Dozens of states have stripped away access to abortion, sending reproductive health providers scrambling. Some clinics are going mobile, hoping the flexibility of being able to relocate along the edges of states with bans or severe limits on abortion will reduce expensive and time-consuming burdens on patients forced to travel hundreds of miles for healthcare.
Decoupling from brick-and-mortar locations should allow mobile clinics to go wherever need is greatest, as providers try to adapt to the quickly shifting map of abortion access in the U.S. In some states, the procedure’s legality has flipped multiple times since last month’s Supreme Court decision in Dobbs v. Jackson Women's Health Organization.
Abortion access nonprofit Just the Pill plans to build a fleet of mobile clinics offering mobile procedural abortion “for the first time in U.S. history,” the nonprofit said.
The program, called Abortion Delivered, is in response to patient demand, which spiked following the Supreme Court’s decision to overturn Roe v. Wade. Just the Pill normally receives between 20 and 25 requests for abortion pills per day from patients. But in just the three days following the Dobbs decision, it had more than 260.
Just the Pill, which was founded in 2020, provides reproductive healthcare in Colorado, Minnesota, Montana and Wyoming. Some of their services include medication abortion, which typically consists a two-pill regimen of mifepristone and misoprostol.
The group currently operates two mobile clinics in Colorado and plans to build out its network of vans and deploy them in states where abortion is legal but surrounding states have banned the procedure, such as New Mexico, Pennsylvania and Illinois.
“Our mobile clinics will travel to parts of these states based on where the need is greatest,” Julie Amaon, medical director of Just The Pill, told Healthcare Dive.
Just the Pill’s long-term plan is to operate 30 clinics around the U.S., with timeline depending on fundraising, Amaon said.
One van, which is currently being retrofitted to serve Illinois is Just the Pill’s biggest yet, with two exam rooms plus a recovery room. It cost more than $500,000.
The mobile clinics, which provide contraception in addition to abortion care, are also bulletproof.
Mobile health clinics have been held up as an avenue to cut costs and expand healthcare access, especially in underserved or marginalized communities. One 2009 Boston study found that a mobile health clinic, The Family Van, had a return on investment of $36 for every $1 invested in the program. Mobile clinics can also provide primary and preventative care, an important feature given that many regions in the U.S. lack healthcare access.
Currently, there are an estimated 2,000 mobile clinics in America, providing almost 7 million visits each year.
“Mobile clinics remove three of the major barriers to care: distance, time and cost,” while also building trust within specific communities, said Mollie Williams, executive director of The Family Van, a mobile health clinic associated with Harvard Medical School that does not provide abortion services.
“With the pandemic and the recent changes around laws in access to abortion, it really has heightened this trust barrier,” Williams said.
Advocates are hoping the mobile health model can provide an alternate portal to the healthcare system for medically disenfranchised patients lacking access to abortion services due to their state of residence.
Currently, 15 states have bans on abortion before the Roe fetal viability line of 24 weeks of pregnancy, according to a Healthcare Dive tracker.
The Dobbs decision has resulted in patchwork abortion access in the U.S.
Reproductive health providers Hey Jane and Choix also have geographic and clinical expansions in the works following Dobbs.
One-year-old Hey Jane provides medication abortion in New York, California, Washington, Illinois, Colorado and New Mexico. The provider saw site traffic grow tenfold and patient demand more than double after the Supreme Court’s decision, spurring business expansion plans, CEO Kiki Freedman told Healthcare Dive.
Choix, which was founded in 2020 and provides medication abortion in California, Colorado, Illinois and New Mexico, experienced a 600% increase in web traffic the day Roe fell, and continues to see higher than normal traffic, CEO Cindy Adam said.
Choix is focused on adding more providers to its team, and plans to expand to every state where abortion is legal by the end of 2023.
Pills, which can be prescribed in other states and sent back to a patient’s home (or another address), are an important mechanism for continuing access to safe abortions, advocates say. The pills, which have been approved by the Food and Drug Administration for more than two decades, currently make up more than half of all abortions.
Conservatives have zeroed in on restricting abortion pills and the use of telemedicine to prescribe them as a next step in the anti-abortion campaign. Currently, 19 states already require clinicians providing medication abortions to be physically present, according to the Guttmacher Institute.