Punjab features among the states in India with a high prevalence of hysterectomy at 2.63, almost two times higher than the national average of 1.7, pointing out the prevailing reproductive health condition of women in the state, as well as the inadequate role that the healthcare system currently plays in dealing with the reproductive health needs of women.
The trend has been noted in a study published in Dynamics of Health Care Services in India, a compendium of studies conducted by the Population Research Centers 2020-21. The compendium was released by Dr Rajiv Kumar, vice-chairman Niti Ayog and Gokhle Institute of Politics and Economics (GIPE) chancellor on Saturday.
The study focuses on the data of the national family health survey (NFHS) and covers married women aged 15-49 years with an aim to examine the dynamics of acceptance of hysterectomy in Punjab. A total of 19,484 women were included in the study, of which 513 had got themselves operated on.
The spread of hysterectomy has been found higher in Ludhiana and Patiala in the Malwa region, Nawanshahr, Jallandhar and Hoshiarpur in the Doaba region, and Amritsar in the Majha region. Nawanshahr tops the list with hysterectomy rate of 9.37% in Ludhiana in comparison to the state’s average of 2.63%, followed by 5.24% in Nawanshahr, 4.36% in Jalandhar, 4.41% in Patiala and 3.35% in Hoshiarpur.
The pattern of hysterectomy shows some interesting patterns in terms of social, economic and demographic characteristics of the acceptors. The findings indicate that hysterectomy is linked significantly to age, religion, cohabitation and fertility of women. However, it is not associated with the caste and standard of living of the married woman.
The occurrence of hysterectomy higher among the women from the general category (3%) and other backward castes (2.5%) than among women from scheduled caste (2.3%) communities.
The age group analysis shows that delayed age at cohabitation among women increased the chances of hysterectomy. The probabilities of hysterectomy increased by 90% among those who started their first cohabitation during 19-23 years and increased by 72% among those who started the first cohabitation during 24-28 years in comparison to the women who were exposed to their first cohabitation prior to age 19 years. The number of living children of a woman also contributes to hysterectomy. The possibility of women opting for the procedure is substantially higher after the second living child. The bulk of the surgeries were performed at private healthcare centres.
As hysterectomy is generally performed on medical grounds for a variety of conditions, 56.14% cited uterus prolapsed as the key reasons for the surgery followed by 48.34% revealed Fibroids/Cysts and 43.86% excessive menstrual bleeding and or pain. Assessment of the reported reasons indicates a lack of appropriate healthcare facilities.
The study done by Prof Aswini Kumar Nanda and associate professor Rajesh Kumar Aggarwal of Population Research Centre, CRRID, Chandigarh called for the need to weed out unwanted hysterectomies in Punjab for which a holistic strategy involving management of problems and symptoms before surgical intervention is required.
Prof Nanda, who is also the editor of the compendium, maintained that the findings of the study are expected to add to the overall understanding of hysterectomy prevalence in Punjab besides being of substantial academic and policy interest to the stakeholders. Adding, he said that further research is needed to explore the scope of interventions at the non-medical level to stem the tide of rising hysterectomy.