Abortion clinics are closing nationwide. Could urgent care help fill the gap?

When the only clinic that offered abortions in Michigan's rural Upper Peninsula closed, an urgent care decided to step in to fill the gap. Now, others are considering similar moves as brick-and-mortar clinics close in blue states.

Marquette Medical Urgent Care in Michigan started offering medication abortion to patients last summer. The physician who owns the urgent care started the service after Planned Parenthood closed a clinic, leaving the remote Upper Peninsula without in-person options for abortion care. Kate Wells/KFF Health News hide caption

Providing abortions was the last thing Shawn Brown thought she'd be doing when she opened an urgent care clinic in Marquette, a small port town on the remote shores of Michigan's Upper Peninsula.

But she also wasn't 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. "It's a 500-mile stretch of no access," Brown said.

This story was produced in partnership with KFF Health News .

So the doctor, who describes herself as "individually pro-life," added medication abortions to Marquette Medical Urgent Care's 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're still legal, according to data collected by I Need an A , a project supported by a number of nonprofits that helps people find abortion options.

Even states that recently passed constitutional amendments protecting abortion rights, such as Michigan, have had clinics close since the U.S. Supreme Court overturned Roe v. Wade in 2022. And as rural hospitals shutter labor and delivery units , patients are losing access to pregnancy care. "You cannot have a high-risk pregnancy up here," Brown said. "It's a scary place."

Now communities are coming up with alternatives, such as Brown's urgent care clinic.

Dr. Shawn Brown, who calls herself "individually pro-life," said "it's very strange for me to own the abortion clinic of the Upper Peninsula." But she wanted patients at her urgent care center to have access to medication abortions, especially after Planned Parenthood closed its only location in that part of the state last spring. Kate Wells/KFF Health News hide caption

The idea that urgent cares "could be an untapped solution to closures for abortion clinics across the country is really exciting," said Kimi Chernoby, the chief operating and legal officer at FemInEM , 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 who requested NPR identify her by her first initial, A, so she could talk candidly about a sensitive medical decision. 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.

"Financials, housing, vehicles — it's a lot," she said. And another baby is "just not something that we could really do even at this time."

She said she was making the long round trip because receiving abortion care in an office felt more secure than being treated by "someone that I've never met, or receiving meds that were just shipped to me."

In one of the urgent care's exam rooms, A waited quietly for the doctor, sitting in a chair against the wall. Viktoria Koskenoja, an emergency medicine physician, knocked on the door then greeted her warmly, pulling up a stool across from her.

"Are you confident in your decision that you want to go ahead? Or do you want to talk about options?" she 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: "What are we going to do?"

One of her first calls was to Brown, a friend and fellow emergency medicine doctor. Their families harvest maple syrup together each spring.

Mifepristone and misoprostol, the drugs used in medication abortions, are kept on hand at Marquette Medical Urgent Care in Michigan. Shawn Brown knew from her years working as an emergency medicine physician that medication abortions aren't complicated to provide. "Clinically, I was never worried about it," she says. "It's first-trimester miscarriage management." Kate Wells/KFF Health News hide caption

In the wake of the Planned Parenthood closure, Koskenoja convened a community meeting downtown at the Women's 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.

Planned Parenthood of Michigan officials said that growing financial challenges and the Trump administration's 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's 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, according to #WeCount , a national reporting project that tracks shifts in abortion volume.

Planned Parenthood of Michigan's 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.

Marquette Medical Urgent Care started offering medication abortion last July, and sees about four patients a week for the care. Kate Wells/KFF Health News hide caption

All the abortion patients Koskenoja sees at the urgent care have one thing in common: They want to talk to someone in person.

"I 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't sure they could rely on the pills," she said. "So they literally came in here with the pills in their hand."

Others have medical complications or need an ultrasound to determine how far along they are with the pregnancy.

"It annoys me that telehealth is considered an acceptable thing in rural areas," Koskenoja said. "As though we're not the human beings that like talking to human beings and looking someone in the eye, especially when something serious is going on."

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 new? patients on months-long waitlists or were too "rightward leaning," Brown said.

But urgent cares are designed to fill gaps in the system, she said, ready to take walk-ins who aren't already patients.