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Some clinics that offer abortion are closing their doors, even in states where abortion is still legal. It's happening in New York, Illinois, in Utah and now in Michigan, where voters passed a constitutional amendment in 2022 protecting abortion rights. Planned Parenthood of Michigan closed four brick-and-mortar clinics last month, including the last remaining clinic in the rural Upper Peninsula. Kate Wells from member station Michigan Public reports that reproductive health care is facing new financial pressures.
KATE WELLS, BYLINE: On the last day, they saw patients at the Planned Parenthood in Marquette, Michigan, a port town on the shore of Lake Superior, dozens of people lined up outside. They held handmade pink signs that said Thank You and Grateful For You. And when the small clinical team finally exited the building...
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED PERSON #1: Off they go (ph).
WELLS: ...The crowd erupted in cheers.
(CHEERING)
WELLS: We're not done, someone shouted.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED PERSON #2: We're not done.
WELLS: We're not giving up.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED PERSON #2: We're not giving up.
WELLS: Finally, Planned Parenthood physician assistant Anna Rink addressed the crowd.
(SOUNDBITE OF ARCHIVED RECORDING)
ANNA RINK: I'm not leaving this community. I'm not leaving this camp. I'm not giving up on this dream. It's going to continue. It's going to grow. We're going to build it and make it better. I promise.
WELLS: But Planned Parenthood of Michigan is giving up on this clinic, the only clinic in the Upper Peninsula offering abortion. They're also shutting down three other health centers in the state. Dr. Sarah Wallett is their chief medical operating officer.
SARAH WALLETT: Our smallest health centers, those patients are important. Their health care is important, but operationally, because of their small size, are the most difficult to operate.
WELLS: Instead, Planned Parenthood of Michigan is encouraging many of those patients to turn to telehealth. Their organization's virtual clinic is expanding, and it already sees more than 10,000 Michigan patients a year.
WALLETT: In telehealth, I can have an appointment in my car during lunch. I don't have to take extra time off. I don't have to drive there. I don't have to find child care.
WELLS: And this is a big shift because until just a few years ago, doctors could only prescribe abortion pills in person. That requirement was lifted because of COVID, but telehealth abortion really took off in 2022, when the Supreme Court overturned Roe v. Wade with the Dobbs ruling. Caitlin Myers is an economics professor at Middlebury College.
CAITLIN MYERS: And Dobbs almost paradoxically accelerated expansions in telehealth because it drew all this attention to models of providing abortion services.
WELLS: Myers tracks every brick-and-mortar abortion clinic in the U.S., and she says, suddenly, after Dobbs, you could just get pills shipped directly to your home as long as you were in your first 11 weeks of pregnancy. And that appealed to a lot of patients, including those who might otherwise go to traditional clinics.
MYERS: That's going to create new pressures on kind of the older-school brick-and-mortar facilities. I think, put more simply, it's got to change their business model.
WELLS: At the same time, running an in-person clinic is getting harder financially. Although donors have stepped up after the Dobbs decision, since then, fundraising has slowed. And Planned Parenthood is expecting the Trump administration to once again exclude its clinics from Title X funding. That is the federal money for medical providers who do free and low-cost family planning. So Planned Parenthood of Michigan is leaning into telehealth. But Hannah Harriman is skeptical.
HANNAH HARRIMAN: I say that those people have not spent any time in the UP.
WELLS: That's the Upper Peninsula. Harriman is a public health nurse there at the Marquette County Health Department. She previously worked for 12 years at the Planned Parenthood that is closing. And she says some of those patients simply won't be able to access telehealth.
HARRIMAN: There are people that have to drive to McDonald's to use their WiFi. There are places here that don't even have internet coverage. I mean, you can't get it.
WELLS: And she says, even for the patients who can get virtual care, it's limited. Telehealth can't give you an ultrasound or insert an IUD. And she says you lose the human touch, the stuff that was her favorite part of the job.
HARRIMAN: Sometimes you cry with them and you laugh with them. And then when they have that trust, they keep coming back for care.
WELLS: Now the closest Planned Parenthood will be a nearly five-hour drive south. And Harriman says that is just not a trip that every patient will be able to make.
HARRIMAN: There's going to be an increase in undetected cervical cancers, many more unplanned pregnancies. Lots of families are going to suffer.
WELLS: For patients, it doesn't really matter why a clinic closes, whether it's a legal ban or a funding cut. Either way, it can make the care that they need that much harder to get.
For NPR News, I'm Kate Wells in Ann Arbor, Michigan.
MARTIN: This story comes from NPR's partnership with Michigan Public and KFF Health News. Transcript provided by NPR, Copyright NPR.
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