By Shreya Kumar
Mapping the prevalence of hysterectomies across India lead us to a startling number— approximately 50 to 60 per cent of women in many rural parts of the country have undergone this particular procedure. It is not just visible in one part of India; but the rise in development of this controversy leads us to travel across the length and breadth of the country. States like Karnataka, Andhra Pradesh, Telangana, Rajasthan, Madhya Pradesh are just a few hard facts— difficult to digest.
What is Hysterectomy?
A hysterectomy is an operation to remove a woman’s uterus for different reasons-
So, why should we worry about a medical practice?
Our faith in the medical practices lead us to believe in the sanctity of the profession too easily— dig a little deeper, and although some hysterectomies are absolutely urgent to perform, most of them are found laced with deceit and corruption, pushing one’s reproductive and overall health to a major decline. Rampant prescription of this surgery has given birth to a norm of ‘ignorance’ post reproduction of children— to thrive and ironically, become widely acceptable.
Research studies that have been carried out spells out a similar process—the willingness of the poor illiterate women stem out from the worry behind white discharge, irregular menstrual cycles, even abdominal pain—of all these being a symptoms of ‘cancer’. Many times, women involved in rigorous labour tend to have prolapse of the uterus — where the uterus drops into the vaginal canal, and with periods being a financial strain, it robs off the women of her contribution towards household, making the surgery a ‘lifestyle choice’ to be compulsorily made to survive.
Spread of Epidemic
Ideally, it has been suggested that ovaries should be retained by every woman at least till 65 years of age, but the inhumane practice has led many activists to term it as ‘human rights violation’ owing to post-surgery medical issues—menopause, irritable bowel syndrome, depression, loss of sexual pleasure, thrombosis, increases chances of Breast Cancer, Brain strokes, increase in risk of bloating and water retention by body, heart attacks, and other diseases. Hysterectomy along with removal of ovaries can cause calcium deficiency which results in early osteoporosis, leading to fractures, joint pains and back pain. Once the hysterectomy is performed, it requires hormonal replacement therapy which is again, not advisable.
The high number of hysterectomy claims under its community health insurance schemes has went a step ahead in blaming the ill-managed government schemes which was initially designed to fill the gap exhibited by inaccessible healthcare facilities. Aarogyasri, Rashtriya Swasthya Bima Yojana (RSBY) and the likes in various states are fuelling the trend, making the practice a mere money-hacking tool. Studies suggest that as social insurance spreads, there is also an increase in the rate of services— but while earlier hysterectomies were more prevalent among the middle classes, now higher insurance coverage has resulted in a rise in the procedure among the lower classes.
Saving the uterus
Extremely limited attention has been given to nurturing women’s bodies and their reproductive health. With lack of time, lack of proper transportation and doctors with right skill-set, women are being deprived of their rights, but are also being subjected to varied forms of social evils— menstrual taboos, violence against women and sex-selective abortion, just to name a few. There is a need for regulation like in the case of the PNDT (Pre-Conception and Pre-Natal Diagnostic Techniques Act) that doesn’t allow an ultrasound without proper documentation as well as for developing protocols and procedures to understand the factors at play, and ways to effectively eliminate them.
Moreover, the challenge is not just to identify the causes but also to find ways to counter the rising incidences. Private practices being driven by monetary motivation is not new, but often, government practices also feeds into private practice (the ill-managed schemes that we discussed above). Whereas withdrawing insurance cover will be seen as a knee-jerk reaction for some, a much better way to deal with it lies in practicing of coercion to prevent the need of women from being unethically exploited and commercialized. Regulation, thus, needs to be backed up by primary reproductive healthcare and ethical awareness in the medical set-up of the country—this merits much attention here. Public education about health, partly to clarify procedures and partly to protect against medical malpractice will surely serve as a good way in maintaining medical records along with patient interviews.
The crisis of data advocacy for this issue renders it an image of being ‘invisible’. Strong evidence needs to be gathered and exhibited to make regulations more stringent; also to deal with the absence of benchmarks, incomplete and inconsistent record-keeping, and paving way for medical interventions to gauge links between hysterectomies and other associated diseases. The National Family Health Survey-4 has included a question on hysterectomies—first comprehensive data on this deadly trend, and hopefully this will lead us to the seek number of hidden answers, and yet more questions.
While acknowledging the asymmetry of information is a good step ahead, working over it via gender sensitization, spreading awareness about patient’s right to informed consent and second opinion, improving community information channels by targeting students and school curriculum, and initiating co-ordination and dialogue between overlapping schemes should be followed by the government on an urgent basis.
The time has arrived, for the altar of commercialization of ‘reproductive health’, to rest in peace!
Mean age in US and UK is 55-65 years, whereas in India it is 30-40 years
Over 18,000 insurance-funded hysterectomies are conducted in Bihar and Chhattisgarh alone
(Shreya Kumar is an independent researcher. You can reach out to her with your suggestions and opinion: firstname.lastname@example.org)