A study has revealed that 4.8 per cent of Indian women in the reproductive age group have undergone a hysterectomy, a surgical procedure to remove the uterus, with agricultural workers showing the highest prevalence at 6.8 per cent. Alarmingly, many women utilise government health insurance schemes for unnecessary procedures.
The findings highlight clinical disparities driven by occupational hazards and socioeconomic factors, exposing young women to long-term complications such as hormonal imbalances, early menopause, and chronic health issues, underscoring the urgent need for policy intervention.
Hysterectomy has become a significant public health concern in India. This study, published in the Journal of Medical Evidence, was conducted by Gaurav Suresh Gunnal of the International Institute of Population Sciences, Mumbai, and Dr Sudeshna Roy of the National Institute of Health and Family Welfare, New Delhi. It highlights the prevalence and patterns of hysterectomy among Indian women aged 25 to 49 and explores the contributing factors.
The research revealed significant occupational disparities, with agricultural workers recording the highest prevalence of hysterectomy. Strenuous labour and regular exposure to pesticides make these women prone to gynaecological issues such as excessive menstrual bleeding, fibroids, and uterine disorders.
Gunnal explained that many agricultural workers view hysterectomy as a solution to manage work demands, often without awareness of less-invasive alternatives. “This highlights the urgent need for greater awareness and preventive care to reduce unnecessary surgeries,” he said.
Misuse of health insurance
Ironically, health insurance, intended to improve healthcare access, has exacerbated the problem in certain states. Women with health insurance were found to be 10 per cent more likely to undergo a hysterectomy. In states such as Bihar and Chhattisgarh, government health insurance schemes have been linked to unnecessary surgeries, often driven by profit motives within private healthcare settings. “The misuse of health insurance for non-essential surgeries highlights systemic gaps in the regulation and oversight of healthcare practices,” Dr Roy explained.
Geographically, the study uncovered significant regional variations. The southern states of Andhra Pradesh and Telangana reported the highest prevalence rates of hysterectomy, at 12.6 per cent and 11.1 per cent, respectively, compared to just 1.4 per cent in Assam and 1.5 per cent in Mizoram. A striking majority—67.5 per cent—of these surgeries were performed in private healthcare facilities. This raises concerns about the commercialisation of women’s reproductive health. Dr Roy noted, “The high concentration of hysterectomies in private facilities raises serious ethical concerns about the exploitation of vulnerable women under the guise of medical necessity.”
Socioeconomic factors also played a crucial role in the prevalence of hysterectomy. Women in rural areas were found to be 30 per cent more likely to undergo the procedure than their urban counterparts. Educational attainment emerged as a key factor, with illiterate women and those with only primary education being particularly vulnerable. However, wealthier but less-educated women were more likely to afford the surgery, further complicating the socioeconomic dynamics. The study revealed that women in the wealthiest quintile were more than twice as likely to undergo hysterectomy compared to those in the poorest quintile, underscoring disparities in healthcare access and decision-making. “The interplay of economic status, education, and healthcare access highlights the challenges in addressing these disparities,” Gunnal added.
Early childbearing and repeated pregnancies
Age and parity were also significant factors influencing the likelihood of hysterectomy. Women aged 40 to 49 showed the highest prevalence, with 9.2 per cent in this group having undergone the surgery. Additionally, women with higher parity—those who had three or more children—were more likely to opt for hysterectomy. Early childbearing and repeated pregnancies exacerbate gynaecological health issues, further increasing the likelihood of surgical intervention. Overweight and obese women were also at greater risk, with 9.2 per cent of obese women undergoing hysterectomy compared to 5.1 per cent of underweight women.
The primary reasons cited for hysterectomy were excessive menstrual bleeding, which accounted for 55.4 per cent of cases, followed by fibroids or cysts (19.6 per cent) and uterine disorders such as ruptures (13.9 per cent). Cancer and uterine prolapse were less common but still significant contributors. The data revealed that professional and clerical workers were more likely to undergo hysterectomy for excessive bleeding, while manual labourers cited fibroids and uterine disorders. Many women, particularly those from rural areas or less-educated backgrounds, were unaware of less-invasive alternatives or the long-term health consequences of hysterectomy, such as early menopause, osteoporosis, and cardiovascular risks.
Awareness and regulation key
The study underscores an urgent need for policy interventions. Strengthening public healthcare systems, increasing access to gynaecological counselling, and promoting awareness about menstrual and reproductive health are critical to reducing unnecessary hysterectomies. “Women must be empowered with information about their health and available treatment options,” Dr Roy emphasised. “Preventive care and early diagnosis can significantly reduce the need for invasive surgeries.”
The findings also highlight the importance of addressing occupational health hazards and improving working conditions for women in agriculture and other labour-intensive sectors. Exposure to harmful chemicals like pesticides has been linked to gynaecological issues, further underscoring the need for stricter regulations. The researchers also called for enhanced oversight of private healthcare facilities and insurance schemes to curb unethical practices and ensure women receive comprehensive and informed care. “Hysterectomy should only be a last resort and not a default response to systemic neglect of women’s health,” Gunnal said.
Strenuous labour and regular exposure to pesticides make these women prone to gynaecological issues such as excessive menstrual bleeding, fibroids, and uterine disorders. (Representational/File) 
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