HYSTERECTOMIES – SCI & TECH
News: Explained
| What has India done to curb unnecessary hysterectomies?
What's in the news?
● In
2020, a study on Maharashtra’s cane cutters identified a widening blind spot in
women’s health: the unchecked rise of hysterectomies.
● Laws
regulating private clinics were poorly implemented, awareness about the
procedure of uterus removal was dismal, gynaecological services were absent and
no standard protocols existed, the authors noted.
Hysterectomy:
● A
hysterectomy is the surgical removal of
the uterus and in some cases the cervix as well.
● It
is a common medical procedure that is performed in order to address conditions
such as endometriosis, pelvic inflammatory disease, adenomyosis, cancer,
uterine fibroids, etc.
Classification of Hysterectomy:
● It
can be classified as a partial
hysterectomy (removal of the uterus), total
hysterectomy (removal of the uterus and cervix), or radical hysterectomy (removal of the uterus, cervix, part of the
vagina, and surrounding tissues).
Datas on Hysterectomy:
● According
to NFHS-5 data, highest percentage
of hysterectomies were to treat excessive menstrual bleeding or pain (51.8%);
24.94% for fibroids; 24.94% for cysts and 11.08% for uterine disorder or
rupture.
● A
majority of these cases were reported among socially and economically disadvantaged women. But, studies have
shown that “many of these causes were considered to be treatable and surgery
could be avoided.”
Reasons for increasing hysterectomy surgeries:
1. False assumption regarding health:
● A
2017 study from Gujarat found most women assumed that the uterus served no role
outside of pregnancy and that removing the uterus would solve their health
issues.
2. Misuse and Insurance fraud:
● The
procedure can easily be misused by either private clinics that earn profits
(from insurance money) or by contractors in unorganised sectors such as the
sugar-cane-cutting industry, where ‘wombless women’ are the norm to eliminate
the need for menstrual care and hygiene among workers.
3. Marginalized women were targeted:
● Women
from marginalized communities, such as Scheduled Castes, Scheduled Tribes, and
Other Backward Communities, were disproportionately affected.
4. Looked as a way to become productive:
● A
2019 investigation found that women from rural areas look at hysterectomies as
a way of increasing days of productive work and earning more wages.
Issues with Hysterectomy:
1. Overuse and unnecessary procedures:
● Hysterectomy
can be performed without exploring alternative treatments.
2. Psychological and emotional impact:
● The
procedure may lead to feelings of loss and changes in body image.
3. Surgical risks and complications:
● Hysterectomy
carries risks such as infection and damage to surrounding organs.
4. Long-term health effects:
● Removal
of the uterus may have impacts on hormones and bone health.
5. Patient autonomy and informed consent:
● Patients
should be fully informed about the procedure and involved in decision-making.
6. Access and equity:
● Disparities
in access to healthcare may contribute to overuse, particularly among
marginalized communities.
Measures taken by government:
1. Guidelines by Health Ministry:
● In
2022, the Union Ministry of Health issued guidelines to prevent unnecessary
hysterectomies and recommended the establishment
of district, state-level, and national hysterectomy monitoring committees.
● The
committees are also mandated to collect data related to age, mortality,
occupation, etc.
● The
government has also proposed the setting up of a grievance portal i.e. the National Hysterectomy Monitoring
Committee for hysterectomy beneficiaries.
● The
guidelines emphasized that hysterectomies on women below the age of 40 should
be reported by the authorities and the reasons incorporated into the existing
checklist.
● The
monitoring committees are responsible for creating awareness among
practitioners and patients about issues such as bodily anatomy, the role of the
uterus, and when hysterectomies are required.
2. SC Judgement:
● Under
the order issued by the Supreme Court, the states and the Union are required to
conduct audits of hysterectomy trends and furnish a report.
3. Pradhan Mantri Jan Arogya Yojana:
● The
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, the country’s flagship health insurance scheme provides health coverage
worth ₹5 lakhs per annum to each eligible family.
● The
scheme covers 1,949 procedures including hysterectomies with 45,434 hospitals
authorized to conduct these surgeries.
4. ICMR treatment guidelines:
● The
Union Ministry of Health and the Indian Council of Medical Research (ICMR) has
developed two treatment guidelines for hysterectomy-related procedures after
consultation with experts.
● The
guidelines explicitly state that the procedure should be considered only after
the completion of child-bearing and in very rare cases in younger women.
5. International Conventions:
● India
is a signatory to various conventions such as the International Covenant on
Economic, Social, and Cultural Rights, the Convention on the Elimination of All
Forms of Discrimination Against Women, and the International Covenant on Civil
and Political Rights.
The
increasing trend of mass hysterectomies
is linked to misconceptions related to menstruation, childbirth, breastfeeding,
ovulation, pregnancy, etc. A larger
cultural shift is necessary in order to build awareness of the need to care
for women and wombs beyond their reproductive value in a patriarchal society. Awareness on issues related to women
not related to pregnancy and childbirth must be spread as this section of
women’s health has been totally ignored as of now.