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Women’s health doctor in Bozeman reflects on decision to close clinic, abortion access in Gallatin Valley

Dr. Claire Putnam is a private practice women’s health doctor in Bozeman. She's closing her doors on Sept. 6 after four years.
Dr. Claire Putnam is a private practice women’s health doctor in Bozeman. She's closing her doors on Sept. 6 after four years.

Bozeman’s only provider of elective abortions recently announced she is closing her doors next month after four years.

Dr. Claire Putnam opened her private women’s health clinic SHE Health & Wellness in 2018, and while she says abortions were a small part of her overall practice, her departure leaves a gap in service in the Gallatin Valley. Bozeman Health and Billings Clinic’s Bozeman location do not provide elective abortions, and the nearest Planned Parenthood Clinic is in Helena.

Putnam says she does between 4-8 abortions per month. She says more than half of patients seeking abortions are referrals from doctors at Bozeman Health. Providers there perform abortions only if the mother’s life is in danger.

Bozeman Health declined to be interviewed, but a spokesperson said the health system is currently reviewing its reproductive health policy as part of a routine review of its policies.

Dr. Putnam spoke with Yellowstone Public Radio’s Olivia Weitz about the state of abortion access in Montana, the need for comprehensive women’s health care, and what went into her decision to close.

This interview has been edited for length and clarity.

Olivia Weitz: There isn't a Planned Parenthood in Bozeman. Bozeman Health does not provide elective abortions. Since you've been open in 2018, you've been the only provider in Bozeman providing elective abortions. I'm wondering what went into your decision to close?

Dr. Claire Putnam: When I'm closing, I'm saying that I cannot financially do this anymore on one level. I mean there are many factors for me closing, one big arm of that is the financial arm.

My medical malpractice as an OB-GYN, and a lot of people don't know this, OB-GYNs have the highest level of medical malpractice of any doctor specialty, higher than surgeons, orthopedists brain surgeons, but our salaries or what we’re paid is not as high as the ones. So, we have a very high medical malpractice burden with not the salary to support that. And mine specifically as a solo doctor having to go out and say, I need medical malpractice to cover me individually is a lot higher than it would be if I were to be in a group or at the hospital. When the hospital has to pay for an OB GYN, they get a group discount and they can negotiate that. I don't have that power as a solo doctor.

Also, right now we have a huge shortage of medical supplies and access to them, things like lidocaine for our office is a national shortage.

You've operated SHE Health since 2018, what has it been like providing abortion care in Bozeman, in Montana, these last few years?

When I came to this community, I was really surprised as everyone else really was that there wasn't someone here or a clinic doing that kind of care and you know, like Planned Parenthood, and that there was no option really in the community. It was a shock to me because it's a college town. It's a growing town. It's legal in Montana. Why is it not in this town? And so I sort of felt somebody better step in a little bit and help with these patients.

So you're the only private practice women's health doctor in Bozeman, and I'm wondering what sort of role I know that you do a lot of other things, you know, routine checkups, birth control, that sort of thing, I'm wondering what role abortions play in your overall women's health practice, and in what kind of instances do you do you provide abortions to women who come to your clinic?

I wanna really be clear with everyone that abortion to me is a very small part of what I do. And in general, I would rather not do any, honestly. I would like to have a situation where there is no need for women to come in for abortions or elective abortions if you wanna call them.

There's a lot of distinction around abortions and there are a lot of different types of abortions. There are abortions that really if you don't do an abortion, you're going to lose the mother and the baby. People don't know this. People really don't know what abortions are and the different types of them. But there are situations where a mother has broken her bag of water for instance at 20 weeks and that baby will not live outside of the womb.

And I've had these patients, right, and I say, ‘I'm so sorry. This baby isn't gonna develop. You can't carry this baby and this baby isn't gonna work out for you and we need to take the baby out so that you can clean your uterus. It won't get infected, and so that you can go on to maybe have a healthy baby next time.’

Just for my own understanding, when people say elective abortions, I guess what I'm picturing, and maybe I'm not having the right perception, but it's that it's women who don't want their baby anymore, but you're saying that that's not really it: there's some sort of issue with the fetus or with the women's, how it may impact her, in those situations that’s really what you’re providing. Can you define elective abortion?

When I say I'm doing elective abortions in my clinic, I am saying that I have patients who are coming to me either with health issues, with situational issues, with birth control failures, with rape with, I don't think I've seen incest in my office here, with complications because they're on a medication that would make their baby abnormal. And they are seeking my services to have their pregnancy ended. And most of that is done with medication in my office at an earlier gestation.

The Montana Republican party is seeking to ban abortions in all instances, without exceptions. Governor Greg Gianforte has said he wants to ban abortions. I'm wondering if that comes into effect, what could that mean for women's healthcare in Montana?

It will throw us into even a further crisis of lack of access and poor and worsening community health of our women and all of our health, the children, our doctors, and it will create a mental health, additional mental health strain on every aspect of our community.

I think a ban is a decision that would come out of no understanding of what truly abortion is.

I think it shouldn't come from a governor or a legislature. If you really want to try and enact a ban, I think you need to ask the people directly of the state and have the people say, yes, we understand what abortion is, and we are gonna make this decision for all of us.

I think that's really important that legislatures should not be defining what should be banned or these kind of decisions. I think you should leave those decisions to doctors, a panel of experts, who know the ins and outs of this, and add in people from the religious and faith community to come into those discussions and bring in people from the public who don't really know and bring in people who have, you know, perspectives together to make decisions for what should be and what shouldn't be.

After your clinic closes in September, what are women's options in Bozeman and where might they be referred if they were in the situation seeking an abortion?

If patients need abortions going forward, I'm directing them to call the Planned Parenthood network or to call Blue Mountain Clinic.

With me closing, I'm just creating another deficit in this community, and I'm abandoning the needs of the community in a way. And I'm sorry for that.

I hope to continue to do all the work that I do for women, hopefully somewhere in Montana, but I'm not sure yet. And I also hope to continue the discussions and have the opportunity to explain women's health care and the needs and to talk about these difficult issues and why they are necessary. And also to try and help promote programs that could be used in place of a ban to help, as we all want, decrease the number of abortions that are needed or done.

And what are some of those (programs) that you're looking at? 

Well, I think one program that would be fantastic is to have free walk-in sort of birth control clinics, not only in Montana, maybe mobile units as well and nationally.

We think that, yeah, everybody has insurance and everybody can get birth control, and it's irresponsible for them not to use birth control, but that's really a myth. I would like to continue to expand the access for birth control and education around that.

I'd like to also really take a look at how we support adoption and that option for adoption. I feel like there's not been a lot of discussion about how to, you know, somehow compensate a woman who's in a pregnancy that she herself can't take care of. But, then there's a family over here where they would really love to have a child and they can't have one themselves and they would like to adopt.

I also think there's a big role in trying to do genetic testing and figuring out trying to help women understand how to find out if this is a pregnancy that will be turned into a child that will be without suffering and without severe abnormalities going forward, so they can make that decision sooner.

I think, you know, at the basis of it all, what we all want is for women to have good health care access and to use birth control that works for them and to have the option of having babies, if they want that. And to not be in a predicament where they're, you know, in a situation where that pregnancy is either gonna cost their own life, their own social situation and wellbeing, trauma or bringing in a life that is such a hardship both for the family and for the child itself. Anyone who really examined it would agree.

Olivia Weitz covers Bozeman and surrounding communities in Southwest Montana for Yellowstone Public Radio. She has reported for Northwest News Network and Boise State Public Radio and previously worked at a daily print newspaper. She is a graduate of the University of Puget Sound and the Transom Story Workshop.