Centre writes to States to curb trend of unnecessary hysterectomies

States and UTs were instructed by the Supreme Court to implement health guidelines formulated by the Centre to monitor “unnecessary” hysterectomies within three months

Hysterectomy is a surgical procedure to remove the uterus and it was found, through a public interest litigation, that in the States of Bihar, Chhattisgarh, and Rajasthan “unnecessary hysterectomies” were carried out. | Photo Credit: The Hindu

Worried that poor, less-educated women, particularly in the rural areas, continue to be at higher risk of undergoing unnecessary and often unjustified hysterectomies, the Health Ministry has written to all stakeholders to work towards plugging “such hysterectomies performed by certain medical institutions”.

The action comes following Supreme Court’s direction last month, where States and Union Territories were instructed to implement health guidelines formulated by the Centre to monitor “unnecessary” hysterectomies within three months.

What is hysterectomy?

It is a surgical procedure to remove the uterus, and sometimes surrounding organs and tissues.

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.

These procedures may be done through the vagina (with no incisions in the abdomen) or through an incision (cut) in the abdomen. (Source: National Cancer Institute)

Hysterectomy is a surgical procedure to remove the uterus and it was found, through a public interest litigation (PIL), that in the States of Bihar, Chhattisgarh, and Rajasthan “unnecessary hysterectomies” were carried out under the Rashtriya Swasthya Bima Yojana as well as other government schemes related to healthcare.

The petition also highlights the involvement of private hospitals in performing such hysterectomies.

A PIL was instituted by Dr. Narendra Gupta in 2013, based on his fieldwork and highlighted that women, who should not have been subjected to hysterectomies and to whom alternative treatment could have been extended, were subjected to hysterectomies, seriously endangering their health in the process.

The petitioner also submitted that most women who were subjected to hysterectomies of this kind belonged to the Scheduled Castes, Scheduled Tribes, or Other Backward Communities.

It was also noted with concern that several healthcare institutions were found to be misusing the procedure only to claim high insurance fees from governments under various health insurance schemes.

According to the recent letter written by Health Secretary Rajesh Bhushan, the issue of hysterectomies is being closely monitored.

“States are requested to share the hysterectomy status and data before and after the implementation of these guidelines,” the letter said.

“They are also advised to undertake compulsory audits for all hysterectomies, as is already being done for maternal mortality in all healthcare institutions — both public and private,’’ it added.

In 2022, the Health Ministry had issued ‘Guidelines to prevent unnecessary hysterectomies’, and asked States to comply with them.

The recent judgement also noted that the guidelines indicate that while in developed countries hysterectomies are typically conducted among premenopausal women above the age of 45 years, in India, community-based studies have consistently found rising hysterectomy rates among young women, ranging from 28 to 36 years old.

“The right to health is an intrinsic element 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. There has been a serious violation of the fundamental rights of the women who underwent unnecessary hysterectomies,’’ said the judgement.