One in every 10 elderly Indian women underwent uterus removal: Survey

Around 11 per cent of Indian women above the age of 45 years have undergone hysterectomy, found the first Longitudinal Ageing Study in India. The Union Ministry of Family and Health Welfare (MoFHW) study surveyed over 72,000 elderly Indians between 2017 and 2018.

Hysterectomy refers to the surgical removal of the uterus and sometimes the cervix and supporting tissues to treat health complications.

A much lower proportion (3.2 per cent) of women between 15 to 49 years of age had undergone the operation, according to the National Family Health Survey, 2015-16. NFHS-4 was the first to gather data on hysterectomy in the country. Its report showed that 67 per cent of Indian women preferred private hospitals and only a third preferred public ones.

In Andhra Pradesh (23.1 per cent) and Punjab (21.2 per cent) at least one in every five elderly women had undergone the surgery.

Some studies show that in Andhra, the surgery is performed unnecessarily especially on young pre-menopausal women belonging to poor socio-economic backgrounds. In Medak district of Andhra, there are reports of women given no choice of treatment other than hysterectomy even for common gynaecological problems like abdominal pain and white discharge by private healthcare institutions who benefit from this procedure. 

The lowest proportion of women got hysterectomy in the north-eastern states of India. In Assam, 3.3 per cent, in Arunachal Pradesh 3.1 per cent, in Nagaland 1.7 per cent and in Meghalaya just 0.92 per cent underwent the operation.

The strong local-level public health infrastructure and the preference for public hospitals is the main reason behind the low figure, the report pointed out.  

Variations were also observed based on the economic status and level of education of women. The proportion of elderly women from the richest quintile (18 per cent) of the population who have gone for the surgery is over twice that of the poorest quintile (eight per cent).

A higher proportion of women (15 per cent) went for the operation in urban India, where the level of education is higher among women, compared to rural India (10 per cent), the report said. The major reason for the surgery among urban women was uterine fibroids while that among rural women was menstrual disorder.

In Andhra Pradesh, Jammu and Kashmir, Kerala, Maharashtra, Punjab, Rajasthan, Telangana, Uttarakhand and the Union territory of Daman and Diu, however, a higher percentage of women in rural areas chose the surgery.

While the LASI report showed a higher proportion of hysterectomy cases in urban areas, NFHS-4 had pointed at a higher proportion in rural areas. 

In general, the surgery is performed for the following reasons:

• Excessive menstrual bleeding or pain which contributes to about 29 per cent of all hysterectomies in elderly women
• Fibroids or cysts which contribute to 22 per cent
• Uterine prolapse (sliding of the uterus from its normal position into the vaginal canal) contributes to 14 per cent
• Uterine disorders (rupture) or injury that contribute to 7 per cent
• Severe postpartum haemorrhage that contribute to 3.8 per cent
• Cancer that contributes to 1.8 per cent

Views expressed are the authors' own and don’t necessarily reflect those of Down To Earth

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