Hysterectomies

Context: 

Recently, a petition in the Supreme Court argued that women from marginalised locations are at risk of unjustified hysterectomies for economic gains and exploitation. 

About Hysterectomies:

• A hysterectomy is a surgical procedure that removes the uterus. After surgery, a woman can’t become pregnant and no longer menstruate.

Issues Identified in Hysterectomy Trends:

• Poor Implementation of Laws and Lack of Awareness:

• • 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.

High Prevalence of Hysterectomies:

• National Family Health Survey-5 data shows that half of the women undergo hysterectomies before the age of 35.
• Concerns raised regarding unjustified hysterectomies for economic gains and exploitation.

Criteria for Hysterectomy:

• Timing and Medical Indications:
  • Hysterectomies should be conducted in the later part of a woman’s reproductive life or during emergencies.
  • Medical indications for removing a uterus include fibroids, abnormal uterine bleeding, uterine prolapse, chronic pelvic pain, and premalignant and malignant tumours of the uterus and cervix.

• Oophorectomy and Surgical Menopause:
  • In some cases, oophorectomy (removal of ovaries) is performed, leading to surgical menopause.
  • Oophorectomy is frequently performed and linked to several chronic conditions.

Concerns and Alternative Treatments:

• Overemphasis on Hysterectomy as a Permanent Solution:
  • Reports suggest that hysterectomies are presented as a permanent solution, even when less invasive treatments are available.
  • Low-invasive treatments are overlooked in favor of surgery.

• Leading Causes for Hysterectomies:
  • Excessive menstrual bleeding or pain accounted for the highest percentage of hysterectomies (51.8%).
  • Other causes include fibroids (24.94%), cysts (24.94%), and uterine disorder or rupture (11.08%).
  • Studies indicate that many of these causes were treatable, and surgery could have been avoided.

Government Measures Taken to Address Unnecessary Hysterectomies:

• Issuing Guidelines:
  • The Union Health Ministry issued guidelines in 2022 to prevent unnecessary hysterectomies.
  • Guidelines listed possible indications for when hysterectomy may be required and recommended alternative clinical treatments for gynaecological issues.

• Establishment of Monitoring Committees:
  • District, State-level, and national hysterectomy monitoring committees were recommended to collect data on age, mortality, and occupations.
  • These committees are tasked with creating awareness among practitioners and patients about the role of the uterus and when hysterectomies are actually indicated.

• Grievance Portal:
  • The government proposed a grievance portal monitored by the National Hysterectomy Monitoring Committee for hysterectomy beneficiaries.

• Ayushman Bharat Pradhan Mantri Jan Arogya Yojana:
  • The government’s health insurance program provides coverage for hysterectomies.
  • Standard treatment guidelines have been developed for hysterectomy-related procedures.

• Blacklisting and Legal Action:
  • Hospitals and healthcare facilities found coercing women into hysterectomies without informed consent can be blacklisted under the Clinical Establishments (Registration and Regulation) Act, 2010.

• International Conventions:
  • Unnecessary hysterectomies were noted to violate international conventions to which India is a signatory, including the International Covenant on Economic, Social and Cultural Rights and the Convention on the Elimination of All Forms of Discrimination Against Women

 News Source: The Hindu

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