Patterns of hysterectomy in India: a national and state‐level analysis of the Fourth National Family Health Survey (2015–2016)

Abstract

Objective The National Family Health Survey‐4 in India provided the first nationally representative estimates of hysterectomy among women aged 15–49. This paper aims to examine the national and state‐level age‐specific prevalence of hysterectomy, individual and household level factors associated with the procedure, and state‐level indicators that may explain variation across states. Design Cross‐sectional, nationally representative household survey. Setting National Family Health Survey was conducted across all Indian states and union territories between 2015 and 2016. Population The survey covered 699 686 women between the ages of 15 and 49 years. Methods Descriptive analyses and multivariate logistic regression. Main outcome measures Women who reported ever having a hysterectomy and age at hysterectomy. Results Age‐specific prevalence of hysterectomy was 0.36% (0.33,0.39) among women aged 15‐29; 3.59% (3.45,3.74) among women aged 30‐39; and 9.20% (8.94,9.46) among women 40‐49 years. There was considerable variation in prevalence by state. Four states reported age‐specific prevalence similar to high‐income settings. Approximately two‐thirds of hysterectomies were conducted in private facilities, with similar patterns across age groups. At the national level, higher age and parity (at least two children); not having had formal schooling; rural residence (adjusted odds ratio [AOR] 1.36; 95% CI 1.27,1.45; P < 0.01) and higher wealth status were associated with higher odds of hysterectomy. Previously sterilised women had lower odds (AOR 0.64; 95% CI 0.61,0,68; P < 0.01) of reporting hysterectomy. Exploratory analyses suggest state‐level factors associated with prevalence of hysterectomy include caesarean section, female illiteracy, and women's employment. Conclusions Hysterectomy patterns among women aged 15–49 in India indicate the critical need to ensure treatment options for gynaecological morbidity and to address hysterectomy among young women in particular. Funding This study was part of the RASTA initiative of the Population Council's India country office under the Evidence Project supported by USAID. Tweetable abstract Hysterectomy patterns in India highlight the need for alternatives to treat gynaecological morbidity among younger women.

Indications and Prevalence of Hysterectomy for Benign Conditions at a Tertiary Care Hospital in Rural South India–A Descriptive Study

“…Excessive bleeding or pain was the most common reason for hysterectomy (56%), and the index study also has the indication of abnormal bleeding and pain abdomen as the common indications. It was found that more rural women in the age group 45-49 years were predisposed to undergo hysterectomy especially those without schooling, high parity and those living in east and south India (Desai et al, 2015) and this is consistent with the present study. This could be in turn due to either lack of awareness among these rural women or an unwillingness for a followup, thus getting subjected to an unnecessary procedure.…”

“…However, leiomyoma has remained the leading factor leading to hysterectomy in most of the cases, but with an increas-ing trend towards an acceptance of other conservative options. The NFHS-4 survey listed the prevalence, indications and trends of hysterectomy in India for the irst time (Desai et al, 2015). From the numbers obtained, it was analysed that India could be the country with the maximum number of hysterectomies.…”

Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery

“…The negative association between membership of the RSBY scheme and CS and lack of association with hysterectomy and CS surgery and the state insurance scheme, also found in other studies, 30 remains puzzling given that both form part of the respective insurance packages. One explanation is that since RSBY is largely a scheme for the poor, the negative effect of lower income over-ride any positive impact of holding insurance.…”

Robotic-Assisted Hysterectomy for Benign Indications of Uteri Less Than Fourteen Weeks Size Versus More Than Fourteen Weeks Size: A Comparative Study

“…Hysterectomy for benign diseases is the most common gynaecological surgery performed worldwide [ 1 , 2 ]. According to the National Family Health Survey (NFHS 4 survey 2015-16), in India, 6% of women in the age group of 30-49 years had undergone hysterectomy for heavy menstrual bleeding or chronic pelvic pain (56%), followed by fibroids (20%) [ 3 ].…”