Context: The Union Health Ministry recently urged State governments to audit hysterectomy trends in public and private hospitals, in response to a Supreme Court petition arguing that women from marginalised locations are at risk of unjustified hysterectomies for economic gains and exploitation. The Court also gave a three-month deadline to States, directing them to implement the guidelines previously issued by the Centre.
What is hysterectomy?
- Hysterectomy is the partial or total surgical removal of a woman’s uterus. It may also involve the removal of the cervix, ovaries, fallopian tubes, and other surrounding structures. After a hysterectomy, a woman no longer menstruates and is unable to conceive.
- According to NFHS-5 data, the highest percentage of hysterectomies were to treat excessive menstrual bleeding or pain (51.8%) followed by treatment for fibroids, cysts and uterine disorder or rupture. Studies have shown that many of these causes were considered to be treatable and surgery could be avoided.
Measures taken by the government:
- The Union Health Ministry in 2022 issued guidelines to prevent unnecessary hysterectomies — listing possible indications of when a hysterectomy may be required and alternative clinical treatments for gynaecological issues.
- It recommended setting up district, State-level and national hysterectomy monitoring committees to monitor and collect data on age, mortality, and occupations, among other details.
- The monitoring committees are also tasked with creating awareness, among both practitioners and patients, about bodily anatomy, the role of the uterus and when hysterectomies are actually indicated.
- The government’s flagship health insurance programme, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana provides health cover of ₹5 lakh for 1,949 procedures, including hysterectomies. The government has authorised 45,434 hospitals to conduct these operations.
Concerns:
- Lack of awareness: There is a dearth of awareness and informed consent in the absence of sexual and reproductive health education. Most women assumed that the uterus served no role outside of pregnancy and that removing the uterus would solve their health issues.
- A majority of hysterectomies were reported among socially and economically disadvantaged women.
- Women from rural areas look at hysterectomies as a way of increasing days of productive work and earning more wages, as it eliminates the need for menstrual care and hygiene among workers.
- Misuse by private clinics: Private clinics engage in unethical practices, and unnecessary procedures and did not inform women of side effects to earn profits (from insurance money) by quick surgery, turning healthcare into a business.
- Long-term health consequences: Hysterectomies may cause long-term injuries and disabilities, requiring follow-up and post-operative care in some cases like additional surgery or hormone replacement therapies. But these interventions are limited to private hospitals and remain unaffordable for low-income groups.
