Hysterectomies are vital in many medical situations, but it's a well-established medical principle that they should not be performed indiscriminately. Less invasive procedures and medication should always be preferred when viable, given the potential for serious side effects. Crucially, all patients must be fully informed about their options, the genuine need for the procedure, and its potential consequences.
Unfortunately, compelling evidence from various parts of India reveals a disturbing trend: hysterectomies are frequently performed without adequate consideration for safer alternatives, particularly among poorer and less educated women. This is highlighted by the unusually high number of younger women undergoing the procedure, a stark contrast to the significantly higher average age in many developed nations. Numerous women who have undergone hysterectomies report a lack of proper information regarding the procedure, its necessity, or alternative treatments. This widespread issue led to a protracted case in the Supreme Court of India, culminating in directives aimed at curbing the misuse of this medical procedure for commercial gain. However, adherence to these directives remains questionable, with reports, such as those concerning sugarcane workers in Beed, Maharashtra, indicating continued alarming instances of unnecessary hysterectomies. While this article focuses on India, similar patterns in other countries suggest that avoidable problems and severe side effects are affecting a vast number of women globally, including younger individuals.
Early Revelations and Investigations in India
The widespread prevalence of unnecessary hysterectomies in India gained significant public attention around 2010. In Rajasthan's Dausa district, news reports prompted a Right to Information (RTI) application, which uncovered that between April and October 2010, 286 out of 385 operations reported by three private hospitals were hysterectomies. Many of these patients were under 30, with the youngest being just 18. Evidence from Dausa showed a hasty progression from diagnosis to surgery, often on the same day, with no prior medical treatment. Furthermore, many women reported that their original complaints persisted even after the hysterectomy.
Similar reports from Chhattisgarh and Bihar indicated an excessive number of hysterectomies performed under the Rashtriya Swasthya Bima Yojana (RSBY) insurance scheme, raising suspicions of profit-driven procedures. Earlier, Andhra Pradesh had already banned hysterectomies in private hospitals under a state insurance scheme after surveys revealed hospitals were motivated by higher insurance claims. Maharashtra followed suit, further demonstrating the widespread nature of the problem.
Dr. Narendra Gupta played a pivotal role in bringing these findings to public attention. He conducted investigations and organized a national consultation on the subject with the support of Health Watch Trust, Human Rights Law Network, Prayas, and UNFPA. With expert medical opinions, Dr. Gupta then escalated the matter to the Supreme Court of India while continuing his efforts to reduce unnecessary hysterectomies.
During the Supreme Court case, various states were asked to respond. Bihar authorities confirmed that "many of the allegations in regard to the performance of unnecessary hysterectomies were true." The state government subsequently issued a circular requiring hospitals on the panel to obtain permission from the concerned insurance provider before conducting hysterectomies on women aged 40 or below. Investigations also led to some hospitals being blacklisted from the RSBY.
In 2019, another significant national consultation on unnecessary hysterectomies was organized, identifying key challenges and future tasks. By 2022, the Union Ministry for Health and Family Welfare, following stakeholder consultations, developed and circulated guidelines to prevent unnecessary hysterectomies to all states and union territories.
These guidelines acknowledged consistent findings from community-based studies: rising hysterectomy rates among younger women (aged 28-36). They also stated that field studies indicated unnecessary hysterectomies were performed in cases where medical or non-invasive treatment would have sufficed, with a higher risk among poor, less educated women, particularly in rural areas.
In 2023, the Supreme Court delivered its decision in the long-pending case. A Bench comprising Chief Justice Dr. D. Y. Chandrachud and Justice J. B. Pardiwala issued detailed directives, based on the earlier guidelines, to prevent unnecessary hysterectomies.
However, these directives are far from being fully implemented. Recent reports from Beed, Maharashtra, tragically illustrate that unnecessary hysterectomies continue to occur, sometimes in shocking ways. Clearly, further concerted efforts are urgently needed to halt this disturbing trend.
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The writer is Honorary Convener, Campaign to Save Earth Now. His recent books include Saving Earth for Children, Planet in Peril, A Day in 2071, and Man over Machine
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