MARQUETTE, Michigan — The last thing Shawn Brown thought he would do when he opened an urgent care clinic in this remote town in Michigan’s Upper Peninsula was getting an abortion.
But she wasn’t even expecting Planned Parenthood to be in Marquette to close last spring. About 1,100 patients depend on that clinic each year for cancer screenings, intrauterine device insertions and medication abortions. There are now no other individual resources for abortion in the area. “It’s 500 miles of trail with no access,” Brown said.
So the doctor, who describes himself as “personally pro-life,” added medication abortion to Marquette Medical Urgent Care’s already busy practice, which treats babies suffering from the flu, college students suffering from migraines and tourists with skiing injuries.
At least 38 abortion clinics closed last year in states where they are still legal, according to data collected by the i want aA project supported by several non-profit organizations that helps people find alternatives to abortion. It has even been said recently passed constitutional amendments Clinics protecting abortion rights like the one in Michigan are closing after US Supreme Court overturn roe vs wade In 2022. and like rural hospital shutter Labor and distribution unitsPatients are losing access to pregnancy care. “You can’t get a high-risk pregnancy here,” Brown said. “It’s a scary place.”
Now communities are coming up with alternatives, like Brown’s urgent care.
The idea that urgent care “could be an untapped solution to closing abortion clinics across the country is really exciting,” said Kimi Chernoby, MD, chief operating and legal officer. FemInEMA national nonprofit organization that works to improve professional training and patient outcomes for women in emergency medicine.
One patient at Marquette Urgent Care on a recent day was a woman kff health news She agreed to be identified only by her initials “A” to protect her medical confidentiality. She drove for more than an hour on icy roads while her children were at day care to get to her appointment.
Her youngest child is still a toddler, A said, and she became pregnant again while taking the progestin-only birth control pill, which is less likely to interfere with breast milk production but is slightly less effective than the regular pill.
“Financial, housing, vehicles – it’s a lot,” she said. And the other child said “It’s not something we can really do right now.”
She said she was making the long trip because receiving abortion care in the office felt safer than “getting treatment from someone I’ve never met, or getting medications just shipped to me.”
one-on-one care
In one of the urgent care’s exam rooms, A sat in a chair facing the wall, quietly waiting for the doctor. Victoria Coscanova, MD, an emergency medicine physician, knocked on the door and then pulled up a stool in front of her to greet him warmly.
“Are you sure you want to move forward? Or do you want to talk about options?” He said.
“No, I’m all in on it,” A said.
Coskenzo previously worked at Planned Parenthood. When she learned her Marquette clinic was closing, she started crying and making phone calls. He recalled asking everyone involved in health care at Marquette: “What are we going to do?”
Her first call 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, Coscagnoza convened a community meeting at the Women’s Federated Clubhouse, an 1880s building where guests sipped gold-rimmed Chinese tea on lace tablecloths. The goal: to brainstorm new ways to provide abortion access in the Upper Peninsula.
Planned Parenthood of Michigan Growing financial challenges and funding cuts by the Trump administration, including Medicaid, the public insurance program, have led some brick-and-mortar clinics in the state to close, officials said.
Plus, availability of pills by mail explodes after 2022 Dobbs v. Jackson Women’s Health Organization the decision was overturned Roe deer. As abortion became illegal in many states, telehealth abortions increased from 5% to 25% of all abortions by the end of 2024, according to #WeCount, a national reporting project that tracks changes in the volume of abortions.
Paula Thornton Greer, president and CEO of Planned Parenthood in the state, said Michigan’s telehealth appointments increased 13% for patients in the Upper Peninsula after the Marquette location closed.
All the abortion patients Coscenzoa sees in urgent care have one thing in common: They want to talk to someone in person.
“I had a patient who ordered pills online and then was afraid to use them because they thought they would screw it up, or they weren’t sure they could trust the pills,” he said. “So they literally came here with bullets in their hands.”
Others have medical complications or need an ultrasound to determine how far along they are in their pregnancy.
“It bothers me that telehealth is considered an acceptable thing in rural areas,” Coskenoja said. “As if we’re not the type of people who like to talk to humans and look someone in the eye, especially when there’s something serious going on.”
urgent care options
The options presented at that community clubhouse meeting were limited. Some family medicine doctors and obstetricians/gynecologists in the area were either already putting patients on months-long waiting lists or were too “right-wing” leaning, Brown said.
But urgent cares are designed to fill gaps in the system, he said, and they are ready to include people who are not already patients.
Brown knew from her years in the emergency room that medication abortion was not that complicated. professional guidelines for the first quarter drug abortion And abortion Are basically the same: one dose of mifepristone, followed 24 to 48 hours later by misoprostol.
“Medically, I was never worried about it,” she said.
The biggest hurdle, Brown said, was obtaining medical malpractice insurance. At first, he said, insurers balked, demanding “onerous and unrealistic” documentation and additional training. Then they quoted an annual premium of $60,000 for medication abortion – almost three times the cost of insuring complete urgent care. Ultimately, Brown said, the urgent care broker pushed back, providing data that medication abortions were not associated with “significant liability.”
The company agreed to a premium of about $6,000 per year, he said.
The community also participated in it. A local donor covered an ultrasound machine. And supporters started a nonprofit to help pay the cost of the drug and additional staffing, reducing the price for patients from about $450 to an average of about $225, depending on the sliding scale.
Brown said when Marquette Medical started offering medication abortion, word spread quickly. The office now serves four patients per week, with patients coming from as far away as Louisiana. Brown said the clinic is on track to match the number of abortion patients treated at the local Planned Parenthood office before its closure.
As pills by mail become the next major target for abortion opponents, Chernoby said, it will be important to provide more care in more brick-and-mortar locations. Brown said Marquette Clinic has already fielded questions from a large academic medical center that plans to begin providing abortion medication in its urgent cares later this year.
“It’s a wonderful idea, but it could potentially have huge harms,” said David Cohen, a professor at Drexel University Kline School of Law who studies abortion access.
Urgent care providing medication abortion must comply with state-specific laws – some mandate 24-hour waiting periods or have facility structural requirements – and federal regulations, such as the FDA’s requirement that mifepristone prescribers be certified by distributors of the drug and obtain signed patient agreements.
If abortion access is not a core part of a health organization’s mission, “do you want to be added to that list? I don’t know if you do,” Cohen said. “There is a very particular regulatory environment” around abortion.
make a choice
In the exam room, Coskenoja overhears A talking about why she decided to have an abortion. He has four children including baby at home.
“You okay if we do an ultrasound, just confirm how far along you are, make sure it’s not an ectopic pregnancy?” Koskenoja asked.
“Yes,” said A.
Coskenoja notes A’s response to the question. “Okay. Are you making faces?”
“Yeah, I just don’t want to – yes, it’s fine. I just don’t want to see it.”
“Oh, you don’t have to see it,” Coskenoja said.
“I don’t want to hear a heartbeat or anything like that,” A said.
“Definitely not,” Coskenzo said.
After the ultrasound, Koskenoja left the hall to give A time to call her partner.
When A said she was ready, Coskenoja intervened and asked her how she was feeling. A had made up his mind. She said that whatever decision she takes, her partner will support her and she does not want to have another child right now.
“As much as I know this baby will be loved no matter what, this just isn’t a good time,” A said softly, her hands in her lap.
“Most people who get abortions love children,” Coskenoja said. And you can get even more in the future, he assured A.
This began a long conversation about the mental burden of parenting and the advantages and disadvantages of various birth control options. A said she wanted to have her tubes tied, but Coskenzo suggested her partner consider a vasectomy instead. “It’s a much less invasive procedure,” he said. “You have a lot of kids. I think it might be his turn to take on some responsibility.”
Coskenoja gave her a small, hand-sewn “comfort bag”, which all abortion patients receive. It was filled with pills, reminders about when to take them, a handwritten note of support from local community members, pain medications, comfortable socks, and a heating pad.
“Call us if you need anything,” she told A. “Got a question?”
“No,” A said.
“Okay. Good luck,” Coscanova said, before A left the waiting room filled with sick children and other patients to return to his children.
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