Why so many clinics that provide abortion are closing, even where it's still legal

Residents of Marquette, a metropolis successful Michigan's Upper Peninsula, gathered extracurricular Planned Parenthood to observe and convey staffers arsenic they vanished nan past time of diligent attraction connected April 23. Bobby Anttila hide caption

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Bobby Anttila

On nan past time of diligent attraction astatine nan Planned Parenthood session successful Marquette, Mich., a larboard municipality connected nan statement of Lake Superior, dozens of group crowded into nan parking batch and alley, holding pinkish homemade signs that publication "Thank You!" and "Forever Grateful."

"Oh my god," expert adjunct Anna Rink gasped, arsenic she and 3 different Planned Parenthood labor yet walked outside. The crowd whooped and cheered. Then Rink addressed nan gathering.

"Thank you for trusting america pinch your care," Rink called out, her sound quavering. "And I'm not stopping here. I'm only going to make it better. I promise. I'm going to find a way."

"We're not done!" personification called out. "We're not giving up!"

But Planned Parenthood of Michigan is giving up connected four of its wellness centers successful nan state, citing financial challenges.

That includes nan 1 successful Marquette, nan only session that provided abortion successful nan vast, sparsely populated Upper Peninsula. For nan astir 1,100 patients who visited nan session each twelvemonth for thing from crab screenings to contraceptive implants, nan next-closest Planned Parenthood will now beryllium a astir five-hour thrust south.

It's portion of a increasing trend: At slightest 17 clinics closed past twelvemonth successful states wherever abortion remains legal, and different 17 person closed successful conscionable nan first 5 months of this year, according to information gathered by ineedana.com. That includes states that person go abortion destinations, like Illinois, and those wherever voters person enshrined wide reproductive authorities into nan authorities constitution, for illustration Michigan.

Experts opportunity nan closures bespeak that financial and operational challenges, alternatively than early ineligible bans, whitethorn beryllium nan biggest threats to abortion entree successful states whose laws still protect it.

"These states that we person touted arsenic being really nan champion benignant of versions of our imagination for reproductive justice, they excessively struggle pinch problems," said Erin Grant, a co-executive head of nan Abortion Care Network, a nationalist rank statement for independent clinics.

"It's gotten much costly to supply care, it's gotten much vulnerable to supply care, and it's conscionable gotten, frankly, harder to supply care, erstwhile you're expected to beryllium successful nan session and past connected nan statehouse steps, and besides speaking to your representatives and trying to find personification who will hole your tile aliases overgarment your walls who's not going to insert their sentiment astir wellness attraction rights."

But immoderate abortion-rights supporters mobility whether leaders are prioritizing diligent attraction for nan astir susceptible populations. Planned Parenthood of Michigan isn't cutting executive pay, moreover arsenic it reduces unit by 10% and shuts down brick-and-mortar clinics successful areas already facing wellness attraction shortages.

Hannah Harriman, a caregiver pinch nan Marquette County Health Department, antecedently worked for Planned Parenthood successful Marquette for 12 years. Now that nan Planned Parenthood session is closed, nan region will connection family readying services 1½ days a week, but that won't beryllium enough, she says. Victoria Tullila for KFF Health News hide caption

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Victoria Tullila for KFF Health News

"I wish I had been successful nan room truthful I could person fought for america and I could person fought for our community," said Viktoria Koskenoja, an emergency medicine expert successful nan Upper Peninsula, who antecedently worked for Planned Parenthood successful Marquette.

"I conscionable person to dream that they did nan mathematics of trying to wounded arsenic fewer group arsenic imaginable and that's really they made their decision. And we conscionable weren't portion of nan group that was going to beryllium saved," Koskenoja said.

Why clinics are closing now, 3 years aft Roe was overturned 

If a session could past nan autumn of Roe v. Wade, "you would deliberation that resilience could transportation you forward," said Brittany Fonteno, president and CEO of nan National Abortion Federation.

But session operators opportunity they look caller financial strain, including rising costs, constricted reimbursement rates and increasing request for telehealth services.

Clinics are besides bracing for nan Trump management to again exclude them from Title X, nan national backing for low- and no-cost family readying services, arsenic nan previous Trump administration did successful 2019.

Planned Parenthood of Michigan (PPMI) says nan cuts are achy but basal for nan organization's semipermanent sustainability.

The 4 clinics being closed are "our smallest wellness centers," said Sarah Wallett, PPMI's main aesculapian operating officer. While nan thousands of patients those clinics served each twelvemonth are important, she said, nan clinics' mini size made them "the astir difficult to operate."

The clinics being closed had offered medicine abortion, which is disposable successful Michigan up until 11 weeks of pregnancy, but not procedural abortion.

Planned Parenthood of Illinois (a authorities that has go a post-Roe v. Wade abortion destination) shuttered 4 clinics successful March, pointing to a "financial shortfall."

Planned Parenthood of Greater New York is now trading its only Manhattan clinic, aft closing 4 clinics elsewhere successful nan authorities past summertime owed to "compounding financial and governmental challenges."

Planned Parenthood Association of Utah, wherever courts person blocked a near-total abortion prohibition and wherever abortion is presently ineligible until 18 weeks of pregnancy, announced it will close 2 centers successful May.

This spring, nan Trump management began temporarily freezing costs to galore clinics, including each Title X providers successful California, Hawaii, Maine, Mississippi, Missouri, Montana and Utah, according to a KFF analysis.

While nan existent Title X frost doesn't yet see Planned Parenthood of Michigan, PPMI's main defense officer, Ashlea Phenicie, said it would magnitude to a nonaccomplishment of astir $5.4 cardinal annually, aliases 16% of its budget.

But Planned Parenthood of Michigan didn't unopen down immoderate clinics nan past clip nan Trump management froze its Title X funding. Leaders said that's because nan backing was stopped for only astir 2 years, from 2019 until 2021, erstwhile nan Biden management restored it.

"Now we're faced pinch a longer play of clip that we will beryllium forced retired of Title X, arsenic opposed to nan first administration," said PPMI President and CEO Paula Thornton Greear.

At nan aforesaid time, nan emergence of telehealth abortion has put "new pressures successful nan older-school, brick-and-mortar facilities," said Caitlin Myers, a Middlebury College economics professor who maps brick-and-mortar abortion clinics crossed nan United States.

Balancing costs and care

Until a fewer years ago, doctors could prescribe abortion pills only successful person. Those restrictions were lifted during nan pandemic, but it was nan Dobbs determination successful 2022 that really "accelerated description s successful telehealth," Myers said. "Because it drew each this attraction to models of providing abortion services."

Suddenly, caller online providers entered nan field, advertizing virtual consultations and pills shipped straight to your home. And plentifulness of patients who still person entree to a brick-and-mortar session for illustration that option. "Put much simply, it's gotta alteration their business model," she said.

A caregiver practitioner useful astatine a Planned Parenthood session successful Fairview Heights, Ill., wherever she confers via teleconference pinch patients seeking medicine abortions connected Oct. 29, 2021. The 2 medications utilized successful nan process are mifepristone and misoprostol. Jeff Roberson/AP Photo hide caption

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Jeff Roberson/AP Photo

Historically, astir 28% of PPMI's patients person Medicaid benefits, according to Phenicie. And for illustration galore states, Michigan's Medicaid programme doesn't screen abortion, leaving those patients to either salary out-of-pocket aliases trust connected thief from abortion funds, respective of which person besides been struggling financially.

"When patients can't spend care, that intends that they mightiness not beryllium showing up to clinics," said Fonteno of nan National Abortion Federation, which had to cut its monthly fund astir successful half past year, from covering up to 50% of an eligible patient's costs to 30%.

"So seeing a benignant of diminution successful diligent volume, and past associated revenue, is decidedly thing that we've seen," Fonteno said.

Meanwhile, much clinics and abortion costs opportunity patients person delayed attraction because of those rising costs. According to a mini November-December 2024 survey of providers and funds conducted by ineedana.com, "85% of clinics reported seeing an summation of clients delaying attraction owed to deficiency of funding."

One abortion money said nan number of patients who've had to hold attraction until their 2nd trimester "has grown by complete 60%" spanning six months successful 2024.

The Planned Parenthood–Marquette Health Center closed successful April, on pinch 3 different wellness centers successful Michigan. Now, patients who request in-person attraction will request to thrust almost 5 hours to nan nearest Planned Parenthood clinic. Victoria Tullila for KFF Health News hide caption

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Victoria Tullila for KFF Health News

Even erstwhile non-abortion services for illustration commencement power and cervical crab screenings are covered by insurance, clinics aren't ever reimbursed for nan afloat cost, Thornton Greear said.

"The reality is that security reimbursement rates crossed nan committee are low," she said. "It's been that measurement for a while. When you commencement looking astatine nan costs to tally a wellness attraction organization, from proviso costs, etc., erstwhile you furniture connected these backing impacts, it creates a chasm that's intolerable to fill."

Yet, dissimilar immoderate independent clinics that person had to close, Planned Parenthood's nationalist federation brings successful hundreds of millions of dollars a year, nan mostly of which is spent connected argumentation and ineligible efforts alternatively than state-level aesculapian services.

The statement and immoderate of its authorities affiliates person besides battled allegations of mismanagement, arsenic good arsenic complaints astir staffing and diligent attraction problems. Planned Parenthood of Michigan staffers successful 5 clinics unionized past year, pinch some citing guidance problems and workplace and diligent attraction conditions.

Asked whether Planned Parenthood's nationalist backing building needs to change, PPMI CEO Thornton Greear said: "I deliberation that it needs to beryllium looked at, and what they're capable to do. And I cognize that that is actively happening."

The gaps that telehealth can't fill 

When nan Marquette clinic's closure was announced, dozens of patients voiced their concerns in Google reviews, pinch respective saying nan session had "saved my life," and describing really they'd been helped aft an assault, aliases been capable to get low-cost attraction erstwhile they couldn't spend different options.

Planned Parenthood of Michigan responded to astir comments pinch nan aforesaid connection and pointed patients to telehealth successful nan clinic's absence:

"Please cognize that closing wellness centers wasn't a prime that was made lightly, but 1 forced upon america by nan escalating attacks against intersexual and reproductive wellness providers for illustration Planned Parenthood. We are doing everything we tin to protect arsenic overmuch entree to attraction arsenic possible. We cognize you're sad and angry — we are, too.

"We cognize that telehealth cannot span each gap; however, nan mostly of nan services PPMI provides will stay disposable via nan Virtual Health Center and PP Direct, including medicine abortion, commencement control, HIV services, UTI treatment, emergency contraception, gender-affirming care, and yeast infection treatment. Learn much astatine ppmi.org/telehealth."

PPMI's virtual wellness halfway is already its astir celebrated clinic, according to nan organization, serving much than 10,000 patients a year. And PPMI plans to grow virtual appointments by 40%, including play and evening hours.

"For immoderate agrarian communities, having entree to telehealth has made important changes successful their health," said Wallett, PPMI's main aesculapian operating officer. "In telehealth, I tin person an assignment successful my car during lunch. I don't person to return other clip off. I don't person to thrust there. I don't person to find kid care."

Yet moreover arsenic nan number of clinics has dropped nationally, brick-and-mortar facilities still account for astir 80% of clinician-provided abortions, according to nan most caller #WeCount report looking astatine April-June 2024.

Hannah Harriman, a Marquette County Health Department caregiver who antecedently spent 12 years moving for Planned Parenthood of Marquette, is skeptical of immoderate proposal that telehealth tin switch a agrarian brick-and-mortar clinic. "I opportunity that those group person ne'er spent immoderate clip successful nan U.P.," she said, referring to nan Upper Peninsula.

Some areas are "dark zones" for compartment coverage, she said. And immoderate residents "have to thrust to McDonald's to usage their Wi-Fi. There are places present that don't moreover person net coverage. I mean, you can't get it."

Telehealth has its advantages, said Koskenoja, nan emergency medicine expert who antecedently worked for Planned Parenthood successful Marquette, "but for a batch of wellness problems, it's conscionable not a safe aliases realistic measurement to return attraction of people."

She precocious had a diligent successful nan emergency room who was having a complication from a gynecological surgery. "She needed to spot a gynecologist, and I called nan section OB office," Koskenoja said. "They told maine they person 30 aliases 40 caller referrals a month," and simply don't person capable clinicians to spot each those patients. "So adding successful nan load of each nan patients that were being seen astatine Planned Parenthood is going to beryllium impossible."

Koskenoja, Harriman, and different section wellness attraction providers person been strategizing privately to fig retired what to do adjacent to thief group entree everything from Pap smears to IUDs. The section wellness section tin supply Title X family readying services 1½ days a week, but that won't beryllium enough, Harriman said.

And location are a fewer backstage "providers successful municipality that connection medicine abortion to their patients only — very, very quietly," Harriman said. But that won't thief patients who don't person bully security aliases are stuck connected waitlists.

"It's going to beryllium a patchwork of trying to capable successful those gaps," Koskenoja said. "But we mislaid a very functional strategy for delivering this attraction to patients. And now, we're conscionable having to make it up arsenic we go."

This communicative comes from NPR's wellness reporting business with Michigan Public and KFF Health News.