Alarming Rates of Hysterectomy Among Indian Women Reported by National Family Health Survey-5

Highlights:

Hysterectomy is on the rise in India, more common in rural (3.6%) than in urban (2.5%) areas
Private hospitals in India perform majority of the procedures (66%)
Andhra Pradesh (8.7%) recorded the highest and Meghalaya (0.7%) recorded the lowest prevalence of hysterectomies in India

Hysterectomy - Overview
Hysterectomy is the surgical procedure to remove the uterus and is one of the most commonly done procedure by the gynecologist.

‘An alarming number of Indian women especially in rural areas are undergoing hysterectomy surgeries. Saving the uterus is the need of the hour now!’
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Hysterectomy in India According to NFHS-5

The National Family Health Survey 2019-2021 report reflects some alarming stats on hysterectomy from India. It indicated that overall, 3.3% of Indian women have had hysterectomy surgical procedures.

The fifth survey in the series, the National Family Health Survey 2019–21 (NFHS–5), offers insight into the health and nutrition for each State and Union Territory (UT) of India.

Hysterectomy surgeries conducted by gynaecologists both in government and private hospitals were found to be 1% higher among the women in rural (3.6%) India than in urban (2.5%) India. In the age group from 40 to 49 years, it was 9.7%, 3.3% in 30-39 years and 0.2% in the 15-29 age group. Hysterectomy is the second most common surgical procedure after the caesarean section performed by obstetricians and gynaecologists in India.

Policy makers and other experts are worried about the high prevalence.

Western countries have seen a reduction in hysterectomies with doctors favouring more conservative approaches however, the number of hysterectomies done in India continues to rise and there seems to be no reason except profiteering for conducting the surgical procedure.

Hysterectomy was reported by about 5% of Indian women from the south, 3.3% from the east, 3.1% from the west, 2.4% from the center, and 2.1% from the north.

With the exception of the northeast, every area adopted the same rural-urban pattern as the rest of the country.

The majority of hysterectomy instances occurred in the state of Andhra Pradesh (8.7%), followed by Telangana (8.2%), Bihar (6%), Gujarat (3.9%), Ladakh (3.6%) and Punjab (3.2%).

Meghalaya (0.7%) had the lowest prevalence of hysterectomy. About two-thirds of hysterectomies were done in a private setting().

Hysterectomy Rates Decrease among U.S. Women
Women getting hysterectomies are lesser now, as they are choosing minimally invasive methods and can save millions in health care costs.

Are Hysterectomy Procedures Unwarranted in India

This is the question that troubles our policy makers and experts. There have been many scandals reported by researchers regarding this subject in the past.

A Thomson Reuters Foundation investigation in India some years ago found that many young women were being targeted by doctors by advising surgery for minor ailments and the worst part is that the operation costs have driven families into debt. Sometimes doctors get an ultrasound of the uterus and put a scare in the minds of patients by saying that the innocent small growth in the uterus can become cancerous.

With advances in medical sciences and better diagnostics, many countries that had a high prevalence of hysterectomy surgeries earlier, are reporting a decline. However, in India, this trend is showing a reverse. In America only 6 out of 1000 women undergo hysterectomy however in India, it is 17 out of 1000 which is almost three times higher.

Rising Cases of Hysterectomy: Experts Raise Warning
Experts warn against the rising number of hysterectomies done in India continues despite no concrete reason.

National Family Health Survey 2019–21 (NFHS–5):

The NFHS-5 fieldwork for India was carried out in two parts by 17 Field Agencies, collecting data from 636,699 households, 724,115 women, and 101,839 men between the dates of 17 June 2019 and 30 January 2020 for 17 states and 5 UTs, and 2 January 2020 and 30 April 2021 for 11 states and 3 UTs.

In each round of the survey, a consistent sample design that is representative of the national, state/union territory, and district levels was used. Urban and rural areas were stratified within each district.

Except for Sikkim, all states were included in the first NFHS, which was conducted in 1992–1993().

In 2018, an Indian government survey found that more than 22,000 Indian women aged 15-49 out of the 700,000 surveyed had undergone a hysterectomy surgery.

How to Avoid Hysterectomy for Common Gynecological Condition
A common uterine condition can often go undiagnosed until it results in surgical removal of uterus can be prevented by creating awareness among menstruating women.

Indications for Hysterectomy

The reasons for Hysterectomy can be as follows:

Uterine fibroids,
Bleeding,
Uterine prolapse and
Cancer of the uterus, cervix, or ovaries.

What are the types of Hysterectomies

The surgical removal of the uterus, which may also involve the removal of the cervix, ovaries, Fallopian Tube, and other nearby tissues, is known as a hysterectomy.

A Vaginal Hysterectomy is a surgical operation in which the uterus is removed through the vagina.
Video technology is used during Laparoscopic-Assisted Vaginal Hysterectomy to give the physician better view while removing the uterus via the vagina.
The usual and most popular method for removing the uterus and other reproductive organs is an Abdominal Hysterectomy. Depending on the extent of the procedure, doctors can either make a vertical incision or a "bikini cut" while performing an abdominal hysterectomy.
With a Laparoscopic-Assisted Abdominal Hysterectomy, the uterus is removed through a single incision.
Three to four incisions are needed for A Robotic-Assisted Laparoscopic Hysterectomy close to the abdominal button(1^✔ ✔Trusted Source
National Family Health Survey (NFHS-5) 2019-21

Go to source).

The different types of hysterectomy can be:

Partial: removing the uterus body leaving the cervix in place
Total or Simple: removal of whole uterus and the cervix
Radical: removing the uterus, the cervix, the fallopian tubes, the ovaries, and also the upper part of the vagina and lymph glands that are affected
With Bilateral Salpingo-Oophorectomy: removing the uterus, the cervix, and also the fallopian tubes(2^✔ ✔Trusted Source
Hysterectomy in the United States: Background

Go to source).

Risks after Hysterectomy surgery Hysterectomy has a low (less than 1%) mortality rate, however there are some real risks associated with the procedure, including infection, bleeding before or after surgery, and injury to internal organs including the intestine or urinary system().

Some studies have also found an association between hysterectomy and an increased risk of heart disease, diabetes, osteoporosis and depression.

Women generally also tend to put on weight after hysterectomy, and the majority will have had their ovaries removed in addition to the uterus. This results in severe post-menopausal symptoms.

Preserve and Save the Womb Few studies righty point out the uterus requires care beyond childbirth and its function is not just limited to mere reproduction().

What is required is proper timely counselling and education of women on personal hygiene and also empowerment to promote access to sexual and reproductive health services. To eliminate unwarranted hysterectomies it is important to undertake medical audits.

‘Saving the womb’ and avoiding unnecessary hysterectomies will go a long way in improving women’s health in India.

References:

National Family Health Survey (NFHS-5) 2019-21 - (http://rchiips.org/nfhs/NFHS-5Reports/NFHS-5_INDIA_REPORT.pdf)
Hysterectomy in the United States: Background - (https://nwhn.org/hysterectomy/)
Medical Ethics: A case study of Hysterectomy in Andhra Pradesh - (https://signalsinthefog.files.wordpress.com/2015/02/hysterectomy-ethics-in-s-t-for-setdev-final-1.pdf)

Source-Medindia