Hysterectomy and Disability Among U.S. Women

Abstract

CONTEXT Hysterectomies are the second most common surgery performed on women in the United States, and most are done for elective reasons. Although women with disabilities appear to have an increased risk of undergoing the procedure, little research has evaluated the relationship between disability and hysterectomy. METHODS Data on 42,842 women aged 18 or older from the 2000, 2005 and 2010 National Health Interview Surveys were used to evaluate the relationship between disability and the risk of having a hysterectomy over the life course. Piecewise exponential event history models were estimated to identify associations between timing of disability onset, type of disability, and the occurrence and timing of hysterectomy. RESULTS Women with multiple disabilities experienced a higher risk of undergoing a hysterectomy than women with no disability (hazard ratio, 1.3), and this heightened risk was concentrated at younger ages. During their 20s, 30s and early 40s, women who had multiple disabilities were more likely to have had a hysterectomy than their same-age counterparts with no or one disability (1.3–2.4). Women with a single type of disability, as well as most women who had multiple disabilities and were aged 46 or older, were not at increased risk of having had a hysterectomy. CONCLUSIONS Additional research is needed to investigate why young women with multiple disabilities appear to face an increased risk of having a hysterectomy, especially because it is major surgery that can carry significant health risks.

Female Sterilization and Cognitive Disability in the United States, 2011–2015

“…Earlier studies have shown that women with any type of disability experience an increased risk of hysterectomy, 5 and young women with cognitive disabilities are at greatest risk. 5, 13, 15 A recent study of 42,842 women from the National Health Interview Survey found that young women with multiple disabilities, especially women ages 21 to 25 years of age, experience the greatest risk of hysterectomy compared to their counterparts with a single disability or no disabilities. This raises questions about whether hysterectomies are conducted out of medical necessity, or for reasons such as menstrual management, preventing pregnancy or childbearing.…”

“…This raises questions about whether hysterectomies are conducted out of medical necessity, or for reasons such as menstrual management, preventing pregnancy or childbearing. 5…”

“…Very few studies examined associations between disability, female sterilization and hysterectomy using nationally representative data. 5, 6 Using data from the 2011–13 National Survey of Family Growth, Wu and her colleagues 6 reported that among women ages 15 to 44 years, those with sensory or physical disabilities had higher odds (aOR 1.36, 95% CI 1.03–1.79) of sterilization than their nondisabled counterparts. 6 However, women with cognitive disabilities were excluded and the study could not make robust comparisons between groups because of sample size limitations.…”

Planning for Motherhood: Fertility Attitudes, Desires And Intentions Among Women with Disabilities

“…24 More recently, an analysis of the 2000, 2005 and 2010 National Health Interview Surveys found that women with multiple disabilities experienced higher risk of hysterectomy between ages 25 and 41 than women with one or no disability. 25 The focus on controlling women's reproductive capacity instead of supporting their reproductive desires is especially problematic given that health care providers are often unaware of the health care needs of women with disabilities, to the detriment of quality of care. 10,11,26 General medical care providers and obstetrician-gynecologists often lack understanding of the special needs created by women's disabilities, and specialists responsible for the care of disabling conditions are often unaware of women's fertility desires and the reproductive health issues that women with disabilities face during pregnancy.…”

“…Analysis of the 1992–1996 National Study of Women with Physical Disabilities found that women with physical disabilities had significantly higher rates of hysterectomy—and were more likely to have a hysterectomy for non–medically necessary reasons—than women without disabilities . More recently, an analysis of the 2000, 2005 and 2010 National Health Interview Surveys found that women with multiple disabilities experienced higher risk of hysterectomy between ages 25 and 41 than women with one or no disability . The focus on controlling women's reproductive capacity instead of supporting their reproductive desires is especially problematic given that health care providers are often unaware of the health care needs of women with disabilities, to the detriment of quality of care .…”