Urgent Care Clinics Step Up to Offer Medication Abortions Amidst Clinic Closures
Urgent care clinics are starting to offer medication abortion services in areas affected by the closure of traditional abortion clinics across the United States. This development addresses a need for in-person care, even as telehealth abortion services have increased, and presents specific operational and regulatory considerations for providers.
Urgent care clinics are stepping in to offer medication abortion services, addressing a critical need for in-person care in areas impacted by traditional clinic closures.
Clinic Closures Drive New Models
Across the United States, at least 38 abortion clinics closed last year in states where the procedure remains legal, according to data from I Need an A. These closures have occurred even in states like Michigan, which have enacted constitutional amendments protecting abortion rights following the 2022 U.S. Supreme Court decision overturning Roe v. Wade. Planned Parenthood of Michigan officials have cited financial challenges and funding cuts, including to Medicaid, as factors contributing to these closures.
In response to these closures, some urgent care facilities have begun providing medication abortion services to address gaps in healthcare access. Urgent care clinics are designed to fill system gaps and accommodate walk-in patients, making them a potential model for expanding abortion access.
Marquette: A Case Study in Adaptation
In Marquette, Michigan, Dr. Shawn Brown's urgent care clinic, Marquette Medical Urgent Care, commenced offering medication abortions after the local Planned Parenthood facility closed. This closure left a gap in services for approximately 1,100 patients annually in Michigan's Upper Peninsula. The region also faces challenges with general pregnancy care due to rural hospital closures.
The closure of the local Planned Parenthood in Marquette, Michigan, left a gap in services for approximately 1,100 patients annually in the Upper Peninsula.
Dr. Viktoria Koskenoja, an emergency medicine physician at Marquette Medical Urgent Care and former Planned Parenthood staff member, collaborated with Dr. Brown to establish these services. Community discussions were held to explore options for maintaining abortion access in the Upper Peninsula. The Marquette clinic now provides up to four medication abortions per week, serving patients from various locations, and is projected to match the volume of patients previously served by the local Planned Parenthood.
The Shifting Landscape of Abortion Access
While telehealth abortion services saw a substantial increase nationwide after the Dobbs v. Jackson Women's Health Organization decision, rising from 5% to 25% of all abortions by late 2024, some patients continue to require or prefer in-person care. Reasons for this preference include:
- A desire for face-to-face consultation.
- The presence of medical complications.
- The need for an ultrasound to determine gestational age or confirm the pregnancy stage.
- Apprehension about self-administering pills ordered online.
Planned Parenthood of Michigan also observed a 13% increase in telehealth appointments for patients in the Upper Peninsula after the Marquette location closed.
While telehealth abortions have surged nationally, many patients still prefer or require in-person care due to factors like medical complications or apprehension about self-administering medication.
Integrating Services: Hurdles and Solutions
Integrating medication abortion services into an urgent care setting involves several operational considerations. Dr. Shawn Brown noted that the clinical protocol for first-trimester medication abortions is similar to miscarriage management and is not considered medically complex.
"The clinical protocol for first-trimester medication abortions is similar to miscarriage management and is not considered medically complex," stated Dr. Shawn Brown.
A primary hurdle for urgent care clinics has been securing medical malpractice insurance. Initial quotes for medication abortion services were significantly higher than general urgent care coverage. However, after negotiation and providing data demonstrating that medication abortions did not add substantial liability, the additional annual premium for Dr. Brown's clinic was reduced to approximately $6,000.
Community support has also played a role in the establishment of these services. In Marquette, a local donor provided an ultrasound machine, and a nonprofit organization helps cover medication and staffing costs, which has contributed to reducing patient fees.
Navigating the Regulatory Environment
The integration of abortion services into urgent care settings presents potential challenges, particularly concerning regulatory compliance. David Cohen, a professor at Drexel University Kline School of Law, emphasized that urgent care clinics providing medication abortion must adhere to both state-specific laws and federal regulations. These may include state-specific requirements such as waiting periods or facility standards, and federal regulations, including FDA certification for mifepristone prescribers.
Urgent care clinics providing medication abortion must meticulously adhere to both state-specific laws and federal regulations, navigating a specialized regulatory environment.
Legal experts highlight the specialized regulatory environment surrounding abortion services and suggest that organizations must carefully consider mission alignment before offering these services. Despite these complexities, the approach is being explored, with at least one large academic medical center reportedly inquiring about establishing similar services in its urgent care facilities.
Patient Experiences: The Need for In-Person Care
Patients seeking in-person abortion care at urgent care clinics often travel significant distances. One patient, identified as A, reportedly drove over an hour for an in-person appointment at the Marquette urgent care. This patient cited financial and housing considerations, as well as a preference for supervised care over medication shipped directly. During her visit, an ultrasound was performed to confirm the pregnancy stage and rule out complications, with the patient opting not to view the screen or hear a heartbeat.