Womb, womanhood and medical ethics: concern about rising hysterectomy cases in India

Acharya, Subhendu Kumar

doi:10.1136/jfprhc-2016-101649

Cited by 10 publications

(10 citation statements)

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“…There is a need to devise strategies to deal with the burden of unnecessary hysterectomies by developing some regulatory or ethical clearance mechanism especially for private sector providers. These concerns have also been reported by many studies in the past [18, 19, 32, 33]. In addition to causing multiple health consequences, hysterectomy may also lead to catastrophic health expenditure and may push a family into poverty due to heavy dependence on the private health sector, especially it is not protected under any health insurance scheme.…”

Section: Resultsmentioning

confidence: 82%

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

2019

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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.

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Section: Resultsmentioning

confidence: 82%

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

2019

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“…The average age of hysterectomy was 36 years, and the majority of the women had their hysterectomies at private health institutions, according to this study [ 10 , 19 ]. Some researchers and activists have raised concerns about unnecessary hysterectomies being performed in some parts of India for commercial reasons rather than medical necessity, especially at a considerably younger age in places such as Andhra Pradesh [ 25 – 27 ]. There has also been a lot of debate concerning the effectiveness of elective hysterectomy, because women's reproductive health difficulties don't stop there [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence, socio-demographic determinants, and self-reported reasons for hysterectomy and choice of hospitalization in India

Kumari

Kundu

2022

BMC Women's Health

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Background There is limited evidence of hysterectomy in India because of a lack of data 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. The current study evaluates the prevalence, determinants, and choice of hospitalization (Public vs. Private) for conducting hysterectomy in India among women aged 15–49 years in 29 states and seven union territories (UTs) based on the new large-scale population-based nationally representative dataset (NFHS 5). Methods Cross-tabulations and percentage distributions were utilized to analyse the prevalence of hysterectomy and the choice of hospitalization (public vs. private) across different socioeconomic backgrounds and reasons for undergoing hysterectomy. A multivariate binary logistic regression model was also used to find statistically significant determinants of hysterectomy. Results In India as a whole, 3.3% of women aged 15–49 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. The southern region stands out for the considerably higher prevalence of hysterectomy; particularly in the states of Andhra Pradesh (8.7%) and Telangana (8.2%), the prevalence was very high followed by Bihar (6%) and Gujrat (4%). On the other hand, the North-eastern region had the lowest prevalence of hysterectomy (1.2%). A noticeable fact that emerged was that the majority of the hysterectomies were performed in the private sector (69.6%) in India. But the scenario was quite different in north-eastern region as in this region more hysterectomies were performed in public health facilities (73%) rather than private health facilities (26.7%). Age, place of residence, religion, caste, level of education, geographic region, wealth quintiles, parity, age at first cohabitation of women were found to be the socio-demographic determinants statistically associated with hysterectomy in India. The likelihood of hysterectomy was higher among women living in rural areas (AOR: 1.3, CI: 1.23–1.35), in the richest wealth quintile (AOR 2.6; CI 2.37–2.76) and in the southern region (AOR 1.6; CI 1.47–1.66). The reasons frequently reported for hysterectomy were excessive menstrual bleeding/pain, followed by fibroids/cysts. Conclusion This study has attempted to analyse hysterectomy prevalence and its socio-economic determinants using the latest fifth round of NFHS data of all the states and covering 21 states and union territories of India, which gives wider coverage of hysterectomy and more recent with accurate data. More research is needed therefore to unravel the complex dynamics of hysterectomy in India (and elsewhere) which could be used to help women make more informed choices and in turn advance their reproductive health and rights.

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“…In India, we need to address the flaws in healthcare governance at the community level by empowering women regarding their health and perception [ 21 ]. In Gujarat, India, a study in 2017 suggested that health policy initiatives must increase reach to women's reproductive as well as sexual healthcare, education, research, and audits to encourage women to make excellent decisions throughout the life cycle [ 22 ].…”

Section: Reviewmentioning

confidence: 99%

Unnecessary Hysterectomies Among Premenopausal Women in Developed and Developing Countries: A Critical Review of Steps Taken to Improve Women's Health

Aggarwal,

Wanjari

2023

Cureus

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Women with pelvic organ disease often require a hysterectomy for better health. Still, in countries like India, there are many challenges for them as they are subjected many a time to unnecessary hysterectomies. Through this article, we suggest many ways to address this menace, such as proper health education and sensitization of women of premenopausal age group by health workers and mass media. Many preventable hysterectomies can be avoided if we guide women about their pathology before giving consent for surgery. Role enhancement of health agencies and nongovernmental organizations for early identification of such women in the society of all segments, stopping the greed of various health institutions using government-sponsored insurance health schemes for personal gain, and law enforcement by courts and health departments should also be our main focus. This study aims to review nonsurgical procedures adopted to decrease unnecessary hysterectomies and make suitable directions by government and lawful agencies to curb this menace. All states and union territories received the "Guidelines to Prevent Unnecessary Hysterectomies" recommendations from the Ministry of Health and Family Welfare for compliance. The recommendations suggest creating hysterectomy monitoring committees at the district, state, and federal levels. The duration of hospital stays and associated expenditures can decrease by performing minimally invasive treatments as outpatient operations. Minimally invasive options may shape the future of gynecology in developed nations.

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Womb, womanhood and medical ethics: concern about rising hysterectomy cases in India

Cited by 10 publications

References 1 publication

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

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

Prevalence, socio-demographic determinants, and self-reported reasons for hysterectomy and choice of hospitalization in India

Unnecessary Hysterectomies Among Premenopausal Women in Developed and Developing Countries: A Critical Review of Steps Taken to Improve Women's Health

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