Prevalence, sociodemographic determinants and self-reported reasons for hysterectomy in India

Abstract

Background Evidence of hysterectomy in India is limited mainly due to lack of information in large-scale nationally representative health surveys. In 2015–16, the fourth National Family Health Survey (NFHS-4) – a cross-sectional survey – collected for the first time direct information on hysterectomy and self-reported reasons for undergoing the procedure among women in the reproductive age group. This paper examines the prevalence and determinants of hysterectomy in India among women aged 30–49 years in 29 states and seven union territories (UTs) of India using the NFHS-4 dataset. Methods Percentage weighted by sampling weights was used for estimating the prevalence of hysterectomy. The paper used crosstabulations and percentage distributions to estimate the prevalence of hysterectomy across different socioeconomic backgrounds and reasons for undergoing hysterectomy respectively. A multivariate binary logistic regression model was also used to find statistically significant determinants of hysterectomy. Results In India as a whole, 6 % of women aged 30–49 years had undergone a hysterectomy. The percentage of women who had undergone the procedure was found to vary considerably across the states and the UTs (from a minimum of 2% in Lakshadweep to a maximum of 16% in Andhra Pradesh). A noticeable fact that emerged was that the majority of the hysterectomies were performed in the private sector except in the northeast region. Years of schooling, caste, religion, geographic region, place of residence, wealth quintiles, age, parity, age at first cohabitation, marital status, and body mass index of women were found to be the sociodemographic determinants statistically associated with hysterectomy in India. The reasons reported frequently for hysterectomy were excessive menstrual bleeding/pain (56%), followed by fibroids/cysts (20%). Conclusion The percentage and likelihood of undergoing hysterectomy are relatively high among women from older age groups (45–49), those who reside in rural areas, those without schooling, those who are obese, those having high parity, those with a low age at first marriage, and those who reside in the eastern and southern parts of India. The policy implication of these findings is that the reproductive health program managers should ensure regular screening and timely treatment of the problems resulting in hysterectomy.

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

“…Higher education, however, is less influential, a finding borne out by another study in India reporting higher hysterectomy rates among uneducated, rural women. 11 Turning to sterilisation, economic status is not a strong predictor for prevalence but our results indicate that those with at least secondary education are less likely to be sterilised. Within groups, even after adjusting for distance and socioeconomic factors, CS rates are still higher among non-tribal compared with tribal women, a finding supported by a recent study in western India.…”

Hysterectomy and Oophorectomy in Reproductive Age: A Cross-Sectional Study from a Tertiary Care Hospital

“…It is estimated to be 20.7/1000 women-years in India [2], which is higher than in Western countries, including the United States (5.1/1000), Australia (4.7/1000), and Germany (3.6/1000) [14][15][16]. In the West, a decreasing trend of hysterectomy is observed over time, whereas an increasing trend is being reported from Pakistan's neighboring country, India [2,[17][18]. Although no formal rate of hysterectomy has been calculated from Pakistan, a study has reported an increased frequency of hysterectomy in total gynecological admissions, from 7% in 2013 to 17% in 2016 [19].…”

Role of Topical Tranexemic acid in reducing perioperative blood loss in Abdominal Hysterectomy.

“…Hysterectomy is one of the most frequently performed major gynecological surgical procedures. In India as a whole, 6 % of women aged 30-49 years had undergone a hysterectomy [1]. Translating the prevalence of hysterectomy into absolute numbers for the year 2016, there were about 10 million hysterectomized women (aged 30-49 years) living in India [1].…”

“…The most common indications are uterine leiomyoma, endometriosis, dysfunctional uterine bleeding and malignancy. There are many techniques to perform hysterectomy including abdominal, vaginal, laparoscopic and laparoscopically assisted, total and subtotal [1,2].…”