Hysterectomies going unchecked in Karnataka; no state-level committee formed despite central directive

Unnecessary hysterectomies are on the rise across the country in the absence of state-level audits, despite the Centre's directive.

ByChetana Belagere

Published Dec 20, 2023 | 8:00 AMUpdatedDec 20, 2023 | 2:43 PM

Majority of hysterectomies in the country are allegedly happening at private hospitals. (Wikimedia Commons)

Despite the Supreme Court of India’s directives and guidelines issued by the Union Ministry of Health and Family Welfare to regulate “unnecessary hysterectomies”, Karnataka is yet to form a state-level hysterectomy monitoring committee and has not shared data with the ministry.

Speaking at the 5th round table discussion on “Rational treatment for gynaecological morbidities and prevention of unnecessary hysterectomies”, Dr Roopali Roy, Assistant Directorate General of Health Services (DGHS), New Delhi, confirmed this and said that the state, despite repeated reminders, has failed to send the data.

A hysterectomy is the surgical removal of the uterus.

Hysterectomies a growing concern

At the discussion, Dr Roy said, “Hysterectomy emerged as a health concern in 2013 where it was observed in the NFHS-4 survey that several women below 40 years of age were subjected to a hysterectomy. States including Telangana and Andhra Pradesh ranked high on the list.”

Speaking to South First, Dr Roy said that the National Committee was formed on 26 June 2023 and the first meeting of this committee was held on 25 August 2023.

Expressing concern, she said, only five or six states have sent data on hysterectomy and only Uttar Pradesh has formed a state-level monitoring committee.

This situation raises significant concerns regarding the health and rights of women in the state, particularly given the alarming reports of unnecessary hysterectomies in some regions of the state.

Also Read: Meet Dr Narendra Gupta, the man fighting to stop unnecessary hysterectomies in India

Discussion on unnecessary hysterectomies

Dr Roy was speaking at a round table discussion organised by NGO Prayas, with the support of United Nations Population Fund (UNFPA), and in collaboration with Bengaluru-based St John’s Medical College and Hospital and SOCHARA (Society for Community Health Awareness Research and Action), an independent NGO working towards health and development of people.

Meet the doctor who is ensuring unnecessary hysterectomies are stopped in India.

Meet the doctor who is ensuring unnecessary hysterectomies are stopped in India. (Supplied)

Speaking about why these round table discussions are happening across various states, Dr Narendra Gupta, coordinator of Prayas and the force behind the pivotal Public Interest Litigation (PIL) against unnecessary hysterectomies, said that these discussions focused on enhancing gynaecological care and scrutinising the soaring numbers of hysterectomies.

The discussions are held in major cities, including Guwahati, Jaipur, Chandigarh, Hyderabad, and Bengaluru.

Dr Gupta shared that his interest in this public health crisis was sparked in 2013 from the findings of an investigation, which revealed a disturbing trend of doctors opting for hysterectomy as a first-line treatment, often without considering other medical interventions.

This unethical practice, devoid of proper protocols, led to the realisation that this issue might be more widespread in India than initially believed.

A national consultation was organised, inviting experts from across India to address this health crisis. This meeting played a crucial role in shaping the data collection for the National Family Health Survey (NFHS-4). They agreed to incorporate specific questions to gauge the prevalence of the issue across all the states and Union territories in India.

The results of NFHS-4 and NFHS-5, and the PIL filed in 2013 in the Supreme Court, after ten years, led to the apex court issuing guidelines to the Union government to form a national-level committee to monitor the hysterectomies in the states.

Dr Gupta highlighted the pivotal role of NFHS-4 in identifying the prevalence of hysterectomies in various states, leading to the drafting of comprehensive guidelines.

These guidelines, now published and implemented, stress the responsibility of state governments in monitoring and controlling unnecessary hysterectomies.

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What did the NFHS-5 survey show?

The National Family Health Survey (NFHS) 2019-2021 in India revealed some concerning statistics regarding hysterectomy procedures. The report indicated that 3.3 percent of Indian women have undergone a hysterectomy, making it the second-most common surgical procedure among women in the country, after Caesarean sections.

Significantly, the prevalence of hysterectomies was higher in rural areas (3.6 percent) compared to urban areas (2.5 percent). The age group most affected was women between 40 to 49 years, where the rate was as high as 9.7 percent. Younger age groups saw lower rates, with 3.3 percent in women aged 30-39 years and only 0.2 percent in the 15-29 age group.

This trend raises concerns among policy-makers and experts, especially given the contrast with Western countries, where the rates of hysterectomies have decreased due to more conservative approaches being favoured by doctors.

In India, however, the number of these procedures continues to rise, leading to suspicions of profit-driven motivations behind the high rates.

The NFHS-5 data also showed regional variations in hysterectomy rates across India. The Southern states reported a higher prevalence, with about 5 percent of women having undergone the procedure, followed by the East (3.3 percent), West (3.1 percent), Central (2.4 percent), and North (2.1 percent) regions.

However, the Northeast stood as an exception to this rural-urban pattern.

Focusing on specific states, Andhra Pradesh had the highest prevalence (8.7 percent), followed by Telangana (8.2 percent), Bihar (6 percent) and Gujarat (3.9 percent). Interestingly, Karnataka also reported a rate of 3-4 percent.

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What is the purpose of the guidelines?

Dr Roy told South First that the first meeting of the national monitoring committee was held on 25 August 2023 and the states were asked to immediately form a similar committee for the state level and district level too.

Hysterectomies are being performed on women aged 28-4 years. (Wikimedia Commons)

Hysterectomies are being performed on women aged 28-4 years. (Wikimedia Commons)

The guidelines intended to provide guidance to public health programme managers on measures to address unnecessary hysterectomies at the facility level, strategies for monitoring and community awareness generation activities, clinical guidelines on common condition that have emerged as indications for hysterectomy, and how to perform audit and data collection forms.

The Union government decided to mandate establishment of three-tiered monitoring monitoring committees at the national, state, and district levels, and emphasise the importance of community awareness, the role of public health facilities, and the need for auditing hysterectomy procedures.

The guidelines highlighted that hysterectomies should be reported and monitored, especially for women below 40, to ensure that surgeries are not performed where medical or non-invasive treatments would suffice.

This becomes crucial in the context of rising hysterectomy rates among young women in India, particularly among the less educated and poor in rural areas.

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No monitoring committee yet in Karnataka

Unfortunately, only one state in the country has set-up with a state-level monitoring committee.

“None of the other states, including Karnataka, has formed a committee yet. Despite repeated reminders, we are yet to get any information or even data on hysterectomies from the Karnataka government,” said Dr Roy.

She added that the lack of a state-level monitoring committee and data sharing with the Ministry of Health is a significant gap in addressing this issue. The absence of such mechanisms means there’s limited oversight and accountability for healthcare providers, potentially leading to more cases of unnecessary surgeries, which have profound implications for the health and wellbeing of women.

The experts at the roundtable said that forming a state-level hysterectomy monitoring committee and sharing data with the health ministry are critical steps towards transparency, accountability, and ensuring the health and rights of women. This would allow for the identification of trends, the examination of the reasons behind the surgeries, and the implementation of corrective measures. Moreover, such oversight would serve as a deterrent against unethical medical practices and ensure that women receive the most appropriate medical advice and care.

Dr Roy even at the discussion requested the state government, the health department and the health minister to share the information on hysterectomies in the state with the central health ministry. Meanwhile, when South First tried to reach Dr Rajkumar N, Deputy Director of Maternal Health, health and family welfare department he was not available for the comment.