Health activists and civil society groups have demanded inclusion of hysterectomies as a component in the fourth round of National Family Health Survey, and the data so generated be used for formulating guidelines to conduct surgeries for removing the uterus.

The Indian Council of Medical Research (ICMR) will also be approached for more in depth population-based and facility-based studies, and introduction of medical audits, for gathering information on hysterectomies.

The demand comes following concern over rising cases of hysterectomies reported from across the country, particularly among younger women, and by some unscrupulous doctors for monetary gains.

Hysterectomy is the complete or partial removal of the uterus, and sometimes ovaries, cervix and fallopian tubes.

Ethically, a doctor should suggest this operation in case of certain medical conditions, or when all other treatment options fail.

“There is a great need to generate more data about prevalence of hysterectomies in the country as there is no significant authentic source from where this information can be acquired. This makes it all really challenging for anybody to assess its prevalence, major reasons for hysterectomies,’’ activists have written to the Ministry of Health and Family Welfare, and the Planning Commission.

Whatever best information we have right now is only in bits and pieces from different parts of the country which largely come from Right to Information applied by civil society organisations or brief studies conducted by them .

“Keeping this into consideration, it was agreed upon by all that National Family Health Survey must include some questions around hysterectomies which is one of the most common surgeries carried out on women,’’ the letter sent on behalf of Health Watch–a conglomerate of activists, civil society groups and individuals–said.

The letter also carries a set of questions to be asked during the survey.

On their part, the Indian Medical Association and the Federation of Obstetric Gynaecological Societies of India (FOGSI) have initiated a process of drawing Standard Operating Procedures (SOP) and these should be available in the public domain by December.

Guidelines

“We need to develop more stringent guidelines for conducting hysterectomies. The FOGSI is planning to launch a hysterectomy registry that would help in creating a data bank and also auditing these surgeries,’’ says Hema Divakar, president of FOGSI.

There have been sporadic surveys on hysterectomies. Dr. M. Prakasamma in his working paper on “Study of Operative Intervention in Women-Hysterectomy’’ says the findings of a study done by him on tubectomy and hysterectomy are contradictory in terms of place of operation.

Majority of tubectomies are performed in public health system, where as 89 per cent of hysterectomies were conducted in private.

“This indicates that the public health system is meant only for national programme and less interested in other health programme. This also raises questions whether hysterectomies are justified and whether the higher percentage of hysterectomies in the private sector reflect economic and commercial interest of some groups”.

The study done in two districts of Andhra Pradesh in 2002 suggested that 31.6 per cent of the women who had undergone hysterectomy were below 30 years, 52 per cent were between 30-39 years–the striking finding being 83 per cent of hysterectomies were performed in pre-menopausal women before they reached the age of 40 years.

More shockingly, data revealed that 89 per cent operations were performed in the private sector only and the remaining in the government health facilities.

Half of these women were brought or referred to the hospital by relatives and family members. In 25 per cent of women local peer groups influenced the choice of hospital. The influence of local primary health centre staff and auxiliary nurse midwives was negligible.

The local registered medical practitioner and medical shop owners also played a role in giving women information about hospital.

Majority of the 153 women, studied in the survey, underwent hysterectomy after they had two children and another 28 per cent after having three or more children.

Child birth

This is significant finding is that it could be an indication that the factors leading to hysterectomy could be associated with the last child birth.

There is also a common perception among women that hysterectomy becomes necessary after tubectomy with 65 per cent women who underwent hysterectomy also had tubectomy.

Of these, 39 per cent had tubectomy five years before hysterectomy and 36 per cent between 6-10 years prior to hysterectomy.

Concern over rising cases of hysterectomies in the country, particularly among younger women