You’re having an abortion today—that much you know. The pregnancy is about 7 weeks along, and you’ve booked an appointment for a vacuum aspiration procedure. It’ll be quick, simple, and safe. Five minutes, tops. You’re just not exactly sure where the appointment will be, because the clinic is motoring down a highway somewhere, just like you are.
Abortion is now almost entirely banned in your home state of Louisiana, so you and your best friend had to hit the road yesterday, taking turns driving through miles of swampy Southern wetlands before stopping overnight in the Texas Panhandle. You’re about to cross into eastern Colorado, the Rocky Mountains rising into view, and soon, your phone will buzz with a call directing you to your confidential destination: a seemingly random parking lot just over the state line. That’s where you’ll find an unmarked van waiting for you—a fully operational abortion clinic, hiding in plain sight.
It’s clear—from studies and from the lived experiences of pregnant people throughout time—that abortion restrictions do literally nothing to reduce the need for abortion. That’s why Minnesota nonprofit Just the Pill is racing to meet rising demand with something that’s never been done before: converting ordinary commercial vans into a fleet of specially equipped mobile clinics that can roam where and when they’re needed in order to perform first-trimester abortions on the DL.
Its organizers have dubbed the project Abortion Delivered, and for the record, there’s nothing sketchy about it, despite how it might sound. Abortion Delivered vehicles are staffed by experienced, trained clinicians providing 100 percent legal care. The current sociocultural climate just means they have to operate covertly, with key details kept classified. Cosmo was granted special access as the group made its final preparations to deploy the vans this summer and agreed to share only what’s in this article for the safety of all involved.
You won’t see her real name in the press, but Amanda—a pseudonym—is the founder of Just the Pill and the mastermind behind Abortion Delivered. She got the idea for mobile clinics long before the Supreme Court overturned Roe v. Wade in June, after working for years as a patient counselor in a Florida abortion clinic. Inspiration struck when she relocated to Minnesota a few years ago and observed the sprawl and isolation of her new home state. Wow, it’s hard to get an abortion out here, she remembers thinking. Wouldn’t it be great if we had mobile clinics that could drive around and meet patients in need?
Just the Pill got its start (and its name) as a telemedicine provider of abortion pills, the kind hundreds of thousands of people take at home every year during the first 10 or 12 weeks of pregnancy. But Amanda knew that pills aren’t a perfect solution for everyone, that for some people—herself included—a procedural abortion is best. “When I needed an abortion for an incomplete miscarriage, I chose to have a procedure because I preferred to have the process over as quickly as possible,” she says. “If I or someone I love needs another abortion in the future, I want to have as many options available as possible.”
If the political winds shift, Abortion Delivered can start its engines and set up somewhere else, up to the very edge of where the law allows.
She set off on an intense two-year odyssey of research and fundraising. For logistical insights, Just the Pill tapped like-minded groups providing other kinds of in-person mobile health care—groups like Plan A, which provides free services including STI testing and contraceptive care in the Mississippi Delta region. Amanda gathered cost estimates too, which were kind of sobering. Turns out, transforming an empty van into a safe, legal abortion clinic requires at least eight months and a minimum budget of $375,000. It would be a huge undertaking, but it would be faster and less costly than trying to get a brick-and-mortar clinic off the ground. It also had the potential to serve a broader base of people, especially those without access to reliable transportation.
Abortion Delivered was shifting into launch mode when Roe fell—a grim coincidence that accelerated the group’s efforts while setting nerves on edge.
Security was always a top priority, but now it really is. Organizers aren’t publicly revealing what the mobile clinics look like, for one. (Let’s just say you won’t see “Abortion Delivered” painted on the side.) They’re even secretive about the days and hours they’ll be seeing patients.
Basically, unless you’re rolling up for an appointment, you won’t even know if Abortion Delivered is parked in your neighborhood. “Those of us who have been through arsons, who have been through blockades, who have been through Nazis protesting us, we understand,” Amanda says. “We are the experts in our security in a way that even law enforcement is not.” Each single room van will have a staff of at least four: a clinician, a medical assistant, a driver, and a security guard. “It’s a small group of people who have a lot of trust in one another,” Amanda explains. The vans are outfitted with ballistics protection—bullet-proofing, just in case.
Given the extensive precautions, you might wonder how patients themselves will find the vans. The answer, like so many conversations about abortion access these days, is in community organizing. For months, Just the Pill has been quietly building networks with local groups in the regions it plans to visit, informing clinics and abortion fund organizers of the first-trimester procedural support the vans can offer. It’s through this whisper network that patients will plug in with the mobile team.
Here’s how it’ll likely play out: Let’s say you call a clinic seeking an appointment and learn that all the upcoming spots are booked. The clinic worker might say something like, “Well, there could be another option in the next few days with a mobile provider….” From there, you’ll be connected with Just the Pill directly to complete any safety checks and make arrangements one-on-one with the van’s team. (The clinic that connected you won’t be involved.) You’ll learn the van’s exact location shortly before your appointment.
After that, the plan is for a pretty normal patient experience, Amanda says. The scene inside an Abortion Delivered van isn’t much different from what you’d find in a regular doctor’s office. The clinics are ADA-accessible one-room spaces, each outfitted with an exam table, a few chairs, a sink, a fridge, space for all the necessary medical equipment, and a privacy curtain. An in-clinic abortion—and one in an Abortion Delivered van—is a five-minute deal during the first trimester not unlike an IUD insertion. First, the provider uses a speculum to open the vagina. Then, they use an instrument called a tenaculum to hold the cervix in place. Next, they dilate the cervix using small wands. Finally, they place a cannula—sort of like a straw—into the cervix and use a handheld device to create gentle suction, which removes the pregnancy. After a short recovery period of 20 to 30 minutes, you’re good to go.
This efficiency is one reason that many of the growing number of traveling patients are seeking procedural abortions over medication abortion, says Julie Amaon, MD, medical director of Just the Pill. Abortion pills can be an amazing choice for people who have a safe and comfy place to rest, but the medication does come with several hours of intense cramping and bleeding, she explains. If you’re away from home, you have to either find somewhere to lay up after taking the pills or bring the pills back home with you—to a state where abortion care may be prohibited. This could be legally risky, Dr. Amaon says, especially for people of color and other marginalized communities that are more likely to face criminalization.
Digital security is, of course, its own major concern. Personal internet data, including search history and private Facebook messages, have already been used in criminal cases brought against people who have undergone abortion or experienced pregnancy loss. Meanwhile, data brokers have drawn criticism for selling bundles of location data—mined from people’s phone apps—with information on visits to abortion clinics. Just the Pill works with an organization called Digital Defense Fund to develop strong internet safety measures, for itself and for patients.
Given the group’s care in avoiding outside detection, would the van teams ever just…flout the law and barrel into “ban states” to meet patients closer to home? Heroic as that may sound, it’s a hard no: “We abide by every single law in every single state that we serve. Down to the letter,” Amanda says. Which gives them enough to think about as is. The leadership team is in daily contact with pro bono attorneys who help them stay on top of legal developments across states. If and when the political winds shift, Abortion Delivered can start its engines and set up somewhere else, up to the very edge of where the law allows.
Colorado makes sense as a starting point and a proving ground, Dr. Amaon says. The state is already a safe zone for patients traveling from nearby restricted-access regions like Texas and Oklahoma. And Colorado lacks the medically unnecessary clinic regulations that some other states have enacted—burdensome rules, known as TRAP laws, insisting on trivialities like a certain size for janitors’ closets.
Colorado is among 18 states that permit a range of advanced-practice clinicians—not just doctors but also nurse practitioners, nurse midwives, and/or physician assistants—to perform in-clinic abortions, a reflection of the scientific evidence on safety.
Just the Pill isn’t set up to accept insurance yet—it’s working with a consultant to figure that out—but first-trimester abortions will cost only $350, much less than the national out-of-pocket average of $575. Accessibility and inclusion are core to the group’s values, Amanda says. The majority of staffers are bilingual, speaking 9 languages among them, with translation services in place for an additional 15. Fifty-five percent of staff members are BIPOC and at least 36 percent are LGBTQ+.
Each single-room van will provide up to 16 procedural abortions per day. Eventually, the group hopes to have an entire fleet of mobile clinics on the road full-time in Colorado, and it’s eyeing New Mexico, Illinois, and its home state of Minnesota next. Also in the works is a larger abortion bus, with two procedure rooms and a dedicated recovery space. This will allow the group to perform second-trimester abortions as well. It’s some big “can’t stop, won’t stop” energy. Says Amanda, “This is not the time for fear.”
Several other abortion providers have already reached out for guidance on adapting the Abortion Delivered model to their own operations. “We have the ability to be bold and pivot as we learn how to do this,” Dr. Amaon says. “We are laying the groundwork for others to follow.”
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