MARQUETTE, Mich. 鈥� Providing abortions was the last thing Shawn Brown thought she鈥檇 be doing when she opened an urgent care clinic in this remote town in Michigan鈥檚 Upper Peninsula.
But she also wasn鈥檛 expecting the Planned Parenthood in Marquette to shut down 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. 鈥淚t鈥檚 a 500-mile stretch of no access,鈥� Brown said.
So the doctor, who describes herself as 鈥渋ndividually pro-life,鈥� added medication abortions to Marquette Medical Urgent Care鈥檚 already busy practice, which treats a steady flow of kids with the flu, college students with migraines, and tourists with skiing injuries.
At least 38 abortion clinics shut down last year in states where they鈥檙e still legal, according to data collected by , a project supported by a number of nonprofits that helps people find abortion options. Even states that recently protecting abortion rights, such as Michigan, have had clinics close since the U.S. Supreme Court overturned Roe v. Wade in 2022. And as shutter , patients are losing access to pregnancy care. 鈥淵ou cannot have a high-risk pregnancy up here,鈥� Brown said. 鈥淚t鈥檚 a scary place.鈥�
Now communities are coming up with alternatives, such as Brown鈥檚 urgent care.
The idea that urgent cares 鈥渃ould be an untapped solution to closures for abortion clinics across the country is really exciting,鈥� said Kimi Chernoby, the chief operating and legal officer at , a national nonprofit that works to improve professional training and patient outcomes for women in emergency medicine.
One patient at the Marquette urgent care on a recent day was a woman whom 黑料吃瓜网 News agreed to identify by only her first initial, 鈥淎,鈥� 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.
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.
鈥淔inancials, housing, vehicles 鈥� it鈥檚 a lot,鈥� she said. And another baby is 鈥渏ust not something that we could really do even at this time.鈥�
She said she was making the long round trip because receiving abortion care in an office felt more secure than being treated by 鈥渟omeone that I鈥檝e never met, or receiving meds that were just shipped to me.鈥�
Face-to-Face Care
In one of the urgent care鈥檚 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.
鈥淎re you confident in your decision that you want to go ahead? Or do you want to talk about options?鈥� she said.
鈥淣o, I鈥檓 pretty set on it,鈥� A said.
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: 鈥淲hat are we going to do?鈥�
One of her first calls was to Brown, a friend and fellow emergency medicine doctor. Their families harvest maple syrup together each spring.
In the wake of the Planned Parenthood closure, Koskenoja convened a community meeting downtown at the Women鈥檚 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.
officials said that growing financial challenges and the Trump administration鈥檚 cuts to funding, including for the public insurance program Medicaid, had prompted the closures of some brick-and-mortar clinics in the state.
Plus, the availability of pills by mail exploded after the 2022 Dobbs v. Jackson Women鈥檚 Health Organization decision overturned Roe. As abortion became illegal in many states, telehealth abortions went from 5% of all abortions provided to 25% by the end of 2024, , a national reporting project that tracks shifts in abortion volume.
Planned Parenthood of Michigan鈥檚 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.
All the abortion patients Koskenoja sees at the urgent care have one thing in common: They want to talk to someone in person.
鈥淚 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鈥檛 sure they could rely on the pills,鈥� she said. 鈥淪o they literally came in here with the pills in their hand.鈥�
Others have medical complications or need an ultrasound to determine how far along they are with the pregnancy.
鈥淚t annoys me that telehealth is considered an acceptable thing in rural areas,鈥� Koskenoja said. 鈥淎s though we鈥檙e not the human beings that like talking to human beings and looking someone in the eye, especially when something serious is going on.鈥�
The Urgent Care Option
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 鈥渞ightward leaning,鈥� Brown said.
But urgent cares are designed to fill gaps in the system, she said, ready to take walk-ins who aren鈥檛 already patients.
Brown knew from her years in the emergency room that medication abortions aren鈥檛 that complicated. The for first-trimester and are essentially the same: one dose of mifepristone, followed by misoprostol after 24 to 48 hours.
鈥淐linically, I was never worried about it,鈥� she said.
The biggest hurdle was getting medical malpractice insurance, Brown said. At first, insurers balked, demanding 鈥渙nerous and unrealistic鈥� documentation and additional training, she said. Then they quoted a $60,000 annual premium for medication abortions 鈥� about three times the cost of insuring the entire urgent care. Ultimately, Brown said, the urgent care鈥檚 broker pushed back, providing data that medication abortions didn鈥檛 add 鈥渟ignificant liability.鈥�
The company agreed to a premium of about $6,000 per year, she said.
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.
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.
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.
鈥淚t鈥檚 a wonderful idea, but it鈥檚 potentially got major pitfalls,鈥� said David Cohen, a professor at the Drexel University Kline School of Law who studies abortion access.
Urgent cares that provide medication abortion would have to abide by state-specific laws 鈥� some mandate 24-hour waiting periods or facility structural requirements 鈥� and federal regulations, such as the FDA鈥檚 requirement that mifepristone prescribers be certified by the drug鈥檚 distributors and obtain signed patient agreements.
If abortion access isn鈥檛 a core part of a health organization鈥檚 mission, 鈥渄o you want to be on that list? I don鈥檛 know if you do,鈥� Cohen said. 鈥淭here鈥檚 just a very particular regulatory environment鈥� around abortion.
Making a Choice
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.
鈥淵ou OK if we do an ultrasound, just confirm how far along you are, make sure it鈥檚 not an ectopic pregnancy?鈥� Koskenoja asked.聽
鈥淵eah,鈥� A said.
Koskenoja noted A鈥檚 reaction to the question. 鈥淥K. You鈥檙e making a face?鈥�
鈥淵eah, I just don鈥檛 鈥� yeah, it鈥檚 fine. I just don鈥檛 want to see it.鈥�
鈥淥h, you don鈥檛 have to see it,鈥� Koskenoja said.
鈥淚 just don鈥檛 want to hear a heartbeat or anything like that,鈥� A said.
鈥淒efinitely not,鈥� Koskenoja said.
After the ultrasound, Koskenoja stepped out into the hall to give A time to call her partner.
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鈥檛 want to have another baby right now.
鈥淎s much as I know this baby would be loved no matter what, it鈥檚 just not a good time,鈥� A said quietly, her hands in her lap.
鈥淢ost people who get abortions love babies,鈥� Koskenoja said. And you can still have more in the future, she assured A.聽
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鈥檚 a much less invasive procedure, she said. 鈥淵ou鈥檝e had a lot of kids. I feel like it could be his turn to take some responsibility.鈥�
Koskenoja handed her a small, handsewn 鈥渃omfort bag鈥� 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.
鈥淐all us if you need anything,鈥� she told A. 鈥淎ny questions?鈥�
鈥淣o,鈥� A said.
鈥淥K. Good luck,鈥� Koskenoja said before A walked out past the waiting room, filled with sick babies and other patients, to drive back to her kids.