What has India Done to Curb Unnecessary Hysterectomies?
May 30, 2023

Why in News?

  • The Union Health Ministry has recently urged State Governments to audit hysterectomy trends in public and private hospitals.
  • This was done in response to a Supreme Court petition arguing that women from marginalised locations are at risk of unjustified hysterectomies for economic gains and exploitation.

What’s in Today’s Article?

  • About Hysterectomy (Meaning, Criteria, Risks, etc.)
  • Hysterectomy in India (Data, Challenges, Government Initiatives, etc.)
  • News Summary

What is Hysterectomy?

  • A hysterectomy is a surgical procedure that removes the uterus (womb).
  • After surgery, woman can’t become pregnant and no longer menstruate.

Criteria for Getting a Hysterectomy:

  • After caesarean deliveries, hysterectomies are the second-most frequent procedure in women of the reproductive age group.
  • Reasons for this surgery include abnormal bleeding, uterine prolapse, fibroids and cancer.
    • In some cases, oophorectomy, the removal of ovaries (the primary source of oestrogen), is also frequently performed, which is a form of surgical menopause and linked to several chronic conditions.
  • The highest percentage of hysterectomies (51.8%) were to treat excessive menstrual bleeding or pain.
  • It's more common for women aged 40 to 50.

Health Risks Associated with Hysterectomy:

  • There is evidence about the long-term effects of hysterectomy – both with or without oophorectomy (removal of ovaries).
  • A 2022 study found a correlation between hysterectomy and chronic diseases including an increased risk of cardiovascular events, cancers, depression, metabolic disorders, and dementia.
  • In India, hysterectomies in women above 45 years of age were associated with hypertension, high cholesterol, diabetes and bone disease.

Hysterectomy in India:

  • The average age at which hysterectomies are conducted among Indian women is 34, per community-based studies.
  • In comparison, high income countries allow this procedure for women aged above 45.
  • Most surgeries happen in private hospitals (33,559 procedures) as opposed to government hospitals (11, 875).
  • A majority of these cases are reported among socially and economically disadvantaged women.

Challenges Associated with Hysterectomy in India:

  • Wombless Women –
    • Also, contractors in unorganised sectors such as the sugar-cane-cutting industry misuse hysterectomy, where ‘wombless women’ are the norm to eliminate the need for menstrual care and hygiene among workers.
  • Lack of Awareness –
    • The gap thrives in a culture where gynaecological care and disorders — outside of pregnancy — exist in oblivion.
    • Some reports show “rasoli” — indicating a tumour or growth— is often cited as a reason for hysterectomies in medical documents.
    • These may be benign growths, manageable by conducting investigative tests and undertaking alternative treatments.

What Measures has the Government Taken So Far?

  • Union Health Ministry Guidelines –
    • The Union Health Ministry in 2022 issued guidelines to prevent unnecessary hysterectomies — listing possible indications of when hysterectomy may be required and alternative clinical treatments for gynaecological issues.
    • They recommended setting up district, State-level and national hysterectomy monitoring committees which to collect data on age, mortality, and occupations, among other details.
    • In particular, the guidelines emphasise that authorities should report hysterectomies conducted for women less than 40 years of age and incorporate the reason for hysterectomy.
    • All States and Union Territories were asked to adopt the Guidelines within three months and report compliance to MoHFW.
  • Ayushman Bharat Pradhan Mantri Jan Arogya Yojana –
    • The government’s flagship health insurance programme provides health cover of Rs. 5 lakhs for 1,949 procedures— including hysterectomies.
    • The government has authorised more than 45,000 hospitals to conduct these operations and also developed two standard treatment guidelines for hysterectomy-related procedures.
  • Blacklisting of Certain Hospitals –
    • Under the Clinical Establishments (Registration and Regulation) Act, 2010, hospitals and healthcare facilities found to have coerced women into hysterectomies without informed consent can be blacklisted.
    • The Centre told the Supreme Court that several hospitals were blacklisted and FIRs were filed against facilities that violated norms.

News Summary:

  • A petition was filed in the Supreme Court w.r.t. Hysterectomy.
  • The petitionerargued that despite the provisions, private hospitals in Bihar, Chhattisgarh and Rajasthan engaged in unethical practices and unnecessary procedures.
  • The petitioner argued that that women from marginalised locations are at risk of unjustified hysterectomies for economic gains and exploitation.
  • The Chief Justice of India, Y. Chandrachud, suggested that hysterectomies for those under 40 should be conducted on approval by two certified doctors.
  • The Supreme Court, while hearing the petition, gave a three-month deadline to States and Union Territories, directing them to implement the guidelines issued by the Ministry of Health and Family Welfare in 2022.