Mother and Child Health – Immunization Program, BPBB, PMJSY, PMMSY, etc.

Do no harm: conservative, non-surgical approaches advised over hysterectomy for gynecological conditions


From UPSC perspective, the following things are important :

Prelims level: Hysterectomy Among Women;

Mains level: Health and disease Issues; Hysterectomy Among Women;

Why in the News?

According to the recent report published in Women’s Reproductive Health under the title ‘Reported Reasons for Undergoing Hysterectomy Among Women Aged 45 Years and Above‘, it was seen that data is lacking on women’s health conditions; thus the true magnitude is never known, impeding funding and escaping the attention of policymakers.

What is Hysterectomy?

  • A hysterectomy is surgery to remove the uterus. After a hysterectomy, you will not menstruate (have periods) or be able to get pregnant.
  • Uterus removal is a common treatment for a variety of conditions that affect a woman’s reproductive organs.

Key highlights of the Report:

Reasons for Undertaking Hysterectomy:

  • Medical Conditions: Common medical reasons such as fibroids, excessive bleeding, prolapse, endometriosis, and cancer.
  • Socioeconomic Factors: Influence of sociodemographic factors like age, education, income, and access to healthcare services.
  • Cultural and Regional Differences: Variations in hysterectomy rates and reasons across different regions and cultural contexts within India.

Frequency of Hysterectomy:

  • Global Context: Hysterectomy is one of the most frequently performed surgeries among women worldwide.
  • Prevalence in India: The countrywide hysterectomy prevalence rate is 11.5%. The highest prevalence is reported in the southern (18.2%) and western (12.7%) regions of India.
    • According to the NFHS-5 (2019-2021), 3.3% of women aged 15–49 underwent hysterectomy, a slight increase from 3.2% in NFHS-4. Alarmingly, 50% of women who underwent hysterectomy did so before the age of 35.
  • Regional Variations: Andhra Pradesh has the highest prevalence rate at 63 per 1,000 women, followed by Telangana (55 per 1,000), Karnataka (29 per 1,000), and Punjab (23 per 1,000).
  • Sociodemographic Factors: Higher risk of hysterectomy among women from the OBC category, the richest wealth quintile, those with lower education levels, those who married at a younger age, and those with three or more children.

Most Cited Reasons for Hysterectomy:

  • Primary Reasons: 
      • Heavy Menstrual Bleeding or Pain: Cited by 32.1% of women as the reason for undergoing hysterectomy.
      • Fibroids or Cysts: Cited by 24.2% of women as the reason for the surgery.
      • Uterine Prolapse: Cited by 16.3% of women.
  • Less Frequently Reported Reasons:
      • Cancer: Among the least reported reasons for undergoing a hysterectomy.
      • Severe Post-Partum Hemorrhage is also among the least reported reasons.
  • Sociodemographic Factors: 
    • Higher risk of undergoing hysterectomy among women from the OBC category, the richest wealth quintile, those with lower education levels, those who married at a younger age, and those with three or more children.

What are the Ministerial guidelines?

  • Hysterectomy is a major surgery with a long recovery time and should be considered only after less invasive treatments have been tried.
  • The government emphasizes on attempting nonsurgical alternatives in elective cases before opting for a hysterectomy.

Way Forward:

  • Healthcare Providers: Train healthcare providers about the potential overuse of hysterectomy and emphasize the importance of considering nonsurgical alternatives.
  • Public Awareness: Launch awareness campaigns to educate women about gynecological health, the implications of hysterectomy, and available alternatives.

Mains PYQ:

Q Public health system has limitation in providing universal health coverage. Do you think that private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)

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