Providing abortions was the last thing Dr. Shawn Brown expected when she opened an urgent care in Marquette, a small port town on Michigan’s remote Upper Peninsula. But after the local Planned Parenthood closed last spring — a clinic that served roughly 1,100 patients a year for cancer screenings, IUD insertions and medication abortions — the region was left without any in-person abortion care. “It’s a 500-mile stretch of no access,” Brown said.
Brown, who describes herself as “individually pro-life,” added medication abortion to Marquette Medical Urgent Care’s services. The clinic already treats children with the flu, college students with migraines and tourists with skiing injuries; now it also provides mifepristone and misoprostol on site. Brown, with emergency medicine experience, says clinically the care isn’t complicated: “It’s first-trimester miscarriage management.”
The move came amid a wave of clinic closures even in states where abortion remains legal. Data from I Need an A show at least 38 abortion clinics shut last year in legal states. Since the Supreme Court overturned Roe v. Wade in 2022, clinics have closed for a mix of reasons: financial pressure, policy changes, and the expansion of telehealth and mail-order abortion pills. Telehealth abortions rose from about 5% of all abortions to 25% by the end of 2024, according to the #WeCount reporting project.
Local needs pushed Marquette’s clinicians into action. Viktoria Koskenoja, an emergency medicine physician who previously worked at Planned Parenthood, convened a community meeting after the clinic closed to brainstorm alternatives. Family medicine doctors and OB-GYNs in the area were strained, or politically averse to providing abortions, so urgent care emerged as a practical option: clinics are already set up to manage acute care, accept walk-ins, and handle first-trimester problems similar to medication abortion.
One patient, identified only as A for privacy, drove more than an hour on snowy backroads while her children were in daycare to get in-person care. She said she preferred speaking with a clinician she could see and trust rather than relying on pills mailed from afar or being treated by a stranger. Some patients come after ordering pills online and then feeling too nervous to use them alone; others need ultrasounds or have medical complications.
At Marquette Medical, clinicians take time to counsel patients in person. Koskenoja asks about confidence in the decision, offers an ultrasound to confirm gestation and rule out ectopic pregnancy, discusses contraception and family planning, and provides a “comfort bag” containing the medications with instructions, pain relief, a heating pad and supportive notes. The clinic has averaged about four medication abortions a week since starting last July, with some patients traveling long distances. Community funding and donors helped: a local donor purchased an ultrasound machine, and a nonprofit was formed to subsidize medication and staffing, reducing patient cost from about $450 to an average sliding-scale fee near $225.
Setting up the service wasn’t without obstacles. Brown said obtaining medical malpractice coverage proved difficult. Insurers initially demanded heavy documentation and extra training and quoted a prohibitive $60,000 annual premium — roughly three times the clinic’s total insurance cost. After pushback from the clinic’s broker and presentation of data showing limited added liability, the insurer accepted a smaller additional premium of about $6,000 per year.
Advocates see urgency-care-based abortion as an “untapped solution” to clinic closures. Kimi Chernoby of FemInEM, a nonprofit focused on women’s emergency care, called the idea exciting. Some academic medical centers have already expressed interest in offering medication abortion at urgent care locations.
But legal and practical pitfalls remain. Urgent cares that begin providing medication abortion must comply with state laws that vary widely — some require waiting periods, counseling, or specific facility standards — and federal requirements tied to mifepristone, including certification processes and patient agreements. David Cohen, a law professor who studies abortion access, warned that the regulatory environment around abortion is “very particular,” and organizations need to weigh whether they want to be the ones on lists of providers facing scrutiny or legal risk.
The shift to clinic-based urgent care is happening as opponents increasingly target pills-by-mail. As telehealth and mail access expand — partly in response to clinic closures and restrictions in many states — some rural communities and providers are preparing for tighter constraints on remote options. That makes in-person sites more important for those who need or prefer face-to-face care.
Clinicians at Marquette emphasize the human side of encounters: listening to patients’ reasons, addressing fears, offering contraceptive counseling, and discussing options like partner vasectomy when appropriate. For many patients, the in-person visit provides reassurance and practical support. After an ultrasound and conversation, A said she was certain about her decision and left with medications and instructions to return or call if needed.
Marquette’s experience illustrates both the promise and the complexity of urgent care as a partial stopgap for lost abortion access: urgent cares are widely distributed, accustomed to acute reproductive health issues, and can offer in-person services when telehealth or mail options aren’t suitable. At the same time, regulatory, insurance and mission-alignment challenges mean the model may not be easily or widely replicated without coordinated planning, legal guidance and community support.
As some major medical centers and local clinics consider adding medication abortion at urgent care sites, communities face choices about how to sustain access — through telehealth, mail, in-person clinics, or a mix — while navigating shifting laws and insurance markets. For now, in places like Marquette, urgent care has become an immediate, community-built response to a sudden gap in services, offering a face-to-face option for people seeking medication abortion in a region that otherwise would have none.