MUMBAI: An Indian woman living in a rural area, who is illiterate, obese, and has health insurance, is more likely to undergo a hysterectomy than an urban woman with a desk job, according to a new statistical analysis study. Agricultural women workers were 32% more likely to undergo a hysterectomy compared to other occupation groups, said the study published in the ‘Journal of Medical Evidence’ recently. It found a high number of hysterectomies – many unnecessary – among Indian women. The prevalence of hysterectomy in women aged 25-49 years was 4.8% as per National Family Health Survey-4 (2015-16) and increased slightly to 4.9% in NFHS-5 (2019-21).
The study also found that seven out of every ten hysterectomies are performed in private health facilities, while 32.2% of hysterectomy surgeries are performed in public health facilities. “Private practitioners are emphasising the need for hysterectomy with a profit motive even for benign conditions which can be treated with less invasive methods and medications,” said authors Gaurav Gunnal of Deonar-based International Institute of Population Sciences and Dr Sudeshna Roy of National Institute of Health and Family Welfare, New Delhi.
For instance, in Maharashtra, while 2.2% of professional women in 25-49 age group underwent hysterectomy, the percentage was double (4.4) for agricultural workers. In Andhra Pradesh, the corresponding numbers were 10.3% for professional women and 14.5% for those from the agriculture sector. Women from the states of Andhra Pradesh (12.6%), Telangana (11.1%), Bihar (8.6%), and Gujarat (6.2%) reported highest prevalence of hysterectomy.
“Overall, the prevalence of hysterectomy was high amongst women in the age group of 40-49 years, rural residents, Hindu, OBC, illiterate, middle and richer wealth quintiles, three and above parity, early age at childbirth, obese, and covered under health insurance,” it said. “Women belonging to households with health insurance coverage are more likely to undergo hysterectomy than women from households without proper coverage,” said Gunnal.
The main causes for hysterectomy were prolonged excessive bleeding (55.4%), followed by fibroids/cysts (19.6%) and uterine disorder (13.9%). The authors blamed cultural and social influences for the trend: “Menstrual taboos and limited knowledge about reproductive health contribute to the high prevalence of hysterectomy, with some women opting for it to avoid menstrual issues or due to fear of reproductive health cancers,” they said.
