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Hysterectomies in the Global South: How The Thirst For Profit Robs Women of their Health

Updated: Aug 10, 2023

Three out of every hundred women in India have had a hysterectomy, a surgical procedure to remove the uterus (Kumari & Kundu, 2022). Commonly accepted as a radical, last resort surgery for severe reproductive health issues, the alarming growth in the prescription and prevalence of hysterectomies has created worrying landscapes of health and financial debt, with 8.9% of women in Andhra Pradesh having undergone the procedure. To add to this nightmarish reality, 60% of these women were under the age of 30 (Singh & Govil, 2021) - a patient age that, in developed nations, would instantly halt any conversations about having a hysterectomy.

There is a reason why developed nations have preferred to use less invasive treatments, like endometrial ablation or uterine artery embolization, for gynaecological issues spanning from fibroids to irregular or excessive menstrual bleeding - it is because they lack the painful, debilitating side-effects that hysterectomies can cause (Kumari & Kundu, 2022). Hysterectomies significantly increase the risk of developing high blood pressure, obesity, and coronary heart disease in the long run, especially for women who undergo it before the age of 35. Even in the short run, women are forced to bear with intense back pain, depression and insomnia, amongst a host of other daily impediments to their lives.

The question that must be raised, then, is what goes behind the overprescription of hysterectomies at the cost of less damaging alternatives, and why are these harms concentrated in the lives of women from low-income, illiterate households?

To understand this, it is important to examine why prescribing hysterectomies overwhelmingly benefits doctors. It is no surprise that 95% of hysterectomies are conducted in private hospitals (Singh & Govil, 2021). The invasive nature of the procedure happens to make it additionally lucrative for doctors in private hospitals, who care far more about their profits than patient wellbeing, and are willing to go to the extents of forcing women into getting their reproductive organs removed for the most mundane of issues, such as white discharge or abdominal pain. In South Asia, most of these procedures are done in remote, private medical clinics, which is what leads to countries like India, Bangladesh and Pakistan having the highest rates of hysterectomies for women under the age of 35 globally. In the 2016 to 2017 period, 59% of women who went to doctors in the Central Chhattisgarh region with minor gynaecological issues were prescribed the most extreme forms of hysterectomy (Moore et al., 2021). These trends do not arise from medical concern or proactiveness, but from greed and malice.

Given that doctors have these ulterior motives, it is far easier for them to target their coercion and manipulation at women from poorer communities, who are unable to make an informed choice and are compelled into decision-making that denigrates their health.

Firstly, it is in these rural areas that women often have to engage in physically demanding labour to earn wages and keep their households afloat. For instance, in the Beed village of Maharashtra that majorly depends on sugarcane harvesting, the seasonal nature of the crop means that individuals are only able to access income for 6 months of the year. That means that missing even a single day of work due to period cramps or body aches during menstruation, and watching their wages being cut by cruel contractors, is a reality women cannot risk facing. To compound this, existing taboos around menstruation mean that it is seen solely as an obstruction to efficient labour- doctors capitalise on this stigma, and sell the narrative that being free from menstruation via a hysterectomy means that women will be able to work for far longer and take home a higher income. This messaging becomes more and more compelling because it is currently an unfeasible economic investment to manage menstrual health and hygiene- for women in Beed who earn a daily wage of 202 rupees, having to purchase a packet of sanitary pads that costs 100 rupees every single month sounds far more burdensome than being rid of menstruation as a whole, leading to higher rates of opting into the procedure. This is exactly why poorer women are likely to get hysterectomies 2.4 years younger than their wealthier counterparts.

Secondly, a general lack of education and awareness of reproductive health issues means that it is far easier for doctors to create fear and sell hysterectomies as the only viable solution. Being told that hysterectomies are required as a result of infections (Kumari & Kundu, 2022), or that an enlarged uterus (which is common after giving birth) will eventually lead to the development of cancer, means that women provided with inadequate medical advice are more likely to opt into these procedures. Often, hysterectomies aimed to ‘prevent cervical cancer’ are not even done on the basis of a proper diagnosis to assess risk, and in a lot of cases, aren’t undertaken by gynaecologists (Moore et al., 2021). The lack of alternatives provided by medical professionals becomes far more disillusioning when everyone in a woman’s family and village probably got a hysterectomy in the past (Singh & Govil, 2021). While women who have finished 12 years of education get hysterectomies at a median age of 38, this age reduces to 34 for women who haven’t been able to complete their education.

And finally, government schemes may have had the negative externality of increasing the popularity of hysterectomies. In the 1970s, India and Bangladesh attempted to incentivise women to get tubal ligations, and provided financial rewards for doctors who did the procedure. Hysterectomies were assumed and branded to be the extension of this by doctors (Moore et al., 2021). In fact, the menstrual issues caused after tubal ligation were used as yet another reason for doctors to prescribe hysterectomy as a solution (Singh & Govil, 2021). Additionally, government insurance plans that covered a portion of medical expenses for low-income families, like Aarogyashri in Telangana and Andhra Pradesh, were used to finance hysterectomies. While governments restricted the use of these plans to finance hysterectomies in 2010, thousands of women had already gotten them by that time (Kumari & Kundu, 2022).

Hysterectomies make the lives of women significantly more strenuous and painful. Severe body pains that result from hysterectomies (that are now more difficult to treat) only make it harder to work daily wage jobs. Moreover, it is highly likely that complications to ligaments or nerves occur during surgeries, because public health infrastructure in rural areas lacks the expertise needed to safely complete these procedures (Moore et al., 2021). Doctors often don’t schedule follow ups, and even when they do, geographical barriers to accessing healthcare mean that women are forced to grapple with a myriad of complications by themselves. But even past the health consequences, families are made to shoulder incapacitating debt that they have to take on to finance hysterectomies, leading to long term economic instability within these households.

Procedures that have the potential of saddling women with lifelong health complications and crippling debt should not be offered as the first option to patients, especially when those prescriptions are driven by the thirst of profit. Government and NGO efforts to educate both healthcare providers and women in rural communities must be extended far further, so that more women are not forced into situations where they are unfairly debilitated, just because they happened to access a private hospital, or work a physically demanding job - they deserve to have access to accurate information about their bodies.


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May 23, 2023

Very well written . An eye opener for society .

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