MUMBAI: Is India witnessing a spurt in unnecessary hysterectomies? Data released by international charity organization Oxfam on February 6 says as much. The agency said that unnecessary hysterectomies were being performed in Indian private hospitals to economically exploit poor women as well as government-run insurance schemes.
A right to information ( RTI) request filed by one of Oxfam's local NGOs in the Dausa district of Rajasthan showed that 258 of 285 women—65%—investigated over six months had undergone hysterectomies. Many of these women were under 30, with the youngest being 18 years old.
An editorial in the British Medical Journal quoted Oxfam's global spokesperson Araddhya Mehtta as saying that the "trend is seen all over India but is particularly disturbing in Rajasthan, Bihar and Chattisgarh where doctors simply abuse their power of being a doctor". In 2010, the Andhra Pradesh government tweaked its state-sponsored insurance scheme to disallow hysterectomies in private hospitals after surveys revealed that uteruses of a number of beneficiaries were removed merely to claim higher insurance amounts (the state insurance scheme is only available for the economically poor sections).
Dr Duru Shah, former president of FOGSI (Federation of Obstetric and Gynaecological Societies of India), said that modern medicines could fix 95% of woman's menstrual problems without the need for surgery.
However, experts fear the trend of unnecessary hysterectomies possibly exists in urban centres such as Mumbai as well.
Aniruddha Malpani, medical director of HELP (Health Education Library for People) in Fort, said, "It's easy to get data from a small centre such as Dausa but it would be impossible to get similar data from cities like Mumbai. However, if some doctors in small towns are performing unnecessary hysterectomies, why should it be any different in cities like Mumbai?"
Indeed, an audit performed by insurance companies in Chennai in 2009 had shown that more than 500 women in the 25-35 age group had undergone hysterectomies. A Central government study in the wake of the Andhra Pradesh scam had said that women under 45 rarely needed hysterectomy.
A 2011 research paper in medical journal Reproductive Health Matters, conducted by SEWA Health Cooperative doctors in Ahmedabad, showed that insured women—both in urban and rural areas—had higher rates of hysterectomy. "Among insured women, 9.8% of rural women and 5.3% of urban women had had a hysterectomy, compared to 7.2% and 4.0%, respectively, of uninsured women,'' said the study.
The OXFAM report, in fact, says that India should end its public-private partnership programmes (that allow poor women with government insurance plan to undergo a hysterectomy in private hospitals) until better regulation is in place.
Oxfam official Mehtta has been quoted as saying, "When women came with abdomen pain, doctors prescribed hysterectomy to women from poor economic backgrounds, telling them that it might be a cancer or a hole or a stone in the uterus without doing any thorough necessary investigations."
Dr Duru Shah said that unnecessary hysterectomies affected the concerned woman's health. "A young woman who has undergone hysterectomy may suffer early menopause (stoppage of periods) and the accompanying health problems of increased risk of cardiac diseases and fractures due to brittle bones,'' she said.
Dr Rekha Daver who heads the gynaecology of J J Hospital, Byculla, said, "Generally speaking, there may be a marginal increase over the years. But this may only be because women from rural areas who travel to referral centres in cities don't want to prolong their suffering." She said it wasn't feasible for these women to return to cities a second time for any treatment that may be required.
Incidentally, Maharashtra doesn't allow hysterectomies in private hospitals under the insurance scheme launched last year for the economically weaker sections, called the Rajiv Gandhi Jeevandayee Arogya Scheme. "We have learnt from the Andhra Pradesh experience," said Dr K Venkatesam, CEO of the arogya scheme.
However, not all agree that hysterectomies are on the rise. Gynecologist Dr Rakesh Sinha from Mumbai said, "It would be wrong to say there is an epidemic of hysterectomies in Mumbai or India. What has changed over the past few years is that we have facilities such as USG to make early and accurate diagnosis. Moreover, there are procedures available that allow women to go home within a day or two."
Needless hysterectomies on poor women rampant across India: Study
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Needless hysterectomies on poor women rampant across India: Study
