 addition to offering abortion pills through the mobile clinic in Colorado, Amaon says her organization offers evaluations through telehealth and prescriptions by mail to patients in several more states.

Shifting rules, shifting strategies

With Roe v. Wade overturned, groups opposed to abortion rights are urging midterm voters to choose candidates who will move to ban abortion in their states.

Reagan Barklage, national field director for Students for Life of America, is based in the St. Louis area. She says she'd like to see lawmakers work to prevent patients in states with abortion bans from seeking the procedure elsewhere.

"I know there's legislators that are working on bills that would prevent women from crossing state lines," Barklage says. "They're trying to come up with different strategies to work on that and also ways that they can prevent women from buying [pills] online."

Balancing safety, security — and the law

Barklage, whose group promotes anti-abortion candidates and legislation through door-knocking campaigns and lobbying at state capitals, says she worries about the safety of patients who take pills at home.

That concern is unwarranted, says Amaon, who notes that medication abortion was approved by the Food and Drug Administration more than 20 years ago, and says her mobile patients receive the same evaluation and follow-up care as other patients at other clinics or hospitals.

Mobile clinics will operate in the same complex legal landscape as other abortion providers, with a patchwork of different laws from state to state, says Dr. Carole Joffe, a sociologist at the University of California San Francisco who specializes in reproductive health.

Joffe describes herself as cautiously optimistic that mobile clinics could help close some of the distance for abortion patients in places with new restrictions.

"The reason for my caution, along with the optimism, is because abortion healthcare is like no other branch of healthcare." Joffe says. "Any move that is made to increase abortion access will be met by those opposed to abortion to try to impede it in various ways."

Joffe also points to security concerns — which may be especially heightened for mobile units.

That's also a worry for Just the Pill, according to Amaon, who says the mobile clinic has hired security personnel and installed bulletproofing in the vans, as a precaution.

"We're looking at the same issues that a brick and mortar [clinic] would," she says. "Where can we park our clinic, where we can feel safe where patients don't have to encounter protesters — or if they do that they have a safe route to get to them."

Amaon says they pre-screen patients before scheduling an in-person visit, and reveal the exact meeting location on the day of the appointment. Planned Parenthood says its new unit is developing similar protocols to protect the safety of patients and staff.

A potential model in a post-Roe world

Dr. Colleen McNicholas, Planned Parenthood's chief medical officer for the St. Louis Region and Southwest Missouri, says she thinks the mobile clinic could be replicated in other parts of the country where neighboring states restrict abortion:

"This unit really truly is, for us, a demonstration of an act of defiance," she says. "We're here, and we're going to be here, and we're going to continue to show up for people who need us."

Planned Parenthood plans to begin offering abortion pills from the mobile unit later this year and surgical abortions sometime next year, focusing on patients in southern Illinois. Just the Pill has purchased a second mobile clinic and is making plans for a third. The group also intends to offer surgical abortions next year, and is looking at expanding from Colorado into Illinois and Minnesota.

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