Article:
The Ministry of Health and Family Welfare in India has raised concerns over the increasing number of unjustified hysterectomies performed on impoverished and less-educated women, mainly in rural areas. This pressing issue requires immediate attention due to the high risk it poses on women’s health.
About Hysterectomy
Hysterectomy refers to a surgical operation that involves removing the uterus or womb—where a baby grows during pregnancy. There are three main types of this surgery:
1. Partial hysterectomy: Only the uterus is removed.
2. Total hysterectomy: Both the uterus and cervix are eliminated.
3. Radical hysterectomy: The procedure includes the removal of the uterus, cervix, part of the vagina, and a large portion of ligaments and tissues surrounding these organs.
In India, gynecological conditions like fibroids, endometriosis, abnormal bleeding, and pelvic inflammatory disease often lead to a hysterectomy when other treatment options fail. It’s also used as part of cancer treatment or as a remedy for severe or irresponsive pelvic pain.
The Rising Problem of Hysterectomy in India
Community-based studies reflect an alarming increase in the number of hysterectomies performed on women as young as 28 to 36 years. In contrast, developed nations usually conduct these surgeries on premenopausal women aged 45 and above.
The recent National Family Health Survey (NFHS)-5 data shows that 3% of women aged 15-49 have undergone a hysterectomy. The prevalence rate is highest in Andhra Pradesh (9%) and Telangana (8%), while lowest in Sikkim (0.8%) and Meghalaya (0.7%). The Southern and Eastern regions have higher rates than the national average, at 4.2% and 3.8% respectively. Meanwhile, the Northeast region shows the lowest prevalence at just 1.2%.
Unnecessary Hysterectomies: A Growing Concern
A Public Interest Litigation (PIL) filed in 2013 revealed that unnecessary hysterectomies are becoming a prevalent problem, particularly in states like Bihar, Chhattisgarh, and Rajasthan. Private hospitals were found to have performed these surgeries, putting women’s health at risk. The PIL exposed that about 70% of those who had undergone the procedure did so in private health facilities. It also highlighted misuse as healthcare institutions exploited the surgery to claim higher insurance fees under various government health schemes.
Efforts to Address the Issue
To combat this issue, the Supreme Court has directed all states and union territories to implement health guidelines formulated by the Centre. These guidelines aim to monitor and prevent unnecessary hysterecties within three months. The court acknowledged that these surgeries violate women’s fundamental rights, asserting that the right to health is an integral part of the right to life under Article 21 of the Constitution.
Furthermore, the Health Ministry released guidelines in 2022 to prevent unnecessary hysterectomies. They instructed states to comply and ensure the appropriate use of this surgical procedure. They recently also directed states to share data on the number of hysterectomies performed by medical institutions. An audit for all hysterectomies was suggested, similar to existing audits for maternal mortality.
Additionally, plans are underway to establish national, state, and district-level hysterectomy monitoring committees. A grievance portal is also proposed to address any issues related to this operation. These steps are aimed at providing the necessary checks and balances to curb the issue of unnecessary hysterectomies and prioritize the health of Indian women.