When the Planned Parenthood clinic in Marquette closed in April, it was the only clinic providing abortion medication in the Upper Peninsula.
Healthcare options were already limited in the vast, remote region. The next-closest Planned Parenthood clinic is now a roughly five-hour drive south. While the Planned Parenthood clinic in Marquette didn’t offer procedural abortion, it did provide more than a thousand patients per year services like cancer screenings, birth control and medication abortion.
“All of these reproductive health care services, for a big chunk of the population here, were put into jeopardy,” said Dr. Viktoria Koskenoja, a local emergency medicine physician and former Planned Parenthood of Michigan (PPMI) employee.
The small, tightly-knit network of local healthcare workers and community members started meeting, brainstorming ways to fill the gaps. “The most important thing that we felt we needed to replace immediately, was access to in-person abortion services,” Koskenoja said.
PPMI and other virtual providers were already offering abortion pills online, which are available in Michigan until 11 weeks of pregnancy. PPMI says the organization has seen an 18% increase in telehealth appointments for U.P. patients in the first three months since it(?) REMIND US WHAT CLOSED closed.
ALTHOUGH, for patients who need ultrasounds to determine the stage of their pregnancies, don’t have reliable internet access, or just want to talk face-to-face with a medical professional they know and trust, virtual care isn’t an option, Koskenoja said.
“But I think a lot more people, they feel isolated and they need to be able to just sit in a room with somebody who cares, who can explain what their options are and what they’re going to go through,” said Dr. Shawn Brown, the medical director and owner of Marquette Medical Urgent Care.
So for the past several months, the clinic has been quietly offering medication abortion to patients. “As far as we know, we are the only urgent care in the country offering medication abortions as a service,” said Koskenoja, who’s now director of abortion services at the clinic.
They’ve started small, with mostly word-of-mouth referrals bringing in about a dozen patients from five counties, said Brown. But they’ve also received grant funding “to create a standard of practice, so that urgent cares can recreate this model nationwide,” Brown said.
The clinic is open seven days a week, often late. If patients have questions or need to get on the schedule, an urgent care model fits well, Koskenoja said.
Abortion care is “just delivered as part of normal healthcare, as it should be,” Konkenoja said, noting this new setup destigmatizes care.
“People are in the waiting room with broken ankles, sore throats, rashes, and tick bites,” she said. “Not like, ‘Oh, you have to go to the bad place where people do abortions, because that's where you have to get this done, because it's something that's not part of real health care.’”
An urgent care clinic focused on “what’s best” for patients
The waiting room at Marquette Medical is intentionally designed not to look like the windowless, fluorescent-lit urgent cares of so many suburban strip malls. Patients can sit in the overstuffed leather recliner, or watch Juniper (the urgent care cat) doze on the sunny windowsill. People come in for the standard flu symptoms, ear infections, and broken bones. BUT, they also can receive Reiki therapy, keatmine infusions, sexual assault forensic exams, and now medication abortion.
Brown says she knew she wanted to do something different after years in hospital leadership positions through the pandemic. “I just did not feel like it was capable of changing enough to deliver the right kind of care to patients when they needed it,” Brown said.
She was burned out on the corporate medical structure, she said, and longed for a space that allowed “patients and their doctors to sit down and have a conversation about what's best for them.”
“I'm not going to get some farmer to take off his boots and let me do reflexology on him,” Brown said. “But if I can put him in a comfortable recliner and pretend that he's there for his TV dinner, then he's a lot more likely to show up than he would in the ER waiting room, where he's going to sit for six hours.
But when the prospect of offering medication abortion came up, Brown worried about her personal safety, especially after the Minnesota man who fatally shot a state lawmaker in June was found to have abortion providers on his list of targets.
“Is somebody going to shoot me and Viktoria? Are they coming after our families?” Brown said. “And what is the financial impact on this entire group of people that I employ (at the urgent care) who depend on me keeping the clinic open?”
So far, the response has been largely supportive, she said, including a grant from a Grand Rapids-based abortion fund.
“The Upper Peninsula is, by and large, not a blue swath,” Brown said. “We are a tiny blue dot in Marquette. But our patients are coming from all around. They're not coming from Marquette itself. They're coming from deep red Escanaba and Iron County.”
And some abortion rights proponents worry about whether pills-by-mail, which has become an increasingly popular option since Roe v. Wade was overturned in 2022, will continue to be an option amidst an increase in targeted legislation, federal litigation and even criminal indictment.
Providing the pills in-person “allows us to be prepared for any changes in FDA authorization if there are to access them through the mail,” said Dr. Dara Kass, an emergency medicine physician in New York and the founder and executive director of FemInEM.
She says many doctors are interested in offering medication or surgical abortion care in urgent care settings. “She's basically allowing us to create the blueprint for this,” Kass said of the Marquette clinic. “Especially as we see so many other clinics closing. We're hoping to compensate for the loss of in-person care where we can.”
This month, Planned Parenthood of Wisconsin announced it would halt abortions after President Donald Trump signed a law ending Medicaid payments to abortion providers for one year.
“I do definitely want them to know that they are welcome to come here for care if that works for them,” Koskenoja said.
