Why unwarranted hysterectomies are on the rise in India

A growing blind spot in women’s health was brought to light in 2019 when the problem of needless hysterectomies among female sugarcane cutters in Maharashtra’s Beed district first surfaced. Since then, several regions of India have seen an increase in the number of these procedures. The most recent National Family Health Survey indicates that 3.3 per cent of all women in the country between the ages of 15 and 49 have had a hysterectomy. Thus, in April this year, the Supreme Court ordered the government to take strict action against medical professionals who perform unnecessary hysterectomies in hospitals and clinics, according to The Hindu. But what is a hysterectomy? What are the issues around it? Why are the numbers increasing in India? Let’s look more closely. The procedure of hysterectomy A hysterectomy is a surgical procedure to remove the womb (uterus) and the cervix, according to the National Health Service (NHS) of the United Kingdom. Women who undergo this surgery don’t experience menstruation or pregnancy as a result. It is also referred to as surgical menopause in medical terminology. Hysterectomies are performed to treat conditions affecting the female reproductive system, such as heavy periods, chronic pelvic pain, non-cancerous tumours (fibroids), ovarian cancer, womb cancer, cervical cancer, or fallopian tube cancer. [caption id=“attachment_12717092” align=“alignnone” width=“640”] Over 3.3 per cent of all Indian women between the ages of 15 and 49 had undergone hysterectomies. Pixabay[/caption] It is a serious procedure with a lengthy recovery time and ought to only be performed as a last option when all alternatives have failed. When women are pregnant, a baby develops in the womb. The health of the woman is negatively impacted by hysterectomy since it may cause, among other things, hormonal imbalance, calcium deficiencies, and chronic bodily aches, according to India Times. The figures are increasing In 2019, reports of unjustified hysterectomies from several states, particularly Maharashtra's Beed, shocked the nation. After three years, there is still no change. Over 3.3 per cent of all Indian women between the ages of 15 and 49 had undergone hysterectomies, according to the National Family Health Survey. Andhra Pradesh (nine per cent) and Telangana (eight per cent) had the highest rates of hysterectomy, respectively, according to NFHS data. Sikkim and Meghalaya have the lowest rates with 0.8 per cent and 0.7 per cent, respectively. The Eastern area of India has the second-highest prevalence of hysterectomy with 3.8 per cent, trailing only the Southern region with 4.2 per cent. With a rate of just 1.2 per cent, the Northeast has the lowest rate. Concerning tendencies have been observed over time in terms of age, region, social and economic background, and aim, according to health professionals. According to surveys performed in the community, Indian women undergo hysterectomies on average at the age of 34. Hysterectomies are normally performed on premenopausal women aged 45 and older in industrialised nations, but community-based research in India has found a rising trend of hysterectomies in younger women, between the ages of 28 and 36, according to Times of India. The Times of India reports that the government has authorised 45,434 hospital admissions totalling Rs 126 crore for hysterectomy-related treatment since the world’s largest publicly funded health assurance scheme, Ayushman Bharat PM-Jan Arogya Yojna, was introduced in 2018. It offers health coverage of Rs 5 lakh per family per year to 12 crore families. Surprisingly, the Union Government said private hospitals do 33,559 more surgeries than government hospitals do (11.875), as of March this year. 70 per cent of women who get hysterectomies in private medical facilities were discovered to be involved in these unneeded treatments, according to research on private hospitals. The exploitation of the process was also noted, as medical facilities took advantage of it to demand higher insurance premiums under various government healthcare programmes, according to The Hindu. The appeal to the Supreme Court contended that most of the women belonged to Scheduled Castes, Scheduled Tribes, or Other Backward Communities. According to The Hindu, the procedure is also easily abused, either by contractors working in unorganised industries like the cutting of sugar cane, where “wombless women” are the norm to eliminate the need for workers to take care of their periods and practise proper hygiene, or by private clinics looking to profit from insurance money. Many influences In a 2020 study titled Crushed Hopes on Beed hysterectomies, the authors highlighted that rules governing private clinics, particularly in remote regions, were not well-implemented, that awareness of the technique for removing the uterus was low, that gynaecological services were lacking, and that there were no established protocols. The Hindu cited a 2017 study titled Incidence and determinants of hysterectomy in a low-income setting in Gujarat, India noting that the majority of the women believed that removing their uteruses would cure their health problems because the uterus had no function other than pregnancy. While a different 2019 study discovered that women from rural areas view hysterectomies as a means to lengthen their productive workweeks and increase their pay. The district is primarily populated by migrant workers, sugarcane cutters, and small-scale farmers. These folks move seasonally in the direction of the sugar belt. According to Saroj Shinde’s Insights on the Practice of Hysterectomy among the Women Sugarcane Cutters in Maharashtra (India), they, particularly women, encounter various issues after migrating and working in the fields for more than 12 to 13 hours a day. [caption id=“attachment_12717132” align=“alignnone” width=“640”] Unnecessary hysterectomies cause premature menopause, which frequently renders women disabled and unable to work. They also place a tremendous financial burden on the families of the women. Pixabay[/caption] As shown in ARTE’s Hysterectomies in India documentary, the women frequently complain of stomach aches as a result of their heavy loads, prolonged work in direct sunlight or bad weather, poor nutrition, lack of access to hygienic care while they are menstruating, and inadequate postpartum care. The women must constantly overwork as a result of the severe financial situation in order to survive. The surgeries are generally conducted by the women out of fear and to relieve their agony, but this frequently leads to major health risks like abdominal pain, vaginal infections, cervical issues, and cancers at the tender age of 20 to 30. In 2015, it was discovered that four hospitals were involved in a large scam involving the removal of the uteri of over 2,200 women from underprivileged communities in Karnataka. The health department then claimed in a report that the hysterectomies were unnecessary. Serious consequences of removing the uterus According to The Hindu, there are significant medical and economic repercussions associated with uterine loss. Unnecessary hysterectomies cause premature menopause, which frequently renders women disabled and unable to work. They also place a tremendous financial burden on the families of the women. As per NHS, other possible complications include general anaesthetic complications, bleeding, ureter damage, bladder or bowel damage, infection, blood clots, vaginal problems, and ovary failure. Studies looking at whether having a hysterectomy increases your chance of developing conditions like heart disease and diabetes have produced conflicting findings, with some pointing to potential associations and others stating that more study is required to draw firm conclusions. The Hindu reported, following a hysterectomy, women typically gain weight and many of them will also have had their ovaries removed, which causes significant post-menopausal symptoms. Also read: Committee set up to probe hysterectomies in Maharashtra’s Beed; 4,600 women in district underwent womb removal surgery since 2016 The action The government was compelled to take action by establishing several monitoring committees as a result of Dr Narendra Gupta v. Union of India lawsuit that was brought before the Supreme Court in April, notably by doctors who were abusing women from lower socioeconomic backgrounds. This isn’t the first time the issue came to light, as a public interest litigation (PIL) was also filed in 2013. According to the PIL, women in the states of Bihar, Chhattisgarh, and Rajasthan were forced to have needless hysterectomies, endangering their health. According to Livelaw, in response to the PIL which alleged forcible hysterectomy procedures being carried out in Bihar, Chhattisgarh, and Rajasthan, the Supreme Court ordered the states and union territories to implement the health regulations developed by the Centre to oversee and obstruct such practices. These recommendations must be put into effect within three months, according to the court’s order. In accordance with Article 21 of the Constitution, it acknowledged that unnecessary hysterectomies are a violation of women’s fundamental rights and that the right to health is a crucial component of the right to life, according to India Times. It also directed that stringent action should be taken to “blacklist hospitals once it is detected that any unnecessary hysterectomy was carried out or that the procedure was taken recourse to without the informed consent of the patient,” reported Livelaw. In addition, the Court recommended a course of action that included the formation of hysterectomy monitoring committees at the federal, state, and local levels as well as a complaints site. Additionally, the Health Ministry released guidelines in 2022 to prevent unnecessary surgeries, ordering states to follow them to ensure proper utilisation of hysterectomies. For those who had hysterectomy benefits, the government also suggested a complaints site that would be overseen by the National Hysterectomy Monitoring Committee. Recently, the ministry ordered states to exchange information regarding hysterectomies carried out by healthcare facilities. The ministry has also recommended requiring mandatory audits for all hysterectomies, much as the audits being carried out for maternal mortality, as per India Times. These regulations are designed to encourage responsibility and guarantee the proper and justifiable use of hysterectomy operations. With inputs from agencies Read all the  Latest News,  Trending News,  Cricket News,  Bollywood News, India News and  Entertainment News here. Follow us on  Facebook,  Twitter and  Instagram.