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Published on Jul 11, 2022 Updated 12 Days ago
In light of World Population Day’s focus on individuals’ choices and rights, adequate policies should be adopted to create awareness amongst women about unwarranted hysterectomies.
Hysterectomies in India: Prevalence, problems, and policies

Prevalence of hysterectomies in India

Medical procedures are often viewed purely as physiological issues. It would be naïve to do so, given how inextricably linked they are to policy, gender, class, and other social markers. Hysterectomies—the partial or complete surgical removal of one’s uterus (sometimes one’s cervix and surrounding tissues)—are no exception. After the Caesarean section, hysterectomy is the most commonly performed surgery amongst women globally. Several countries that used to have high record of hysterectomy surgeries are reporting a decline, however, cases in India are on the rise. This warrants an analysis of the prevalence, causes, and consequences of the procedure in the country.

As for women above the age of 45, the Longitudinal Ageing Study in India (2017–18) found that around 11 percent of them have undergone hysterectomy operations.

The fourth National Family Health Survey (2015–16) was the first to collect unit-level data related to hysterectomy cases in India. Out of the 700,000 women between the age of 15-49 years surveyed, 22,000 of them had undergone a hysterectomy. While the overall prevalence in that age group stood at 3.2 percent, it was highest in Andhra Pradesh (8.9 percent) and lowest in Assam (0.9 percent). The number of cases was higher in rural India and a majority of the operations were performed in private hospitals. As for women above the age of 45, the Longitudinal Ageing Study in India (2017–18) found that around 11 percent of them have undergone hysterectomy operations. It is most prevalent in Andhra Pradesh and Punjab with 23.1 percent and 21.2 percent respectively, implying that at least one in every five elderly women underwent a hysterectomy. The prevalence of hysterectomies amongst women above 45 years of age was lowest in states in Northeast India.

Reasons for performing hysterectomy

Given the recent surge in hysterectomy operations in India, it is pertinent to ask why this is the case. The most commonly reported reasons include menstrual bleeding or pain, having fibroids or cysts, cervical dysplasia—a precancerous condition, pelvic inflammatory disease, an abnormal thickening of the uterine lining (endometrial hyperplasia), and sometimes cancer and postpartum haemorrhage. Yet, two phenomena, in particular, that are noteworthy. First, it is no coincidence that a major chunk of these surgeries takes place in private hospitals. To illustrate, while only 43 percent of the operations were performed in private hospitals before 1997, the number increased to 74 percent in 2016. Further, it is also not a coincidence that in the Northeast, where most surgeries are performed in public hospitals, the prevalence of hysterectomies is low. Research suggests that doctors in private hospitals sometimes prescribe the procedure even when a hysterectomy is not a necessity to gain profits. There are also cases of women, who are poor and illiterate, that are being conned into getting surgery by frauds posing as doctors or hospitals claiming treatment compensation from the state’s funds reserved for those hailing from lower socioeconomic backgrounds.

Research suggests that doctors in private hospitals sometimes prescribe the procedure even when a hysterectomy is not a necessity to gain profits.

Second, in rural areas, women are asked by their contractors to toil hard as manual labourers on farms on a daily basis, resulting in health problems. Since these women lack awareness and access to medical advice related to menstruation, doctors suggest hysterectomies—which are performed in response to a select few medical conditions and usually as a last resort—to purportedly remedy these conditions, even in extremely young women. A study conducted by the Thompson Reuters Foundation also shows that several families were forced to enter into debt traps because of the loans they took to pay for the unnecessary removal of the women’s uteruses. In the Beed district, Maharashtra, for instance, an unusually high rate of hysterectomies was recently reported, particularly amongst women who travel to neighbouring districts to cut sugarcane. Further investigation confirmed that the local doctor recommended hysterectomies to them after receiving complaints about menstrual cramps and vaginal discharge.

The silent cost of a hysterectomy

Performing unwarranted hysterectomies could be grave due to the side and aftereffects associated with it. A study conducted by the Maharashtra Legislative Council revealed that out of the 13,861 women in Beed who had undergone the operation, more than 45 percent of them experienced aching joints, back pain, depression, insomnia etc. Other studies suggest that post-operation, side effects like ovarian reserve reduction, increased incidence of heart disease, and early onset of osteoporosis, amongst several others, can be witnessed. Considerable weight gain after the surgery is also common, which impedes the agility of women and their capacity to work. Increased risk of diabetes has also been found to be linked to hysterectomy. These perilous effects raise questions about policy and legislation around operating in India.

The Federation of Obstetric and Gynaecological Societies of India—a professional organisation representing gynaecology practitioners—also launched a campaign in 2019 titled ‘Save the Uterus’ to advocate, and train doctors for non-invasive procedures to treat uterine and related issues rather than simply removing the uterus.

Policies and legislations

For one, to address the health scandal in rural India, the Central government set up task forces of government officials, health advocates, and other community representatives to spread awareness about unnecessary hysterectomies and track the number of hysterectomy cases across the nation. For another, as of 2019, the Indian Council of Medical Research (ICMR) had also been working on drafting stricter guidelines on the performance of hysterectomies in India. The Federation of Obstetric and Gynaecological Societies of India—a professional organisation representing gynaecology practitioners—also launched a campaign in 2019 titled ‘Save the Uterus’ to advocate, and train doctors for non-invasive procedures to treat uterine and related issues rather than simply removing the uterus. Further, as part of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, the Central government has reportedly been working on building IT systems that would indicate if hysterectomies were done sans sufficient approval and require further approval. Procedures like hysterectomies and Caesarean sections would also be performed in government hospitals under the scheme. Other scholars, however, have pointed out that this mandate would merely curb women’s access to the hysterectomy operation when required rather than tackle the actual issue of violating medical ethics by regulating the private sector. While these are commendable initiatives, little is known about how effectively they have been implemented and whether they have helped reduce the rates of unnecessary hysterectomies. It is needless to say that a woman’s rights over her body and her health and lifestyle must not, at any cost, be traded for economic benefits like profit or ‘labour productivity’. This becomes all the more important on this World Population Day, whose theme revolves around the need to uphold individuals’ choices and rights. Collecting continuous data on the issue, increasing awareness about the procedure, and implementing timely legislation is thus imperative to ensure that hysterectomies are a way for women to exercise their choice rather than hamper their being.
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