Conduct audits on hysterectomies: Centre to state govts

The Union health ministry has asked states to conduct audits on hysterectomies in private and public hospitals after a complaint to the Supreme Court that doctors perform the surgery without need on many women purely for financial gains.

Union Health Secretary Rajesh Bhushan has also advised the states to “share the hysterectomy data”.

This is in line with the commitment the Union government gave to the top court to collect information from the states with steps to cut down on the number of unnecessary female sterilisation surgeries.

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According to the National Family Health Survey-5 conducted during 2019-21, three per cent of women between 15 years and 49 years have undergone hysterectomies and the median age of hysterectomy ranged from 33 years to 37 years.

While in developed countries hysterectomies are typically conducted among pre-menopausal women above 45, the much lower median age in the NFHS data has triggered concern.

Independent studies in India have also found rising hysterectomy rates among young women between 28 and 36 years of age.

Such studies have indicated that unnecessary hysterectomies are performed in cases where medical or non-invasive treatment would have been sufficient.

The evidence indicates that poor, less educated women, particularly in rural areas, are more likely to become victims of unnecessary hysterectomies.

This is the second letter from Bhushan who in October wrote to the states appealing to them to act against “unnecessary hysterectomies”. The states were told to audit all sterilisation cases below 40 years and follow a guideline that the ministry had prepared.

Ruling on a PIL submitted in 2013, the Supreme Court also stressed on adhering to the guidelines and told the states to take action against violators. The ministry said once the full data on hysterectomies was duly captured and monitoring committees were formed at the national, state and district levels, a considered decision might be taken.

“While the national monitoring committee headed by the Director General Health Services was formed three weeks ago, there are no such committees at the state and district levels,” Narendra Gupta, coordinator of a voluntary organisation named Prayas who filed the PIL told DH.

There are instances of unnecessary hysterectomies in government medical insurance schemes like RSBY and sterilisation camps run by the states as well as private organisations.

Under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, there are 45,434 instances of hospital admission for hysterectomies till March 16. But when a hysterectomy is performed on a woman below 40 years, AB-PMJAY needs two doctors to certify the requirement.

This model, however, may not be extended in other programmes because there is a danger that such a requirement may result in the denial of treatment to women who are genuinely in need of it.