Planned Parenthood is hoping more telehealth and virtual visits for reproductive health care will offset the damage from the closure of four Minnesota clinics, announced in response to federal budget cuts and other pressures.

Clinic closures in Iowa a decade ago became associated with an increase in sexually transmitted diseases, but the goal now is to avoid similar public health consequences, said Ruth Richardson, chief executive of Planned Parenthood North Central States, in one of her first interviews since Friday's closure announcement.

"We will look different. We will have less brick and mortar, but we're thinking really strategically about the ways that we will be able to meet the needs of our patients into the future," said Richardson, whose organization provides abortions and reproductive health education and services, including prescriptions, in Minnesota, Iowa, Nebraska and the Dakotas.

Closures that will take effect by July 1 include Planned Parenthood clinics in Apple Valley and Richfield in the metro area, and Alexandria and Bemidji in northwest Minnesota. Three Iowa clinics also are being shuttered by Planned Parenthood, which anticipates more federal funding cuts from President Donald Trump's administration beyond the freezing of $2.8 million in Title X funds. That funding covered services for patients who otherwise couldn't afford them.

The downsizing includes 66 layoffs and reassignment offers to another 37 workers.

None of the shuttered clinics performed surgical abortions or prescribed abortion medications. The facilities largely provided access to contraception, STD testing and pregnancy planning. Abortions remain available in Minnesota at Planned Parenthood's St. Paul headquarters and through online appointments with its Rochester clinic.

Richardson said Planned Parenthood already was facing challenges, including low reimbursement rates from the state-federal Medicaid program that covers about 30% of its patients. The organization had opened numerous satellite clinics over the past decade to improve access, but many patients have since turned to online care for routine visits and refills of prescription contraceptives.

Then came the cuts this year, starting with the loss of Title X funds and proposed Medicaid cuts that would reduce the number of people who could afford any health care, not just reproductive health. Planned Parenthood remained financially stable during the challenges of the COVID-19 pandemic, reporting a 5% revenue margin of $3.6 million in the fiscal year that ended June 2023, but Richardson said the organization was in jeopardy without changes.

"There are bills that are working their way through the federal government that would completely defund Planned Parenthood," Richardson said, "and that's also on top of the challenges that have only gotten worse with the Dobbs decision in 2022."

That decision by the U.S. Supreme Court ended nationwide protections for abortion access and led lawmakers in border states such as Iowa to ban most abortions or severely restrict access. Minnesota preserved abortion access, and Planned Parenthood clinics in the state saw an increase in patients as a result.

The state reported a 16% increase in annual abortions in 2023, fueled largely by more women traveling to Minnesota from other states. Planned Parenthood in 2020 performed 72% of abortions in Minnesota, but the emergence of abortion medications and online providers has changed the market. The organization performed just over half of the state's abortions in 2023.

Richardson acknowledged that the closure of two outstate clinics exacerbates the problem of "health care deserts" where patients have less access, but she said it is proving increasingly difficult to staff clinics in smaller towns.

Planned Parenthood has invested in online clinic options to maintain care for as many existing patients as possible, she said, and renovated clinics in Eden Prairie and other locations so they can serve as regional hubs in the absence of the smaller sites.

The provider also added services such as menopause management and fertility treatments in response to patient demand, and could add maternity care as well.

One goal is to avoid the disruptions that occurred in Iowa a decade ago, when gonorrhea infections increased statewide after closure of some family planning clinics, according to a federally funded research study.

After years of record increases, Minnesota reported a decline in 2024 in cases of gonorrhea and chlamydia — suggesting efforts to reduce the sexually transmitted infections were working. The University of Minnesota will present data early next month showing whether the state continued in 2023 to reduce teen pregnancies, which have declined by 70% in Minnesota since 1990.