Context

The Union Health Ministry recently urged State Governments to audit hysterectomy trends in public and private hospitals.

What is Hysterectomy?

• A hysterectomy is a surgical procedure that involves the removal of the uterus (womb), the organ in a woman's body where a baby develops during pregnancy.
• Types:
  • When only the uterus is removed, it is called a partial hysterectomy.
  • When the uterus and cervix are removed, it is called a total hysterectomy.
  • When the uterus, cervix, part of the vagina, and a wide area of ligaments and tissues around these organs are removed, it is called a radical hysterectomy.

About the issue:

• A Supreme Court petition claims that women from underserved areas are vulnerable to unwarranted hysterectomies performed for financial gain and exploitation.
• The top Court handed States and Union Territories a three-month deadline last month to execute these Health Ministry directives.
• Women who had needless hysterectomies have had their fundamental rights gravely violated.

What are the criteria for getting a hysterectomy?

• After caesarean births, hysterectomies are the second most common operation among women of reproductive age.
• Hysterectomies should be performed at the latter stages of a woman's reproductive life, or as an emergency intervention.
• Fibroids (growths surrounding the uterus), abnormal uterine bleeding and uterine prolapse, chronic pelvic pain, and premalignant and malignant tumors of the uterus and cervix are all medical reasons for removing a uterus.
• In some situations, oophorectomy, or the removal of the ovaries (the primary source of oestrogen), is also performed, which is a type of surgical menopause and has been related to a number of chronic illnesses.

NFHS-5 Data: The highest percentage of hysterectomies (51.8%) were to treat excessive menstrual bleeding or pain; 24.94% for fibroids; 24.94% for cysts; 11.08% for uterine disorder or rupture.

Health Concern:

• Removal of Ovaries: A 2022 review of 29 studies found a correlation between hysterectomy and chronic diseases including an increased risk of cardiovascular events, cancers, depression, metabolic disorders, and dementia.
  • In India, hysterectomies in women above 45 years of age were associated with hypertension, high cholesterol, diabetes, and bone disease.

According to a report by the Maharashtra Legislative Council, More than 45% of the 13,861 women in Beed, Maharashtra who had undergone hysterectomies experienced aching joints, back pain, depression, and insomnia, among other side effects, impairing their health and ability to work.

What measures has the government taken so far?

• Under the Clinical Establishments (Registration and Regulation) Act, 2010, hospitals and healthcare facilities found to have coerced women into hysterectomies without informed consent can be blacklisted.
• Lack of awareness of gynaecological issues: The gap thrives in a culture where gynaecological care and disorders - outside of pregnancy - exist in oblivion.

NFHS data on hysterectomies: 3.3% of Indian women have had hysterectomy surgical procedures Hysterectomy surgeries were found to be higher among women in rural India (3.6%) than in urban India (2.5%) The majority of hysterectomies occurred in Andhra Pradesh (8.7%), followed by Telangana (8.2%), Bihar (6%), Gujarat (3.9%), Ladakh (3.6%) and Punjab (3.2%).