What is Hysterectomy?

What’s in today’s article?

• Why in News?
• What is Hysterectomy?
• Criteria for Getting a Hysterectomy
• Health Risks Associated with Hysterectomy
• Hysterectomy in India
• Challenges Associated with Hysterectomy in India
• What Measures has the Government Taken So Far?
• News Summary

Why in News?

• The Union Health Ministry has recently urged State Governments to audit hysterectomy trends in public and private hospitals.
• This was done in response to a Supreme Court petition arguing that women from marginalised locations are at risk of unjustified hysterectomies for economic gains and exploitation.

What is Hysterectomy?

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

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Criteria for Getting a Hysterectomy

• After caesarean deliveries, hysterectomies are the second-most frequent procedure in women of the reproductive age group.
• Reasons for this surgery include abnormal bleeding, uterine prolapse, fibroids and cancer.
  • In some cases, oophorectomy, the removal of ovaries (the primary source of oestrogen), is also frequently performed, which is a form of surgical menopause and linked to several chronic conditions.
• The highest percentage of hysterectomies (51.8%) were to treat excessive menstrual bleeding or pain.
• It’s more common for women aged 40 to 50.

Health Risks Associated with Hysterectomy

• There is evidence about the long-term effects of hysterectomy – both with or without oophorectomy (removal of ovaries).
• A 2022 review of 29 studies found a correlation between hysterectomy and chronic diseases including an increased risk of cardiovascular events, cancers, depression, metabolic disorders, and dementia.
• In India, hysterectomies in women above 45 years of age were associated with hypertension, high cholesterol, diabetes and bone disease.
• More than 45% of the 13,861 women in Beed, Maharashtra who had undergone hysterectomies experienced aching joints, back pain, depression, and insomnia, among other side effects.

Hysterectomy in India

• The average age at which hysterectomies are conducted among Indian women is 34, per community-based studies.
• In comparison, high income countries allow this procedure for women aged above 45.
• Most surgeries happen in private hospitals (33,559 procedures) as opposed to government hospitals (11, 875).
• A majority of these cases are reported among socially and economically disadvantaged women.

Challenges Associated with Hysterectomy in India

• Wombless Women –
  • Also, contractors in unorganised sectors such as the sugar-cane-cutting industry misuse hysterectomy, where ‘wombless women’ are the norm to eliminate the need for menstrual care and hygiene among workers.
• Lack of Awareness –
  • The gap thrives in a culture where gynaecological care and disorders — outside of pregnancy — exist in oblivion.
  • Some reports show “rasoli” — indicating a tumour or growth— is often cited as a reason for hysterectomies in medical documents.
  • These may be benign growths, manageable by conducting investigative tests and undertaking alternative treatments.
  • 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.
  • Moreover, medical ailments are not adequately investigated due to lack of resources, unawareness about gynaecological diseases and misinformation.

What Measures has the Government Taken So Far?

• Union Health Ministry Guidelines –
  • The Union Health Ministry in 2022 issued guidelines to prevent unnecessary hysterectomies — listing possible indications of when hysterectomy may be required and alternative clinical treatments for gynaecological issues.
  • They recommended setting up district, State-level and national hysterectomy monitoring committees which to collect data on age, mortality, and occupations, among other details.
  • In particular, the guidelines emphasise that authorities should report hysterectomies conducted for women less than 40 years of age and incorporate the reason for hysterectomy.
  • All States and Union Territories were asked to adopt the Guidelines within three months and report compliance to MoHFW.
• Ayushman Bharat Pradhan Mantri Jan Arogya Yojana –
  • The government’s flagship health insurance programme provides health cover of Rs. 5 lakhs for 1,949 procedures— including hysterectomies.
  • The government has authorised more than 45,000 hospitals to conduct these operations and also developed two standard treatment guidelines for hysterectomy-related procedures.
• Blacklisting of Certain Hospitals –
  • Under the Clinical Establishments (Registration and Regulation) Act, 2010, hospitals and healthcare facilities found to have coerced women into hysterectomies without informed consent can be blacklisted.
  • The Centre told the Supreme Court that several hospitals were blacklisted and FIRs were filed against facilities that violated norms.

News Summary

• A petition was filed in the Supreme Court w.r.t. Hysterectomy.
• The petitioner, Dr Narendra Gupta, argued that despite the provisions, private hospitals in Bihar, Chhattisgarh and Rajasthan engaged in unethical practices and unnecessary procedures.
• The petitioner argued that that women from marginalised locations are at risk of unjustified hysterectomies for economic gains and exploitation.
• The Chief Justice of India, D.Y. Chandrachud, suggested that hysterectomies for those under 40 should be conducted on approval by two certified doctors.
• The Supreme Court, while hearing the petition, gave a three-month deadline to States and Union Territories, directing them to implement the guidelines issued by the Ministry of Health and Family Welfare in 2022.

Q1) How does Vasectomy work?

A vasectomy works by stopping sperm getting into a man’s semen. The tubes that carry sperm from a man’s testicles to the penis are cut, blocked or sealed with heat. This means that when a man ejaculates, the semen has no sperm in it and a woman’s egg can’t be fertilised.

Q2) What is the meaning of Total Fertility Rate (TFR)?

The Total Fertility Rate (TFR) — which is the average number of children who would be born to any women in her lifetime. As per the fifth round of the National Family Health Survey, or NFHS-5, India’s TFR has declined from 2.2 in 2015-16 to 2.0 in 2019-21.

Source: Explained | What has India done to curb unnecessary hysterectomies? | ET