Explained: What Is A Hysterectomy And Concerns Related To It In India

The Union Ministry of Health and Family Welfare has taken action to address the problem of unjustified hysterectomies, particularly affecting poor and less-educated women living in rural areas. The ministry is concerned about the high risk faced by these women and has implemented measures to tackle the issue.

What is a hysterectomy?

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A hysterectomy is a surgery to remove a woman's uterus or womb, which results in no menstrual periods and no pregnancy in operated women. In medical terms, it is also known as surgical menopause. Usually, the whole uterus is removed during the surgery but only fallopian tubes and ovaries can be removed.

The womb is where a baby grows when women are pregnant. Hysterectomy adversely impacts the woman¡¯s health as it could lead to hormonal imbalance, calcium deficiency and constant body aches, among other things.

Andhra Pradesh has the highest numbers

According to the most recent National Family Health Survey (NFHS) data, 3% of women aged 15-49 in India have undergone a hysterectomy. The highest prevalence of hysterectomy is found in Andhra Pradesh (9%) and Telangana (8%), while the lowest rates are in Sikkim (0.8%) and Meghalaya (0.7%).

The Southern region of India has the highest prevalence of hysterectomy at 4.2%, followed by the Eastern region at 3.8% and with only 1.2% Northeast region has the lowest.

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Hysterectomy is performed in India to address various gynecological conditions such as fibroids, endometriosis, abnormal bleeding, and pelvic inflammatory disease when other treatments have failed. It is also used as part of cancer treatment to remove cancerous tissues and in cases of severe and unresponsive pelvic pain.

What are the concerns related to it?

The increase in hysterectomies among younger women is a significant issue in India, as highlighted in the recent Supreme Court case of Dr. Narendra Gupta vs Union of India in 2023.

While developed countries typically perform hysterectomies on premenopausal women aged 45 and above, community-based studies in India have revealed a rising trend of hysterectomies in younger women, ranging from 28 to 36 years old.

A public interest litigation (PIL) filed in 2013 drew attention to the problem of "unnecessary hysterectomies" in India. The PIL revealed that women in the states of Bihar, Chhattisgarh, and Rajasthan were subjected to hysterectomies that were deemed unnecessary, putting their health at risk.

Private hospitals were found to be involved in performing these unnecessary procedures, with 70% of women undergoing hysterectomy in private health facilities. The misuse of the procedure was also observed, as healthcare institutions exploited it to claim higher insurance fees under different government healthcare schemes, reports The Hindu.

Is there any action against it?

According to The Hindu report, in response to a PIL, the Supreme Court directed states and union territories to adopt health guidelines created by the Centre to monitor and prevent such procedures. The Court mandated the implementation of these guidelines within three months.

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It acknowledged that unnecessary hysterectomies violate women's fundamental rights, recognising the right to health as an integral part of the right to life under Article 21 of the Constitution.

The Court also suggested an action plan, including the creation of national, state, and district-level hysterectomy monitoring committees, as well as the establishment of a grievance portal.

Further, the Health Ministry issued guidelines to prevent unnecessary procedures, instructing states to comply with them to ensure appropriate usage of hysterectomies.

Recently, the ministry has directed states to share data on hysterectomies performed by medical institutions. Additionally, the ministry has advised conducting compulsory audits for all hysterectomies, similar to the existing audits conducted for maternal mortality.

These measures aim to promote accountability and ensure the appropriate and justified use of hysterectomy procedures.