LEILA FADEL, HOST:
After the Supreme Court overturned Roe v. Wade in 2022, many states banned abortion and closed reproductive health clinics. In states where abortion is still legal, many clinics are in trouble. Last year, more than 30 clinics that provide abortions closed, including in Michigan's Upper Peninsula. Local doctor Viktoria Koskenoja was stunned.
VIKTORIA KOSKENOJA: Yeah, mostly, like, crying and calling people, like, I can't believe this is happening. This is so terrible. What are we - what are our patients going to do?
FADEL: She and other health care workers in the community came up with a new model - they'd offer medication abortions at an urgent care center. Kate Wells with our partner KFF Health News takes us to the town of Marquette.
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LEANNA: Marquette Med Urgent Care, this is Leanna (ph). How can I help you?
KATE WELLS, BYLINE: The waiting room here is filled with your typical urgent care cases. You've got sports injuries, migraines, a lot of babies with the flu.
UNIDENTIFIED CLINICIAN: I'm going to treat him with Tamiflu. If he's negative, they're good to go.
WELLS: Nobody ever planned on doing abortions here. Least of all the owner, Dr. Shawn Brown.
SHAWN BROWN: I am individually pro-life, so it's very strange for me to own the abortion clinic of the Upper Peninsula.
WELLS: When you say individually pro-life, what does that mean?
BROWN: So, like, I don't personally believe in abortion.
WELLS: Wait. Shawn...
BROWN: (Laughter) But I also believe that is only my internal decision, for me.
WELLS: For Brown, it feels like the health system is falling down around her. Rural hospitals are closing their labor and delivery units. Maternal fetal medicine doctors are leaving town. And then, last spring, the only Planned Parenthood clinic in the Upper Peninsula closed.
BROWN: And when they closed, there is no other resource. So it's a 500-mile stretch of no access to clinical abortion.
WELLS: When Planned Parenthood of Michigan closed this clinic and another in Ann Arbor, they blamed the Trump administration's attacks on Medicaid and other reproductive health funding. And, of course, more patients are just using telehealth instead of brick-and-mortar clinics.
The urgent care owner, Dr. Brown, is close friends with Dr. Viktoria Koskenoja, the emergency medicine doctor that you heard earlier. She used to work for Planned Parenthood. And together, they realized the urgent care could work for this. It had medical malpractice insurance. It's already set up to handle walk-in patients from anywhere, and in Michigan, you can get medication abortion in the first trimester. Dr. Brown knew it was not difficult care. It's two pills which cause the body to expel the pregnancy.
BROWN: Clinically, I was never worried about it. It's first trimester miscarriage management.
WELLS: And they have gotten funding from a national emergency medicine group, FemInEM. It works to reduce health disparities for female patients and support female doctors in the ER. Dr. Kimi Chernoby is the chief operating officer.
KIMI CHERNOBY: As far as I'm aware, the Marquette program is the first urgent care to offer medication abortion services.
WELLS: Chernoby says that as more clinics that offer abortion close, this Marquette urgent care could be a model.
CHERNOBY: Right. I mean, it can be adopted into primary care clinics, into urgent cares, into emergency departments. There are a whole host of places in the health care system where we could increase access to medication abortion.
WELLS: Marquette Medical Urgent Care rolled out the new service in July, and word traveled pretty fast. First, they got about four abortion patients a month. Now it's at least four patients a week. One recently came all the way from Louisiana. And although a lot of patients are using telehealth or get the abortion pills through the mail, some patients still need to be seen in person. Sometimes they have to get an ultrasound first, or they have a medical complication. Dr. Koskenoja says some come to the urgent care because they are worried about the pills that they got off the internet.
KOSKENOJA: 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. So they literally came in here with the pills in their hand.
WELLS: But most of them, she says, just want to see somebody in person.
KOSKENOJA: It annoys me that telehealth is considered an acceptable thing in rural areas, as though we're not, like, human beings that like talking to human beings and looking someone in the eye, especially when something serious is going on.
WELLS: One of those patients is a woman who requested NPR identify her by her first initial - A - so she could talk candidly about a sensitive medical decision.
KOSKENOJA: All right. So I understand you're here for a medication abortion today.
A: Yeah.
KOSKENOJA: Are you confident in your decision that you want to go ahead, or do...
A: Yeah.
KOSKENOJA: ...You want to talk about options?
A: No, I'm pretty set on it. We've kind of battled between - not battled, but talked, I should say...
KOSKENOJA: Yeah.
A: ...Me and the father, about what we should do.
WELLS: She drove an hour and 15 minutes through the snow just to get here.
A: Quite honestly, I'd prefer to come in person. I feel more secure about what I'm doing, rather than just doing it over someone that I've never met or receiving meds that, you know, were just shipped to me.
WELLS: A has kids already, including a baby. She says she got pregnant while she was breastfeeding and taking birth control, but it didn't work. Dr. Koskenoja asks her, are you OK if we do an ultrasound to just confirm how far along you are, make sure it's not ectopic pregnancy?
A: Yeah.
KOSKENOJA: OK. You're making a face.
A: Yeah. I just don't want to see it...
KOSKENOJA: Oh, definitely not. No.
A: ...Anything like that.
WELLS: They do the ultrasound and Dr. Koskenoja steps out into the hall.
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WELLS: Did she do OK?
KOSKENOJA: Yeah. It's kind of an interesting development that...
WELLS: A has asked for some time to call her partner.
KOSKENOJA: In some ways, she feels like it's too much to add another child, but in some ways, they want another child, and so they're really on the fence. So I told her she has plenty of time to decide. She can take as long as she needs.
WELLS: When A's ready, Dr. Koskenoja comes back in, asks her how she's feeling, and A says she has made up her mind.
A: As much as I know this baby would be loved no matter what...
KOSKENOJA: Yeah.
A: ...It's just not a good time.
KOSKENOJA: OK. Yeah. I mean, most people who get abortions love babies. It doesn't mean anything that - you know, about you as a mom or you as a person.
A: That's the hardest part, just because...
WELLS: Then they have this long conversation about motherhood and life and child care and birth control options. A starts to relax. She warms up. And at the end, Dr. Koskenoja hands her this little bag that local volunteers have put together. It's got her pills and pain meds, but it's also got lip balm and comfy socks and a heating pad and a supportive handwritten note from one of the volunteers.
KOSKENOJA: OK. All right. All your pills are in here.
A: OK.
KOSKENOJA: Call us if you need anything.
A: OK.
KOSKENOJA: OK. Any questions?
A: No.
KOSKENOJA: OK. Good luck.
A: OK, thank you.
KOSKENOJA: I hope you...
A: Thank you.
KOSKENOJA: ...Are happy with whatever happens.
A: Yes. I will be OK.
KOSKENOJA: OK.
WELLS: A takes the bag, walks back out past the waiting room filled with all the sick babies and the skiing injuries and drives the hour and 15 minutes home to her kids.
In Marquette, Michigan, I'm Kate Wells.
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FADEL: That story comes to us from our partner KFF Health News. Transcript provided by NPR, Copyright NPR.
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