Data from India’s National Family Health Survey indicated a rise in the number of hysterectomies, particularly in women under 40, with alarming rates in states like Andhra Pradesh and Telangana, where hysterectomy rates are double the national average.These procedures were often conducted without adequate medical justification, with women being diagnosed with benign conditions such as abdominal pain or general weakness—symptoms commonly caused by poor diet or hunger.
A disturbing trend in India’s healthcare system has come to light following a public lawsuit filed in 2013, exposing a significant rise in “unnecessary” hysterectomies, particularly targeting undereducated young women from low-income backgrounds.
In a landmark decision in April 2023, India’s Supreme Court ordered all states and union territories to follow the Ministry of Health’s guidelines on hysterectomy procedures, in response to evidence that clinics may be exploiting insurance loopholes for profit.
The case, filed by Dr. Narendra Gupta, highlighted the growing number of hysterectomies performed in several states, particularly Bihar, Rajasthan, and Chhattisgarh.
The lawsuit emphasized that many of these women were encouraged to undergo the surgery as a quick solution, without thorough examinations or alternative treatments.
In many countries, hysterectomy is typically conducted amongst pre-menopausal women above the age of 50 years. In India, we have been seeing, despite several efforts, high hysterectomy rates amongst young women, ranging from 28-40 years of age,” he said.
Hysterectomy, a surgery to remove the uterus, is typically reserved for severe conditions like cancer, prolapse, or postpartum bleeding. However, in numerous cases, it was being used to treat non-critical issues like heavy menstrual bleeding or fibroids. Dr. Gupta and others in the medical community stress that other, less invasive treatments could have been explored first.
One such case is that of Bishan Kumari, a 32-year-old woman from Ahmedabad, Gujarat, who underwent a hysterectomy after being offered the procedure as a first-line treatment for heavy menstrual bleeding. Covered under the Ayushman Bharat government insurance scheme, Kumari was unaware of the potential long-term health risks of such a procedure, including the onset of diabetes and hypertension, conditions that later developed in her case.
Experts argue that low levels of education, gender bias, and unethical medical practices are contributing factors, with women from poorer backgrounds particularly vulnerable.
Alarmingly, the rise in hysterectomies has coincided with an increase in health insurance coverage, such as Ayushman Bharat, in which private clinics often see higher profits from performing these surgeries. Doctors in private clinics report that some hospitals set targets for the number of hysterectomies performed, creating a financial incentive for unnecessary surgeries.
The Supreme Court’s directive in 2023 sought to curb this trend, demanding that all states implement the Ministry of Health’s guidelines, which call for monitoring committees to track hysterectomy practices. However, as of August 2024, only a few states have followed through with setting up these committees, and there is no centralized system to track the number of unnecessary procedures being performed.
While public health officials like Dr. Gupta remain hopeful that the court’s intervention will eventually address this crisis, many health experts argue that more extensive research and community-level surveys are needed to definitively identify the scale of the problem and to ensure that women are receiving the proper care they need.
