Menopaused 20-somethings

Jayamma’s uterus was removed two years ago—she was 18. Married at 12, she had children at 15 and 17 and she did not know she would undergo uterus removal surgery (hysterectomy) when she went to a doctor for pain in her lower abdomen.

The doctor, in a pr-ivate hospital in Zaheerabad in Andhra Pradesh’s Medak district, told her she would die without the operation.

Parvathi, 23, from Sadasivpet in Medak was also talked into hysterectomy. Like Jayamma who still suffers from the pain, Parvathi too was led to believe it was a matter of the uterus or life.

Jayamma and Lakshmi belong to families below poverty line in Andhra Pradesh. They went to private hospitals because they knew they would not have to pay for the surgery. They are covered under the state government’s cashless health insurance scheme, Aarogyasri. Launched in 2007 the scheme aims to provide families below the poverty line access to quality medical care.

Since July 2008, the second phase of Aarogyasri, the state government has received claims of more than 11,000 hysterectomy cases from hospitals and nursing homes. Outside this scheme there are only rough estimates of the number of hysterectomies in the state.

Claims can range anything between Rs 20,000 and Rs 45,000, it depends on the kind of surgery. Sometimes, these are fudged. The vigilance department in a raid last year found hospitals in Guntur district claimed to have done a laparoscopy even though they did not have the equipment for it. Insurance claims for a laparoscopy are more than a conventional surgery. The department found that 68 per cent of the 1,141 women who underwent hysterectomies in 20 hospitals in the district were 21-40 years old.

A 2009 study by a non-profit, AP Mahila Samatha Society, found hysterectomy cases in women between 25 and 40 increased by 20 per cent since Aarogyasri was launched. Their study, on 1,097 women in five districts, also found that doctors told 30 per cent women that they would die if they did not get operated. “Hysterectomies have become a tool for greedy doctors to earn money,” said M B Bharath Bhusan, chairperson of the non-profit Centre for Action, Research and People’s Development (carped).

Given the statistics on hysterectomies, women’s groups in the state have warned the government of severe consequences if indiscriminate hysterectomies continue. They have been conducting workshops and seminars aimed at educating women in villages.

In response, the state government issued guidelines to doctors and hospitals under Aarogyasri, said J Satyanary-ana, principal secretary to the health and family welfare department in Andhra Pradesh. Aarogyasri trust’s members are currently discussing the guidelines, which would be made public soon, said R Gopal Krishna, chairperson of Aarogyasri trust.

“As per the guidelines,” said Krishna, “hysterectomies cannot be conducted in response to minor health problems related to reproductive organs. They can be done if there is a possibility of cancer, or other serious ailments, but these must be supported by medical records. Also, pathologists would have to submit medical records before conducting hysterectomy on a woman under 35.”

He, however, added women were always warned about the long-term effects of removing the uterus, and doctors rarely encouraged hysterectomies.

In denial
“Women insist on getting operated. They want relief from menstrual cycles after they bear children,” said Shamim Rizwana, Aarogyasri’s deputy medical superintendent.

But Chokarappu Ramulu, who disburses medicines in Pampalli village in Nalgonda district, also called registered medical practitioner, narrated a different story. “Doctors first enquire the number of children a woman has. If she has more than two, the doctor asks her to get a hysterectomy,” said Ramulu. If the patient does not agree, she is told her uterus is rotten, and that she would get cancer.

Hysterectomies have become a tool for doctors to earn money. It is easier to abuse the system because women belong to a certain class in society

– M B BHARAT BHUSHAN Chairperson of the non-profit Centre for Research, Action and People’s Development

Ramulu knows at least 20 women from five villages in the district who have had their uteri removed. These women continue to suffer from the pain for which they went to the doctor in the first place, he said.

For example, Muthyalamma of Gaurpur village in Karimnagar district went to the doctor because of pain during her periods. She suffered excessive bleeding and cramps. “The operation did not cure me of the pain. I feel weak and am unable to do physical work like I used to,” said the 25-year-old whose uterus was removed two years ago. Muthyalamma’s weakness is no surprise. Hysterectomy at an early age causes calcium deficiency; its side effects include weakness, hormonal imbalance, depression and joint pains.

Removing the uterus also affects the lumbar vertebra, which helps in bending actions, said Surya Prakash of Life Health Reinforcement Group, a group of doctors working on the right to health for all. A hysterectomy is the last resort if one is suffering from uterine cancer, fibriods (benign tumour) or endometriosis, in which the cells lining the uterus are found outside it, causing pelvic pain. “These operations, done at random, are dangerous for women’s social and economic wellbeing,” said P Padma of AP Mahila Samatha Society.

Prakash said the focus should be on accountablity of doctors and to ensure indiscriminate hysterectomies are che-cked. But, for Laxmi, 19, the damage is irreparable. She was admitted to a private hospital in Kurnool district two years ago because of severe stomach ache. Her family thought she was operated for appendicitis. When she was discharged, the doctor told them her uterus had been removed. “It was a sho-ck. We wanted a second child,” she said. Her husband has stopped supporting her. “He is rarely home. He has another woman he goes to,” she added.

Some names have been changed to protect identity

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