A ‘niche’ service is optional; health care is not

By Jen Jackson Quintano
Reader Contributor

Women’s health care in Bonner County is having a rough go and, by extension, so are patients. Yet, instead of seeing access to care for half our population as an ethical imperative, some public officials seem ready to wash their hands of reproductive health care entirely.

That reality was laid bare when Panhandle Health District Medical Director Gregory Pennock described women’s health care as a “niche” service during a recent discussion of PHD’s clinical audit with the Bonner County Board of Commissioners. After noting that 70% of clinic patients are now female, he said, “Women’s health care, gynecology, family planning — that is the niche that we’re currently serving,” adding, “whether we should be or not.”

Let that equivocation sink in. It frames essential health care for most clinic patients as discretionary. As if cervical and breast cancer screenings were an extravagance. As if sexually transmitted infection treatment were an unfortunate matter that should really be handled by someone else. As if the health of women is, at best, a frivolous matter and, at worst, immoral.

This seems less a conversation about service delivery than it is a statement about community values, and it’s hard to square with Boise State’s recent Idaho Public Policy Survey, which found that six in 10 Idahoans support a ballot measure protecting private reproductive decisions and care.

In response, Commissioner Ron Korn remarked that PHD’s current services “sound a lot like Planned Parenthood.” He went on, “I don’t want to be responsible at a county level to look like we’re funding a Planned Parenthood service.”

By invoking conservatives’ favorite whipping post, Korn exposes the equation underpinning Pennock’s equivocation: Abortion is bad. Planned Parenthood provides abortion. Therefore, Planned Parenthood — and everything it offers — must be bad. This is stigma by association, and all women’s health care suffers for the supposedly unsavory company it keeps, though PHD does not, and has never, provided abortions.

Abortion is so freighted with decades of legislative moralizing that it’s become a singularity dense enough to draw all adjacent matters into the abyss. The whole of women’s health care is more than adjacent; it’s intertwined. Abortion is one of its essential procedures, something providers use to treat nonviable pregnancies, severe infections and other urgent medical complications. It turns out you can’t vilify, stigmatize and criminalize a single pillar of health care — one that a quarter of all women will need in their lifetimes — without the entire edifice crashing down.

“Defund Planned Parenthood” has been a rallying cry for the right for years, their preferred pathway to blocking abortion access. However, Planned Parenthood isn’t an abortion boutique; instead, it’s a one-stop shop for all your reproductive health needs. According to the organization’s 2022-2023 annual report, abortion makes up only 4% of all health services provided. The overwhelming majority of clinic visits are instead for STI testing, contraception and cancer screenings. Thus, Planned Parenthood (like all reproductive care clinics) is supporting people’s well-being, regardless of means, not single-handedly destroying American civilization.

Yet Pennock and Korn view the care of vaginas, uteruses and ovaries as a political hazard, perpetuating the stigmatization of women’s bodies and sexuality. Such resistance is less about anatomy than it is about morality. The message: Women’s bodies are just as much the birthplace of sin as they are of babies. Better to control those bodies than to care for them.

PHD’s mission statement leads with the imperative “to prevent disease, disability [and] premature death.” However, if your disease, disability or death is derived from sex — and you’re a woman — you’re somebody else’s problem, in a place with few others to turn to. 

This debate comes nearly three years after Sandpoint lost all four OB-GYNs, along with most local reproductive health services. Many people focus on the impacts to birthing, but the fallout extends far beyond delivery: no care for endometriosis or uterine prolapse, no cervical or uterine biopsies, no hysterectomies and months-long wait times for routine hormonal or gynecologic care from a health care system now stretched dangerously thin. 

If PHD stops serving the “niche” of women who flocked there after other gynecologic services disappeared, where will these patients go? How will they afford care? Does the rest of Bonner County share Pennock and Korn’s dim views about caring for the body parts from which we all emerged?

Based on a recent gathering facilitated by The Pro-Voice Project, the answer is, “No.” On January 22, over 50 people convened at the East Bonner County Library’s Sandpoint branch to discuss the dearth of women’s health care here, concerned about politicization and a lack of a plan to rebuild access. The crowd spanned ages and ideologies, genders and backgrounds, and included regional clinicians dedicated to this care. In light of the numbers and passion present in the room, women’s health seemed less a niche concern and more a necessity: one worth fighting for.

Here’s what our community understands that some state legislators and local officials seem to have lost sight of: Women’s bodies aren’t partisan. Our health isn’t an issue of vanity or morality, and we are not receptacles for any outside influence — be it semen or sermonizing — without explicit consent. We are human beings, much beloved by family and friends, much needed by this community, and neglecting our well-being impacts everyone’s thriving. 

The group that gathered for PVP’s “OB-GYN Care on the Line: A Community Conversation” was ideologically diverse, yet united in one belief: Women deserve accessible, compassionate, quality health care. We may differ on how that care is delivered or by whom, but those differences make conversation, collaboration and the search for congruence essential. As Chuck Palahniuk writes, “All souls come here to rub the sharp edges off each other. This isn’t suffering. It’s erosion.”

Let’s erode our shame and discomfort and see what we uncover. Rather than dismiss women’s health care wholesale, let’s do the essential work of dreaming something better amidst the current disarray. Rural hospitals like ours are hanging on by the most tenuous of threads, and further Medicaid cuts will make things worse. Provider shortages are deepening, amplified by abortion restrictions and dwindling recruitment. Political attacks on reproductive care are muddying the waters, distracting us from solutions and deepening stigma that only serves to harm women. Let’s write a new chapter now, before the current one gets worse.

So much in the world is beyond our control, but this story is not. Health care is a shared responsibility, and it is within our influence, if only we add our voices to the mix. Thus, the first step is simple: We share the stories of why reproductive health care matters. Only then can we engage PHD, elected officials and regional providers not with shame, but with clarity about our needs and worth.

I invite you to continue the conversation. “OB-GYN Care on the Line” is poised to become a series, allowing us to work together, thinking outside the box — and beyond the stigma — about the kind of reproductive health care Bonner County deserves. If you’re interested in joining us, email me at [email protected].

Let’s move the conversation from whether women deserve full-scope health care to how we provide and safeguard it.

Jen Jackson Quintano writes for and runs The Pro-Voice Project, a reproductive rights organization, in Sandpoint.