Increased Hysterectomy of Indian Women.

Growing Trend

According to the recent statistics, there is a rapid increase in the number of hysterectomy operations performed on women aged 30-40 years, in Andhra Pradesh, Telangana, Bihar and Gujarat. At least one out of every 10 women between 40 and 49 years old, in India, has gone through the surgery and in certain states the rates are well above 20 percent. Median age is only 34 in rural and 36 in urban centres leading to serious health concerns.

Health Risks

Premature removal of the uterus results in premature menopause which predisposes to:

• Cardiovascular disease & metabolic disorders
• Bone density loss & mental health issues
• Ovarian failure, thyroid and urinary tract cancers
• Pelvic prolapse

Such complications have a strong influence on the health and quality of life of women in the long term.

Medical and Insurance Influence

• Approximately 70 percent of the hysterectomies are performed in the private clinics.
• Surgeries that are unnecessary are sometimes encouraged by insurance coverage under schemes such as Ayushman Bharat.
• The poor, rural women are even encouraged to undergo hysterectomy to a minor gynaecological issue without looking at any alternative.

Government Action

National Health Authority has made pre-authorisation of claims of hysterectomy. The second gynaecological opinion and supporting evidence must be approved to women who are less than 40 years old. Guidelines have been issued by the Health Ministry and there has been a proposal of monitoring committees at the district, state and national levels.

Need for Awareness

Most women do not know about the broader health-related role of the womb. Hormonal pills and IUDs are conservative treatments that are not used. Women could take informed decisions and minimise unnecessary surgeries by awareness campaigns.

Broader Concerns

• The increase in trend is indicative of failures in the regulation and insurance based incentives in healthcare.
• It also can be related to a history of population control.
• The fertility rate of India is lower than that of replacement, so mass hysterectomies may have demographic consequences.