Times of
India: Mumbai: Sunday, February 10, 2013.
Is India
witnessing a spurt in unnecessary hysterectomies? Data released by
international charity organization Oxfam on February 6 says as much. The agency
said that unnecessary hysterectomies were being performed in Indian private
hospitals to economically exploit poor women as well as government-run
insurance schemes.
A right to
information ( RTI) request filed by one of Oxfam's local NGOs in the Dausa
district of Rajasthan showed that 258 of 285 women—65%—investigated over six
months had undergone hysterectomies. Many of these women were under 30, with
the youngest being 18 years old.
An editorial
in the British Medical Journal quoted Oxfam's global spokesperson Araddhya
Mehtta as saying that the "trend is seen all over India but is
particularly disturbing in Rajasthan, Bihar and Chattisgarh where doctors
simply abuse their power of being a doctor". In 2010, the Andhra Pradesh
government tweaked its state-sponsored insurance scheme to disallow
hysterectomies in private hospitals after surveys revealed that uteruses of a
number of beneficiaries were removed merely to claim higher insurance amounts
(the state insurance scheme is only available for the economically poor
sections).
Dr Duru Shah,
former president of FOGSI (Federation of Obstetric and Gynaecological Societies
of India), said that modern medicines could fix 95% of woman's menstrual
problems without the need for surgery.
However,
experts fear the trend of unnecessary hysterectomies possibly exists in urban
centres such as Mumbai as well.
Aniruddha
Malpani, medical director of HELP (Health Education Library for People) in
Fort, said, "It's easy to get data from a small centre such as Dausa but
it would be impossible to get similar data from cities like Mumbai. However, if
some doctors in small towns are performing unnecessary hysterectomies, why
should it be any different in cities like Mumbai?"
Indeed, an
audit performed by insurance companies in Chennai in 2009 had shown that more
than 500 women in the 25-35 age group had undergone hysterectomies. A Central
government study in the wake of the Andhra Pradesh scam had said that women
under 45 rarely needed hysterectomy.
A 2011
research paper in medical journal Reproductive Health Matters, conducted by
SEWA Health Cooperative doctors in Ahmedabad, showed that insured women—both in
urban and rural areas—had higher rates of hysterectomy. "Among insured
women, 9.8% of rural women and 5.3% of urban women had had a hysterectomy,
compared to 7.2% and 4.0%, respectively, of uninsured women,'' said the study.
The OXFAM
report, in fact, says that India should end its public-private partnership
programmes (that allow poor women with government insurance plan to undergo a
hysterectomy in private hospitals) until better regulation is in place.
Oxfam
official Mehtta has been quoted as saying, "When women came with abdomen
pain, doctors prescribed hysterectomy to women from poor economic backgrounds,
telling them that it might be a cancer or a hole or a stone in the uterus
without doing any thorough necessary investigations."
Dr Duru Shah
said that unnecessary hysterectomies affected the concerned woman's health.
"A young woman who has undergone hysterectomy may suffer early menopause
(stoppage of periods) and the accompanying health problems of increased risk of
cardiac diseases and fractures due to brittle bones,'' she said.
Dr Rekha
Daver who heads the gynaecology of J J Hospital, Byculla, said, "Generally
speaking, there may be a marginal increase over the years. But this may only be
because women from rural areas who travel to referral centres in cities don't
want to prolong their suffering." She said it wasn't feasible for these
women to return to cities a second time for any treatment that may be required.
Incidentally,
Maharashtra doesn't allow hysterectomies in private hospitals under the
insurance scheme launched last year for the economically weaker sections,
called the Rajiv Gandhi Jeevandayee Arogya Scheme. "We have learnt from
the Andhra Pradesh experience," said Dr K Venkatesam, CEO of the arogya
scheme.
However, not
all agree that hysterectomies are on the rise. Gynecologist Dr Rakesh Sinha from
Mumbai said, "It would be wrong to say there is an epidemic of
hysterectomies in Mumbai or India. What has changed over the past few years is
that we have facilities such as USG to make early and accurate diagnosis.
Moreover, there are procedures available that allow women to go home within a
day or two."
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