Hysterectomy

• 19 May 2023

For Prelims: Hysterectomy, Article 21

For Mains: Issues in Women Health and Related Measures, Importance of Maternal Health

Why in News?

Concerned about the high risk faced by poor and less-educated women, especially in rural areas, who undergo unjustified hysterectomies, the Ministry of Health and Family Welfare, Government of India has initiated measures to address this issue.

What is Hysterectomy?

• About:
  • A hysterectomy is a surgical procedure that involves the removal of the uterus (womb), the organ in a woman's body where a baby develops during pregnancy.
• Types:
  • When only the uterus is removed, it is called a partial hysterectomy.
  • When the uterus and cervix are removed, it is called a total hysterectomy.
  • When the uterus, cervix, part of the vagina, and a wide area of ligaments and tissues around these organs are removed, it is called a radical hysterectomy.
• Indications for Hysterectomy in India:
  • Hysterectomy is performed in India for gynecological conditions like fibroids (non-cancerous growths that develop in or around the womb), endometriosis (disease in which tissue similar to the lining of the uterus grows outside the uterus), abnormal bleeding, and pelvic inflammatory disease, when other treatments fail.
  • It is also utilized as part of cancer treatment to remove cancerous tissues and in cases of severe, unresponsive pelvic pain.

What are the Issues Associated with Hysterectomy in India?

• Increase Hysterectomies in Younger Women:
  • The recent Supreme Court judgment in Dr. Narendra Gupta vs Union Of India, 2023 highlighted that in developed countries, hysterectomies are typically performed on premenopausal women aged 45 and above.
  • However, community-based studies in India have shown an increasing number of hysterectomies among younger women, ranging from 28 to 36 years old.
• NFHS Data:
  • According to the most recent National Family Health Survey (NFHS) -5 empirical data, 3% of women aged 15-49 have had a hysterectomy.
  • The prevalence of hysterectomy is the highest in Andhra Pradesh (9%), followed by Telangana (8%), and lowest in Sikkim (0.8%) and Meghalaya (0.7%) among women aged 15–49.
  • The prevalence of hysterectomy was highest in Southern region, i.e., 4.2%, which was also greater than the national prevalence, followed by Eastern part of India (3.8%).
  • On the other hand, the lowest prevalence was observed in the Northeast region, i.e., only 1.2%
• Unnecessary Hysterectomies:
  • A public interest litigation (PIL) filed in 2013 highlighted the issue of "unnecessary hysterectomies”.
  • The PIL revealed that in the states of Bihar, Chhattisgarh, and Rajasthan, women were subjected to hysterectomies that were deemed unnecessary, endangering their health.
    • Private hospitals were found to be involved in performing these unnecessary hysterectomies. More than two-thirds (70%) of women who have undergone a hysterectomy had the operation in a private health facility.
  • Misuse of the procedure was also observed, with healthcare institutions exploiting it to claim higher insurance fees under various government healthcare schemes.

What are the Efforts to Address the Issue?

• Supreme Court Direction:
  • In response to the PIL, the Supreme Court directed states and union territories to adopt the health guidelines formulated by the Centre to monitor and prevent unnecessary hysterectomies. The implementation of these guidelines was mandated within a three-month timeframe.
  • There has been a serious violation of the fundamental rights of the women who underwent unnecessary hysterectomies.
  • The SC in Dr. Narendra Gupta vs Union Of India 2023 acknowledged that the right to health is an intrinsic part of the right to life under Article 21 of the Constitution. Life, to be enjoyed in all its diverse elements, must be based on robust conditions of health.
  • SC also urged an action plan to tackle the problem including suggestions to create national, state and district-level hysterectomy monitoring committees and the inauguration of a grievance portal.
• Health Ministry Guidelines:
  • In 2022, the Health Ministry issued guidelines aimed at preventing unnecessary hysterectomies. States were instructed to comply with these guidelines to ensure appropriate use of the procedure.
    • Recently, the ministry has directed the states to share data on the hysterectomies performed by medical institutions
    • Compulsory audits for all hysterectomies were also advised, similar to the existing audits conducted for maternal mortality.

Source: TH