I used to work at Blue Cross Blue Shield of Maine when Jack Wennberg was doing his original “small area variation” work. He used our claims file and discovered among other things that women in Lewiston, Maine were (if I remember correctly) seven times more likely than women in nearby Wiscassett to get a hysterectomy during the course of their lifetimes.

Of course, the thing Jack didn’t understand is that Lewiston is heavily French Canadian and Catholic, while Wiscassett is almost entirely Protestant.

The ladies of Lewiston were using hysterectomies as a form of birth control that was acceptable to the Church.

Researchers often ignore cultural differences when making assessments like these. Is it really so awful that, after having six or eight kids, a woman might want to stop without risking eternal damnation?

Greg Scandlen
Consumers for Health Care Choices
The Heartland Institute