Providing abortions was the last thing Shawn Brown expected when she opened an urgent care in Marquette, a small port town on Michigan’s remote Upper Peninsula. But when the local Planned Parenthood closed last spring — a clinic that had served roughly 1,100 patients a year for cancer screenings, IUDs and medication abortions — Brown decided to add medication abortion to her practice. “It’s a 500-mile stretch of no access,” she said of the region after the closure.
Brown describes herself as “individually pro-life,” yet she saw patients’ needs and the practical similarity between medication abortion and first-trimester miscarriage management. Marquette Medical Urgent Care now stocks mifepristone and misoprostol and offers medication abortion alongside routine urgent-care visits for kids with the flu, students with migraines and tourists with skiing injuries.
The move reflects a broader trend. At least 38 abortion clinics closed last year in states where abortion remains legal, according to I Need an A, a project that helps people find abortion options. Even in states that recently protected abortion rights in their constitutions, like Michigan, clinic closures have continued since the U.S. Supreme Court’s 2022 Dobbs decision that overturned Roe v. Wade. As rural hospitals cut labor and delivery units, communities are losing pregnancy-care capacity, compounding access problems.
Some clinics and advocates are exploring urgent care as one way to fill gaps. “The idea that urgent cares could be an untapped solution to closures for abortion clinics across the country is really exciting,” said Kimi Chernoby of FemInEM, a nonprofit focused on women’s emergency medicine. Urgent cares are structured to take walk-ins and fill holes in local systems, and many clinicians in emergency medicine are comfortable with the medication regimen used for early abortion — one dose of mifepristone followed by misoprostol 24 to 48 hours later — which mirrors miscarriage management guidelines.
Yet the model has challenges. Insurers and regulators can push back. Brown said insurers initially demanded onerous documentation and training and quoted a $60,000 annual malpractice premium for providing medication abortion — roughly three times the cost of insuring the whole urgent care. After her broker pushed back with data showing the service did not add significant liability, the carrier agreed to an about $6,000 annual premium. A local donor paid for an ultrasound machine, and community supporters formed a nonprofit to subsidize medication and staffing, lowering patient costs from about $450 to an average sliding-scale fee near $225.
Marquette’s urgent care sees about four medication-abortion patients a week and is approaching the volume the local Planned Parenthood had served before closing. Patients travel long distances; Brown said some come from as far away as Louisiana. For many, in-person care feels more secure than telehealth or mail-order pills. One patient identified as A drove more than an hour on snowy backroads with her young children in daycare to seek care in person. She had become pregnant while using a progestin-only pill and decided now was not the right time to have another baby.
Patients who come to Marquette’s urgent care often want face-to-face care, particularly when they are scared about using pills they ordered online or need an ultrasound to confirm gestational age or rule out ectopic pregnancy. Viktoria Koskenoja, an emergency-medicine physician who previously worked at Planned Parenthood, started performing medication abortions at the urgent care after convening a community meeting to figure out alternatives when their Planned Parenthood closed. “What are we going to do?” she recalled asking colleagues at the time.
Those in-person conversations can be important. In a typical visit, a clinician confirms the patient’s decision, offers an ultrasound, discusses options and potential contraception, and provides the medications and support. Koskenoja described handing a medication-abortion patient a handsewn “comfort bag” with pills, instructions, pain medication, a heating pad, socks and a handwritten note from local supporters, and she offered follow-up contact information.
Telehealth and mail-order abortion pills have expanded dramatically since Dobbs, and they filled some access voids: telehealth abortions increased from about 5% of all abortions to 25% by the end of 2024, according to #WeCount, a national reporting project. Planned Parenthood of Michigan reported a 13% increase in telehealth appointments for patients in the Upper Peninsula after the Marquette clinic closed. But as pills-by-mail become a focus of restrictive efforts by abortion opponents, advocates argue more physical sites offering in-person medication abortion will be crucial.
Legal and regulatory complexity is a significant obstacle to scaling urgent-care abortion services. Providers would need to comply with state-specific laws that can include waiting periods, mandatory counseling, facility requirements, or parental-consent rules. Federally, the Food and Drug Administration requires mifepristone prescribers be certified by distributors and obtain signed patient agreements. David Cohen, a law professor who studies abortion access, warned that the regulatory environment around abortion is “very particular” and could deter organizations whose core mission doesn’t center on abortion from adding the service.
Despite potential pitfalls, some larger health systems are paying attention. Brown said a major academic medical center has asked questions and plans to offer medication abortion at some of its urgent-care sites later in the year.
For patients in rural areas who want or need in-person care, urgent cares can offer an alternative to telehealth or distant clinics — providing counseling, ultrasound confirmation, medication, and human contact. Marquette Medical’s experience shows community support, adaptable clinicians and pragmatic problem-solving can create local access even after clinic closures. But insurance, legal constraints and the political landscape will shape whether urgent care becomes a widespread safety net for abortion access.