A new survey from the Guttmacher Institute reveals that poor women are obtaining abortions in greater numbers than women from other income brackets. From 2000 to 2008, “the proportion of abortion patients who were poor increased 59%,” as women found it more difficult to access affordable birth control during an economic recession:

The survey occurred during an economic recession, which may account for some of the substantial increase in poverty among abortion patients between 2000 and 2008…. More indirectly, recent studies have found that because of financial constraints, women want to delay childbearing or limit the number of children they have, but these same constraints have made it harder for them to access contraceptives and to use them consistently. In these situations, poor women may have found it more difficult than better-off women to obtain and use contraceptives and prevent unintended pregnancies. Additionally, when confronted with an unintended pregnancy during the recession, poor women who might have felt equipped to support a child (or another child) in financially stable times may have decided that they simply were not equipped to do so now.

Significantly, 57% of the women who had abortions paid out of pocket for the procedure, regardless of their insurance status. As Guttmacher observes, “We suspect that several factors contributed to the lack of reliance on private insurance among women who had it. First, some may have had health care plans that exclude abortion services…Others may have been unaware that their plan covered abortion. Some women may have been reluctant to have the abortion on their insurance records out of concern that an employer, regular health care provider or family member whom they did not want to know about the abortion would have access to this information.”

The results are fairly consistent with earlier surveys, which found that continued stigmatization of abortion — treating it as if it is something wholly different something different than “normal” health care — forces women to pay out of pocket and disproportionately disadvantages poor women, who undergo the procedure at higher rates. Ironically, the passage of health care reform — which will certainly help women obtain access to better health care — could indirectly undermine access to abortion coverage and increase the financial stress of poorer women. The Nelson amendment “reignited the abortion wars in the states” and “opened the door for them to legislate away private insurance coverage of abortion.” The next Guttmacher survey may very well find more women paying out of pocket for abortion coverage than ever before.

In November, the Preventive Task Force issued recommendations advising primary care physicians against recommending mammograms to women under 40 years of age. While the guidelines were the result of comprehensive scientific review of the benefits of mammogram testing for women under 40 and have no bearing on coverage decisions, Republicans presented the Task Force as a poster child of health care rationing and even introduced and approved an amendment that essentially disregarded the task force’s recommendation. Many Democrats also voted for the measure.

But now, a new study published in the Journal of National Cancer Institute confirms that politicians should not interfere with science. Researchers tracked the records of “more than 117,000 women who had their first mammogram before 40, and the results support today’s guidelines for average-risk women.” The study found that “in a theoretical population of 10 000 women aged 35–39 years, 1266 women who are screened will receive further workup, with 16 cancers detected and 1250 women receiving a false-positive result.” From the study:

In our population, a substantial percentage of young women [under 40] received screening mammography, but few breast cancers were found, regardless of their specific age, race, or individual characteristics. Yet, these women experience high recall rates with high rates of additional imaging. The sensitivity, specificity, and screening positive predictive value of screening mammography were poor, and cancer detection rates were very low in these young women, who are not yet in an age group for which national organizations recommend regular screening mammography. Harms need to be considered, including radiation exposure because such exposure is more harmful in young women the anxiety associated with false-positive findings on the initial examination, and costs associated with additional imaging.

Undoubtedly for some younger women, an early mammogram is a life saver, but for the majority, it’s an unnecessary test that raises stress levels and contributes to skyrocketing health care costs. Government guidelines can reflect this reality without constraining the doctor. She or he can use the recommendations as just one piece of data among many that could help guide physicians in treating individual patients.

After all, the system can’t accommodate a situation in which doctors order CAT scans for simple headaches or complicated surgeries for problems that can be solved with a regimen of medication, and politicians shouldn’t pretend it can (while also complaining about rising health care costs).