We have linked the large number of reported hysterectomies in Chhattisgarh not only to unregulated RSBY and privatisation but also to poorly functioning public facilities. RSBY offers packages for one-time surgical procedures such as hysterectomies but does not support conservative outpatient options (outpatient treatment is not covered under the scheme). Ironically it is described as a health insurance scheme when all it ensures are medical procedures with no primary care.
Dr. Desai’s attempt at explaining away hysterectomies on gender bias and women’s rights using her qualitative research is confusing, and worrisome. Is she justifying that women have a right to lose their uterus when they believe that it has outlived its role in fertility? That men (and women) doctors have induced the demand for hysterectomies among women is an example of gender bias? As averred by her, good primary care and education are critical but not when there is an unregulated lure of profit for private players.
Excessive hysterectomies are a case in point to highlight the problems of unregulated privatisation. It is well known that significant profit motive raises the incidence of those procedures and investigations in which you can “play” with the indications, whether it is hysterectomies, caesarean sections for women in labour or cholecystectomies for all gallstones.
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We need a judicious mix of primary, secondary and tertiary health care for our huge and complex illnesses and that should primarily be provided by the government.
We don’t just need support for medical procedures.