Many women in the U.S. face significant barriers to accessing even routine care. A survey from 2023 found that nearly half of women skipped preventive health services, such as wellness check-ups or screenings, due to factors like high out-of-pocket costs and difficulty securing appointments. Additionally, gaps in preventive care coverage and awareness persist, with uninsured and lower-income women being particularly affected by these barriers. This shortage in access, combined with logistical and financial challenges, has led to a substantial number of women forgoing routine care despite health policies that were intended to expand access, such as coverage requirements under the Affordable Care Act. These policies have contributed to a system awash with red tape and price controls that contribute to the broader issue of health inequity across the country.
Medical research has historically focused on male bodies and only recently are doctors paying attention to the ways that disease presents differently in female biology. The recent acknowledgement of the unique needs of girls and women is not enough. Research shows that women and girls still have a lower quality of care than their male counterparts.
In addition to the care gap, women and girls lack adequate access to pap smears, mammograms, and maternity care for all stages of pregnancy.
Using the tools and techniques being developed by TSI and its partners, entirely new ways to serve girls and women can be leveraged to satisfy both current and growing needs. That need is predicted to grow faster than population growth. At least some of these statistics are driven by the loss of hospitals and clinics in rural communities and a shortage of doctors and RNs, forcing longer and longer commutes to reach care.
Healthcare in the United States is already the most expensive in the world while only coming in a distant second or third place when it comes to the quality of health outcomes. That is to say, American women spend substantially more for their healthcare than do their peers in the developed world while enjoying a substantially lower quality of outcomes based on both objective and subjective criteria. The gap is widening even while it becomes more costly.
Healthcare, and more specifically providing healthcare to those who lack access to a hospital or clinic with the services they need is one of the eight great moral imperatives of seasteading, one of which includes healing the sick.
In the context of women’s health, this includes offering medical services to girls and women efficiently, cost effectively and reliably.
A Nonpolitical Solution
Imagine a place where girls and women can go for cost-effective, timely services close enough to population centers but far enough away to be outside of state or federal jurisdiction. It would be a place where the focus would be on the patient, and only on the patient. A forty-five minute boat ride could bring them from the coast to the location, the cost covered as part of the visit.
The concept being described in this post isn’t entirely unique. Medical ships accomplish similar missions in providing healthcare where it is either not available or is inadequate. The primary difference between the new approach we’re proposing here and what already exists is that medical service ships are by their very nature mobile and operate on a schedule. As such, medical ships spend a few weeks at a particular location and then move on. A floating artificial island built to provide women’s wellness and care would be semi-permanent and anchored to the sea floor in international waters at a fixed location. It would only be moved if it became necessary to do so.
The Nexus Between Womens’ Reproductive Rights and The Care Gap
As women’s reproductive rights have been pushed into the political spotlight, many states have chosen to enact legislation that either prohibits or severely restricts access to safe, legal termination of pregnancies. However, the specific medical services that are needed to safely end a pregnancy remains a necessity in a wide variety of circumstances that aren’t accounted for in the legislation now on the books in many states. The legal restrictions have made it difficult for doctors to determine when to give care, resulting in the preventable deaths of girls and women.
With such an important and fundamental right at issue, solutions will be proposed by those with the courage to act. The seasteading solution proposed here benefits from being outside of territorial boundaries and in some circumstances might be the only alternative available in regions where the option to terminate a pregnancy, according to a legislatively set timeframe and other circumstances, exceeds the parameters outlined in the statute.
Despite efforts in many states to restrict access, the rate at which pregnancies are being terminated has remained roughly the same year over year, though updates to existing laws and entirely new laws might further restrict access and close the remaining avenues available to girls and women seeking a legal, safe and effective method, whether that be via pills delivered through the mail or via out of state service providers.
While mail-order pills are a loophole that may prove difficult for legislators to completely close in states that have banned or heavily restricted access to safe, legal methods of terminating a pregnancy, there remains a need for more traditional procedures beyond those supplied by a pill which are effective only in the first few weeks of pregnancy when a girl or woman first becomes aware they’re pregnant. In instances where a pill is no longer safe or effective, and where suitable facilities and practitioners in proximity to a patient’s domicile are unavailable, an alternative remains a critical component to providing whole patient care.
There will always be a need for places where a patient can receive the services she needs and where a practitioner can focus on their patient without fear of losing their medical license or facing arrest and imprisonment for performing a medical procedure.
A legal gray area remains for individuals or groups who transport patients to the location where they will receive treatment in some states, but there are methods that have been developed to control those risks. Practitioners, advocates and concerned family members have found ways to transport patients safely to where they can receive treatment without running afoul of local and state law, though this post will not delve into the details nor the legalities. Many of the laws in some states that criminalize or invoke civil penalties to prevent transport of patients out of state are subject to change and many of these same laws are being challenged in court.
What is the seasteading solution?
A floating “village” of comprehensive, mutually supportive services will provide cost efficiencies for both the medical provider(s) and spread the associated costs of upkeep for the infrastructure in a manner similar to some medical pavilions.
The underlying structure could be any number of vessel types, including repurposed cruise ships or freighters, or it could be a purpose-built platform specifically built to accommodate medical suites and temporary housing. More advanced designs might even include a cluster of independent floating structural units connected together to facilitate a modular, success-driven approach to grow the facilities over time.
Beyond ordinary OBGYN types of services, additional services and specialities might also be offered under the same roof, including a wellness retreat replete with a spa, classes, and accommodation spaces outfitted to be more like a hotel than a cold, sterile hospital bed. This is similar to Prospera in Honduras which offers medical innovation in the area of regenerative medicine. A medical seastead could offer a high degree of innovation in women’s medicine.
Prospera is a ZEDE (Zone for Employment and Economic Development), a territory set aside by the Honduran government that’s able to create its own civil code, although it is still subject to the federal criminal laws of Honduras. Similar projects to Prospera might be emerging soon in Africa as part of the Prospera Africa initiative.
While successful on many fronts, the autonomy of Prospera in Honduras is under threat by the current president of Honduras for political reasons. In similar circumstances, a seastead would have the ability to float away (or be towed away if not self-powered) and moved to a location where it can continue its mission.
What really makes a women’s health center on the sea feasible though is its people: coordinators, administrative staff, nurses and doctors who understand what girls and women need and the challenges they faced before finding their way to an ocean-borne medical facility. These facilities will be located off of a coastline but within a reasonable distance to a large metropolitan area, places where similar services are either not offered or are prohibitively expensive, are difficult to access or are inadequate.
Financial assistance could be offered when sources of funding can be secured to cover the operational costs for serving patients facing financial challenges.
How to build healthcare seasteads?
The form a medical services seastead takes, whether that be via a re-used cruise ship, a freighter, a floating hotel or “floatel” similar to those providing accommodations to oil extraction platforms, or a purpose-built hospital seastead, is actually much less important than the financial model that makes such a project possible. TSI is busy developing an approach for classifying, insuring and flagging such a vessel for the open ocean as you read this, while the market already provides a mechanism for interested parties to pool resources to accomplish a common goal.
Re-use of an existing ocean-going vessel would be easier than starting from scratch with an unproven design to attract support from institutions and investors. Indeed, cruise ships, freighters and floatels have been around for more than a century and the technologies and methods used to construct and maintain them are mature and well understood.
The focus of a medical service seastead will not be to push the envelope on novel designs for oceanic construction, but to put the focus where it belongs: the quality and value of medical services provided to girls and women for all stages of life.
A coalition of medical equipment vendors, pharmaceutical companies, individual practitioners, and investors could raise the necessary capital to acquire, refit and renovate some form of existing vessel to provide the desired suite of services as the market continues to develop. Accounting for the maintenance of such a vessel, a feature that would be unique to a medical seastead compared to a land-based medical office building, is a well-known quantity with respect to medical relief vessels, floatels, cruise ships and freighters, all of which already exist. There is thus very little novelty to be found in the droll details of the portion of the facilities that keep it floating on the waves.
Precedence
Around the globe, there are many examples of mobile medical services whether that mobility is facilitated by air, highway, railroad, or via a hospital ship.
Hospital Trains
During the American Civil War, there were hospital trains equipped with beds and operating rooms that could be brought near the front lines to render care to soldiers on both sides of the conflict. In some parts of the world where rail lines exist even when roads do not, such medical trains continue to be used and have been found cost effective to operate. They will continue to be an important tool when population centers are far inland and counted in the figures in the thousands rather than the hundreds of thousands and where towns and small cities are located many hundreds if not thousands of miles apart.
Hospital Ships
In the early part of the 20th Century, medical ships were built to support the war effort, and by mid-century these vessels were a fixture of the support and logistics of the war effort during WWII with many more medical ships serving across the globe. In the post-war period, such medical ships have continued to play an important role during peacetime operations, including during the COVID19 pandemic.
Mobile Doctors Without a Fixed Presence
In the later half of the 20th century, Doctors Without Borders organized volunteer practitioners to help contain the outbreak of infectious disease, provided aid during and after regional conflicts and natural disasters, providing basic care including dentistry, optometry and gynecological care to patients who may never have had access to a doctor before.
Mobile Clinics
In the rural United States and in many parts of the world, both developed and developing, medical buses bring services closer to people living outside of major metropolitan areas where a regional hospital or clinic isn’t always available.
Flotillas of Medical Relief Ships from Small To Large
Increasing interest has been shown globally by both private organizations and by government agencies tasked with disaster relief to purchase more medical ships for providing medical relief services after major events such as natural disasters. Such vessels can provide a mobile base of operation for medical personnel, transport of supplies and equipment to where those services are most needed and do so much more economically than by almost any other means.
Future Opportunities
While mobile medical services have experienced an explosion in interest recently, particularly for over-land medical trucks and buses, a significant, if more limited number of medical ships traversing rivers and visiting ports near major cities across the globe have climbed.
The mobility of these services provides access to treatment that might otherwise have been completely absent, but for all the benefits, mobile services by their very nature are limited in the amount of time where they can offer their services to patients at any particular location. The schedule might call for only a few days or as long as several weeks before they leave the site, and when they depart, they leave a care gap that might last many months or even years before the mobile medical services return to that same location again.
Mobile medical services have demonstrated that the need continues to grow. The number of mobile medical service options that exist also demonstrates that the gaps these solutions are trying to fill remain much too large. While suitable for routine care on an annual basis, there is no mobile service which can adequately provide urgent care, let alone emergency care.
A medical services ship must make scheduled stops, confining how long they can remain at port before it must move on knowing that some patients will not be rendered service within this confined time window and may even require care be prioritized. This is not a problem found with a semi-permanent medical seastead solution.
At some point, and no matter how well financed or staffed, each of these mobile medical service offerings, by the very nature of the service, will have to move locations, replenish supplies and rotate personnel. The logistics network behind these services is impressive, though more could be done to improve on what’s already been achieved.
A mobile services vehicle, such as a bus, train or ship, can have difficulties in replenishing their supplies, replacing exhausted medical professionals and servicing or replacing vital equipment on missions lasting many months. Maintaining a bus or ship while it is still underway is difficult if not impossible without taking a mobile vessel out of service.
By contrast, semi-permanent seasteads have much more predictable supply chains and the points of ingress and egress for supplies, personnel and patients will be well-established. In-situ repair of a vessel at anchor, or as with a seastead, tethered to the seafloor, is made possible by specialists who already exist that provide such services to vessels in the shipping (transport) industry, oil and gas industry and fishing industries. There would be no need to take the unit out of service for routine maintenance as a result.
Unlike a mobile medical ship, the seastead won’t likely be pulling up anchor and leaving untreated patients behind. To make a medical seastead possible, the primary barrier to entry is the classification process, insurance coverage and flagging. All of the technologies needed to make it possible are mature, and the success of the venture requires nothing new in terms of finance or technology. The human species has been making things float for longer than the written word and medical doctors have existed since the earliest human civilizations in Africa, South Asia and West Asia.
Medical seasteads will emerge near major cities in the coming years as the provision of services is further stretched and accelerated by the imposition of new rules on practitioners. Medical seasteads will reduce the pressure on existing but overburdened facilities, and could potentially provide new kinds of care and services in addition to the routine care.
While there are no easy solutions to situations in which there simply aren’t enough doctors and nurses to go around, providing the facilities for those professionals is an important first step. Leveraging medical staff from abroad without the need for H1B visa status provides yet another opportunity to solve the compound challenges described throughout this post. Improvements in the visa process for foreign-trained doctors is already underway to solve the growing gap in general practitioners and specialists, but progress through state and federal legislative bodies is slowed by political agendas that very often don’t consider improving health outcomes the priority.
Many, if not most of these challenges can be solved by placing medical professionals in a more advantageous position, one that is close to a population center while maintaining sufficient autonomy to perform their function without undue and unwarranted intrusion into the care they provide to their patients.
For medical professionals to be effective, a medical seastead offers a way to reduce the burdens imposed by shifting political winds affecting outcomes for patients, drives down the cost of care and unfetters the kinds of care that practitioners are able to offer their patients.
The future of medical services providing specialized care to girls and women might be floating off a coastline near you in the not too distant future.
CITATIONS
- “The Eight Great Moral Imperatives,” The Seasteading Institute, https://www.seasteading.org/the-eight-great-moral-imperatives/
- “Will there be medical services?” The Seasteading Institute FAQ, https://www.seasteading.org/faq/will-there-be-medical-services/
- Health Outcomes and Cost – Comparing the United States to its Peers
Jacqueline Howard, “US spends most on health care but has worst health outcomes among high-income countries, new report finds,” CNN Health, January 2023, https://www.cnn.com/2023/01/31/health/us-health-care-spending-global-perspective/index.html - Emma Wager, Imani Telesford, Shameek Rakshit, Nisha Kurani, and Cynthia Cox , “How does the quality of the U.S. health system compare to other countries?” Health System Tracker, October 9, 2023, https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries
- Emma Wager, Matthew McGough, Shameek Rakshit, Krutika Amin, and Cynthia Cox, “How does health spending in the U.S. compare to other countries?” Health System Tracker, January 23, 2024, https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/
- “Our Mission,” Mercy Ships, https://www.mercyships.org/our-mission/
- “Find your place on board,” Mercy Ships, https://findyourplace.mercyships.org/
- Katherine Weber, “Mercy Ships Founder on Restoring Dignity, Health to Women Suffering From Obstetric Fistula,” Christian Post, May 23, 2013, https://www.christianpost.com/news/mercy-ships-founder-on-restoring-dignity-health-to-women-suffering-from-obstetric-fistula.html
- Eva Grey, “Mercy Ships: a floating hospital for the world’s poorest regions,” Ship Technology, March 2, 2016, https://www.ship-technology.com/features/featuremercy-ships-a-floating-hospital-for-the-worlds-poorest-regions-4803594/
- Doctors without Borders, https://www.doctorswithoutborders.org/
- “Tales of women at sea” (blog), Doctors without Borders, March 8, 2023, https://www.doctorswithoutborders.org/latest/tales-women-sea
- Friendship (Friend-Ship, AKA Ship of Friendship), Friendship hospital ship, https://friendship.ngo/what-we-do/saving-lives/
- Rachel Treisman, “A floating abortion clinic is in the planning stage, and people are already on board,” NPR, Updated July 20, 2022, https://www.npr.org/2022/07/19/1112219566/floating-abortion-clinic-roe-v-wade
- Christian Cauterucci, “If You Can’t Get an Abortion on Land, Can You Get One on a Boat?,” Slate, July 14, 2022, https://slate.com/news-and-politics/2022/07/abortion-care-boat-gulf-of-mexico.html
- Lauren Leffer, “The Future of Abortion: Floating Clinics?” Gizmodo, July 11, 2022, https://gizmodo.com/abortion-floating-clinics-roe-v-wade-gulf-of-mexico-1849163735
- Kelsey Butler, “Abortion at sea? Advocates in the U.S. get creative to protect access,” The Japan Times, July 15, 2022, https://www.japantimes.co.jp/news/2022/07/15/world/abortion-floating-clinics
- Women on the Waves (WoW), an organization founded in The Netherlands in1999, has designed and constructed the A-Portable and hired a ship to carry their services and their messages to women in need around the globe. https://womenintheworld.org/solutions/entry/women-on-waves/
https://www.womenonwaves.org/en/ - Nathaniel Weixel, “Report shows steady increase in abortions in states with bans,” The Hill, October 22, 2024, https://thehill.com/policy/healthcare/4947876-report-shows-steady-increase-abortions-in-states-with-bans/
- Role of International Organizations
https://www.chathamhouse.org/2023/10/un-must-coordinate-field-hospitals-and-hospital-ships-gaza - Mobile mammography in Florida
https://www.cdc.gov/breast-cervical-cancer-screening/features/mammograms-in-florida.html
