MARQUETTE, Mich. \u2014 Providing abortions was the last thing Shawn Brown thought she\u2019d be doing when she opened an urgent care clinic in this remote town in Michigan\u2019s Upper Peninsula.<\/p>\n
But she also wasn\u2019t expecting the Planned Parenthood in Marquette to shut down<\/a> last spring. Roughly 1,100 patients relied on that clinic each year for cancer screenings, IUD insertions, and medication abortions. Now the area has no other in-person resource for abortions. \u201cIt\u2019s a 500-mile stretch of no access,\u201d Brown said.<\/p>\n So the doctor, who describes herself as \u201cindividually pro-life,\u201d added medication abortions to Marquette Medical Urgent Care\u2019s already busy practice, which treats a steady flow of kids with the flu, college students with migraines, and tourists with skiing injuries.<\/p>\n At least 38 abortion clinics shut down last year in states where they\u2019re still legal, according to data collected by I Need an A<\/a>, a project supported by a number of nonprofits that helps people find abortion options. Even states that recently passed constitutional amendments<\/a> protecting abortion rights, such as Michigan, have had clinics close since the U.S. Supreme Court overturned Roe v. Wade<\/em> in 2022. And as rural hospitals<\/a> shutter labor and delivery units<\/a>, patients are losing access to pregnancy care. \u201cYou cannot have a high-risk pregnancy up here,\u201d Brown said. \u201cIt\u2019s a scary place.\u201d<\/p>\n Now communities are coming up with alternatives, such as Brown\u2019s urgent care.<\/p>\n The idea that urgent cares \u201ccould be an untapped solution to closures for abortion clinics across the country is really exciting,\u201d said Kimi Chernoby, the chief operating and legal officer at FemInEM<\/a>, a national nonprofit that works to improve professional training and patient outcomes for women in emergency medicine.<\/p>\n One patient at the Marquette urgent care on a recent day was a woman whom KFF Health News agreed to identify by only her first initial, \u201cA,\u201d to protect her medical privacy. She drove more than an hour on snowy backroads while her kids were in day care to get to her appointment.<\/p>\n Her youngest is still a baby, A said, and she got pregnant again while taking the progestin-only birth control pill, which is less likely to interfere with breast milk production but slightly less effective than the regular pill.<\/p>\n \u201cFinancials, housing, vehicles \u2014 it\u2019s a lot,\u201d she said. And another baby is \u201cjust not something that we could really do even at this time.\u201d<\/p>\n She said she was making the long round trip because receiving abortion care in an office felt more secure than being treated by \u201csomeone that I\u2019ve never met, or receiving meds that were just shipped to me.\u201d<\/p>\n Face-to-Face Care<\/strong><\/p>\n In one of the urgent care\u2019s exam rooms, A sat in a chair against the wall, waiting quietly for the doctor. Viktoria Koskenoja, an emergency medicine physician, knocked on the door and then greeted her warmly, pulling up a stool across from her.<\/p>\n \u201cAre you confident in your decision that you want to go ahead? Or do you want to talk about options?\u201d she said.<\/p>\n \u201cNo, I\u2019m pretty set on it,\u201d A said.<\/p>\n Koskenoja previously worked at Planned Parenthood. When she learned its Marquette clinic was closing, she started crying and making calls. She recalled asking everyone she knew in health care in Marquette: \u201cWhat are we going to do?\u201d<\/p>\n One of her first calls was to Brown, a friend and fellow emergency medicine doctor. Their families harvest maple syrup together each spring.<\/p>\n In the wake of the Planned Parenthood closure, Koskenoja convened a community meeting downtown at the Women\u2019s Federated Clubhouse, an 1880s-era building where guests sip from gold-rimmed china teacups on lace tablecloths. The goal: brainstorm new ways to provide abortion access in the Upper Peninsula.<\/p>\n Planned Parenthood of Michigan<\/a> officials said that growing financial challenges and the Trump administration\u2019s cuts to funding, including for the public insurance program Medicaid, had prompted the closures of some brick-and-mortar clinics in the state.<\/p>\n Plus, the availability of pills by mail exploded after the 2022 Dobbs v. Jackson Women\u2019s Health Organization<\/em> decision overturned Roe<\/em>. As abortion became illegal in many states, telehealth abortions went from 5% of all abortions provided to 25% by the end of 2024, according to #WeCount<\/a>, a national reporting project that tracks shifts in abortion volume.<\/p>\n Planned Parenthood of Michigan\u2019s telehealth appointments increased 13% for patients in the Upper Peninsula after the Marquette location closed, said Paula Thornton Greear, president and CEO of Planned Parenthood in the state.<\/p>\n All the abortion patients Koskenoja sees at the urgent care have one thing in common: They want to talk to someone in person.<\/p>\n \u201cI had a patient order the pills online and then get scared to use them because they felt like they were going to screw it up, or they weren\u2019t sure they could rely on the pills,\u201d she said. \u201cSo they literally came in here with the pills in their hand.\u201d<\/p>\n Others have medical complications or need an ultrasound to determine how far along they are with the pregnancy.<\/p>\n \u201cIt annoys me that telehealth is considered an acceptable thing in rural areas,\u201d Koskenoja said. \u201cAs though we\u2019re not the human beings that like talking to human beings and looking someone in the eye, especially when something serious is going on.\u201d<\/p>\n \t\t\t\t\t<\/p>\n \t\t\t\t\t<\/p>\n The Urgent Care Option<\/strong><\/p>\n The options presented at that community clubhouse meeting were limited. The few family medicine doctors and OB-GYNs in the area were either already putting patients on months-long waitlists or were too \u201crightward leaning,\u201d Brown said.<\/p>\n But urgent cares are designed to fill gaps in the system, she said, ready to take walk-ins who aren\u2019t already patients.<\/p>\n Brown knew from her years in the emergency room that medication abortions aren\u2019t that complicated. The professional guidelines<\/a> for first-trimester medication abortions<\/a> and miscarriages<\/a> are essentially the same: one dose of mifepristone, followed by misoprostol after 24 to 48 hours.<\/p>\n \u201cClinically, I was never worried about it,\u201d she said.<\/p>\n The biggest hurdle was getting medical malpractice insurance, Brown said. At first, insurers balked, demanding \u201conerous and unrealistic\u201d documentation and additional training, she said. Then they quoted a $60,000 annual premium for medication abortions \u2014 about three times the cost of insuring the entire urgent care. Ultimately, Brown said, the urgent care\u2019s broker pushed back, providing data that medication abortions didn\u2019t add \u201csignificant liability.\u201d<\/p>\n The company agreed to a premium of about $6,000 per year, she said.<\/p>\n The community pitched in, too. A local donor covered an ultrasound machine. And supporters started a nonprofit to help pay for the costs of the medication and additional staffing, bringing the price for patients down from about $450 to an average of about $225, based on a sliding scale.<\/p>\n Word spread quickly once Marquette Medical began offering medication abortions, Brown said. Now the office provides as many as four per week, with patients traveling from as far away as Louisiana. The clinic is on track to match the volume of abortion patients treated at the local Planned Parenthood office before its closure, Brown said.<\/p>\n As pills by mail become the next major target for abortion opponents, Chernoby said, it will be critical to offer more care in more brick-and-mortar places. Brown said the Marquette clinic has already fielded questions from a large academic medical center that plans to start providing medication abortion at its own urgent cares later this year.<\/p>\n \u201cIt\u2019s a wonderful idea, but it\u2019s potentially got major pitfalls,\u201d said David Cohen, a professor at the Drexel University Kline School of Law who studies abortion access.<\/p>\n Urgent cares that provide medication abortion would have to abide by state-specific laws \u2014 some mandate 24-hour waiting periods or facility structural requirements \u2014 and federal regulations, such as the FDA\u2019s requirement that mifepristone prescribers be certified by the drug\u2019s distributors and obtain signed patient agreements.<\/p>\n If abortion access isn\u2019t a core part of a health organization\u2019s mission, \u201cdo you want to be on that list? I don\u2019t know if you do,\u201d Cohen said. \u201cThere\u2019s just a very particular regulatory environment\u201d around abortion.<\/p>\n Making a Choice<\/strong><\/p>\n In the exam room, Koskenoja listened as A talked about why she decided to seek an abortion. She has four kids at home, including the baby.<\/p>\n \u201cYou OK if we do an ultrasound, just confirm how far along you are, make sure it\u2019s not an ectopic pregnancy?\u201d Koskenoja asked.\u00a0<\/p>\n \u201cYeah,\u201d A said.<\/p>\n Koskenoja noted A\u2019s reaction to the question. \u201cOK. You\u2019re making a face?\u201d<\/p>\n \u201cYeah, I just don\u2019t \u2014 yeah, it\u2019s fine. I just don\u2019t want to see it.\u201d<\/p>\n \u201cOh, you don\u2019t have to see it,\u201d Koskenoja said.<\/p>\n \u201cI just don\u2019t want to hear a heartbeat or anything like that,\u201d A said.<\/p>\n \u201cDefinitely not,\u201d Koskenoja said.<\/p>\n After the ultrasound, Koskenoja stepped out into the hall to give A time to call her partner.<\/p>\n When A said she was ready, Koskenoja stepped in and asked her how she was feeling. A had made up her mind. She said that her partner would be supportive of whatever she decided and that she didn\u2019t want to have another baby right now.<\/p>\n \u201cAs much as I know this baby would be loved no matter what, it\u2019s just not a good time,\u201d A said quietly, her hands in her lap.<\/p>\n \u201cMost people who get abortions love babies,\u201d Koskenoja said. And you can still have more in the future, she assured A.\u00a0<\/p>\n This kicked off a long conversation about the mental load of parenting and the pros and cons of various birth control options. A said she wanted to get her tubes tied, but Koskenoja suggested her partner consider a vasectomy instead. It\u2019s a much less invasive procedure, she said. \u201cYou\u2019ve had a lot of kids. I feel like it could be his turn to take some responsibility.\u201d<\/p>\n Koskenoja handed her a small, handsewn \u201ccomfort bag\u201d that all medication abortion patients receive. It was filled with the pills, reminders about when to take them, a handwritten note of support from local community members, pain meds, comfortable socks, and a heating pad.<\/p>\n \u201cCall us if you need anything,\u201d she told A. \u201cAny questions?\u201d<\/p>\n \u201cNo,\u201d A said.<\/p>\n \u201cOK. Good luck,\u201d Koskenoja said before A walked out past the waiting room, filled with sick babies and other patients, to drive back to her kids.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n