INTRODUCTION
Wombless women in India are the tip of the iceberg. This phrase often indicates the inattention of people of the country on the significant number of cases of hysterectomy. Hysterectomy refers to the surgical procedure of removal of the uterus, cervix, and other organs of the uterus through the means of vagina, abdomen, or keyhole surgery. Vaginal surgery or keyhole surgery is preferred over abdominal surgery as they are less intrusive than the abdominal surgery. A physician generally prescribes this surgery if the woman is suffering from several issues such as endometriosis, uterine fibroids, adenomyosis, pelvic pain, Uterine cancer, or Uterine prolapse. After this surgery a woman is not able to conceive or to give birth and the menopause period starts immediately if the surgery includes removal of ovaries. The widespread side effects of this surgery can be insomnia, sudden weight gain, hair loss, depression, and vaginal dryness. As with other surgical procedures, this procedure also carries certain risks that affect both the physical and mental well-being of a woman as the woman might experience blood clots, internal infection, difficulty during urinating, and damage to other organs.
Hysterectomy is one of the prevalent gynaecological surgeries. [1] Multiple studies in India have shown that women from rural areas are more prone to this surgery. Also according to the National Family Health Survey- data4, 66.6% of total uterine surgeries were performed by private clinics. [2] These statistics raise the question of unethical behaviour by medical professionals who to make a profit mislead poor and less educated women by prescribing them unnecessary uterine surgery. They manipulate women by giving them the threat of severe results such as cancer. This ruthless practice by some medical professionals is one of the major concerns for the country. There have been minimal studies on the prevalence of hysterectomy in India. However, the government took a step by providing the statistics on the given subject in the National Family Health Survey phase-4 and phase-5.
STATISTICS
According to the National Family Health Survey phase-4 and phase-5 conducted in 2015-16 and 2019-21, the prevalence of hysterectomy in India stood at 3.2% and 3.3% among women aged 15–49 years. [3][4] Although there is a little surge in cases this also raises a deep concern as several developed countries with significant numbers of cases of hysterectomy are reporting a decline but India is witnessing a rising number of cases. The data also revealed major participation from women in rural India and the most common reason for surgery among women aged 15-49 years was menstrual bleeding which can be cured through alternative treatment.[5]Further, according to NFHS-5 69% of the total cases were found in private hospitals.[6]
BEED DISTRICT CASE
Beed is a district in the state of Maharashtra, India. A news article in 2019 revealed that several women sugarcane workers in the Beed district are involved in unnecessary or unjustified hysterectomy.[7] In the sugarcane industry, they have to work for longer periods and due to the demanding nature of the work, women experience heavy menstrual periods which hinders their work life. So to boost their productivity women generally opt for this surgery. The majority of these surgeries were performed in private hospitals, according to the report. Due to the lack of public healthcare facilities women are dependent on private clinics where they are exploited by doctors who see this as an opportunity for them to make a profit, by prescribing them unnecessary surgeries. Private medical professionals while compromising their integrity spread fear among innocent and unlearned women that even a normal infection could lead to uterine cancer which mandates surgery.[8] Also, the women were not provided with proper diagnosis reports.
Then health minister of Maharashtra disclosed that there had been a total of 4,605 cases of hysterectomy in the Beed district from 2016-17 to 2018-19. A predominance of women under the age of 40 was observed. Assessing the severity of the issue and after the notice circulated by the National Commission for Women, The government of Maharashtra formed a committee to investigate the issue. The fact-finding report of the committee found that 4,605 surgeries were performed by 99 private hospitals.[9] This implies a direct question on the administration of district and state.
STEPS TAKEN SO FAR
The Supreme Court in Dr Narendra Gupta v Union of India & Ors affirmed that “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”. While disposing of this PIL Supreme Court directed all the states and union territories to implement the health guidelines drafted by the union government to address the issue of unnecessary hysterectomy in the country. The apex court also recommended forming national, state, and district-level hysterectomy monitoring committees.[10]
Then the union government mandated the approval of two doctors for a hysterectomy under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana if the woman is below the age of 40 years. Also, the government proposed an action plan that included the creation of a National level grievance portal for hysterectomy beneficiaries.[11]Then several hospitals which were involved in malpractices or violating guidelines were blacklisted under the “Clinical Establishments (Registration and Regulation) Act, 2010”.[12] Various measures are taken by both central and state governments but there is a need for more stringent laws and guidelines for addressing this issue.
CONCLUSION
This unethical practice by some medical professionals resulting in the sheer violation of the right to health an intrinsic part of the Right to life and personal liberty, of women demands the sudden attention of authorities. However, several steps are taken by the government but those are not sufficient. Primarily, there is a need for more studies on the prevalence of hysterectomies in India to understand the issue more effectively and to formulate various policies. Then there is a need for proper public health care facilities and the main focus area of government should be awareness campaigns as this will educate women about the dire consequences of the surgery. Also, there should be strict implementation of laws. The issue calls for a comprehensive strategy.
Author(s) Name: Poonam Bhojwani (Lords Universal College of Law, University of Mumbai)
Reference(s):
[1]Aangad Sindh and Dipti Govil, ‘Hysterectomy in India: Spatial and multilevel analysis’ (2021) 17(30) Researchgate<https://www.researchgate.net/publication/352183892_Hysterectomy_in_India_Spatial_and_multilevel_analysis>accessed 17 April 2024
[2] Roli Srivastava, ‘Private Doctors Perform most Hysterectomies in India- Survey’ Reuters (i) (11 January 2018) <https://www.reuters.com/article/idUSKBN1F02HX/> accessed on 17 april 2024
[3] Priyanka Kumari and Jhumki Kundu, ‘Prevalence, socio-demographic determinants, and self-reported reasons for hysterectomy and choice of hospitalization in India’ (2022) 22(514) BMC Women’s Health <https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-022-02072-7#citeas> accessed on 17 April 2024
[4] S Desai et al. ’Patterns of hysterectomy in India: a national and state-level analysis of the Fourth National Family Health Survey (2015-2016)’ (2019) 126(4) BJOG <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6772015/> accessed on 17 April 2024
[5] Ibid
[6] Ibid
[7]Neymat Chadha, ‘Constructing the Female Labouring Body: A case Study of Beed District of Maharashtra’ (2019) SPRF <https://sprf.in/constructing-the-female-labouring-body-a-case-study-of-beed-district-of-maharashtra/> accessed on 17 April 2024
[8] Dr. Manu Sharma, ‘Journal of Critical Reviews Plight of Women Worker in Un- organized Sector: A Review on Cane Cutter Women Without Wombs in Beed District of Maharashtra’ 2020 7(16) Academia <https://www.academia.edu/43520648/JOURNAL_OF_CRITICAL_REVIEWS_PLIGHT_OF_WOMEN_WORKERS_IN_UN_ORGANIZED_SECTOR_A_REVIEW_ON_CANE_CUTTER_WOMEN_WITHOUT_WOMBS_IN_BEED_DISTRICT_OF_MAHARASHTRA> accessed on 17th April 2024
[9] Ibid
[10] Dr. Narendra Gupta v Union of India &Ors, WP (C) 131/2013
[11] Ibid
[12] ‘What is Hysterectomy’ (Vajiram and Ravi, 30 May 2023) <https://vajiramandravi.com/upsc-daily-current-affairs/mains-articles/what-is-hysterectomy/> accessed on 17 April 2024
