Prevalence, socio-demographic determinants, and self-reported reasons for hysterectomy and choice of hospitalization in India

Abstract

Background There is limited evidence of hysterectomy in India because of a lack of data in large-scale, nationally representative health surveys. In 2015–16, the fourth National Family Health Survey (NFHS-4)—a cross-sectional survey—collected for the first-time direct information on hysterectomy and self-reported reasons for undergoing the procedure among women in the reproductive age group. The current study evaluates the prevalence, determinants, and choice of hospitalization (Public vs. Private) for conducting hysterectomy in India among women aged 15–49 years in 29 states and seven union territories (UTs) based on the new large-scale population-based nationally representative dataset (NFHS 5). Methods Cross-tabulations and percentage distributions were utilized to analyse the prevalence of hysterectomy and the choice of hospitalization (public vs. private) across different socioeconomic backgrounds and reasons for undergoing hysterectomy. A multivariate binary logistic regression model was also used to find statistically significant determinants of hysterectomy. Results In India as a whole, 3.3% of women aged 15–49 years had undergone a hysterectomy. The percentage of women who had undergone the procedure was found to vary considerably across the states and the UTs. The southern region stands out for the considerably higher prevalence of hysterectomy; particularly in the states of Andhra Pradesh (8.7%) and Telangana (8.2%), the prevalence was very high followed by Bihar (6%) and Gujrat (4%). On the other hand, the North-eastern region had the lowest prevalence of hysterectomy (1.2%). A noticeable fact that emerged was that the majority of the hysterectomies were performed in the private sector (69.6%) in India. But the scenario was quite different in north-eastern region as in this region more hysterectomies were performed in public health facilities (73%) rather than private health facilities (26.7%). Age, place of residence, religion, caste, level of education, geographic region, wealth quintiles, parity, age at first cohabitation of women were found to be the socio-demographic determinants statistically associated with hysterectomy in India. The likelihood of hysterectomy was higher among women living in rural areas (AOR: 1.3, CI: 1.23–1.35), in the richest wealth quintile (AOR 2.6; CI 2.37–2.76) and in the southern region (AOR 1.6; CI 1.47–1.66). The reasons frequently reported for hysterectomy were excessive menstrual bleeding/pain, followed by fibroids/cysts. Conclusion This study has attempted to analyse hysterectomy prevalence and its socio-economic determinants using the latest fifth round of NFHS data of all the states and covering 21 states and union territories of India, which gives wider coverage of hysterectomy and more recent with accurate data. More research is needed therefore to unravel the complex dynamics of hysterectomy in India (and elsewhere) which could be used to help women make more informed choices and in turn advance their reproductive health and rights.

Prevalence and determinants of hysterectomy in India

“…Here, it is worth noting that the prevalence of hysterectomy has almost doubled in less than a decade which could be a major concern in the future. A recent study conducted using NFHS-5 (2019–2021), estimated the prevalence of hysterectomy to be around 3.3% among women aged 15–49 years which is lower than the present study 19 . A probable reason for this could be the different age groups considered in these studies.…”

“…A probable reason for this could be the different age groups considered in these studies. Nonetheless, this study also revealed that the prevalence was highest (9.7%) for women aged 40–49 years 19 . A similar study conducted in China during 2017 reported the prevalence of hysterectomy to be around 7% among women aged 45–54 years which is comparatively lower than our study 20 .…”

Audit of all cases of total abdominal hysterectomy (TAH) at a private hospital in Enugu, Nigeria: Indications and post-operative outcomes

“…While this was a study in a tertiary hospital in the North-eastern part of Nigeria, our study was in the small private facility in the south-eastern part of Nigeria with different, culture, religion and population demographics. In a study carried out in India across many hospitals, it was found that 3.3% of women of reproductive age had undergone hysterectomy [10]. Even though this value appeared very low compared with our value of 34.5%, their study was limited to women of child bearing age and was also a multi-centre study while ours was a one centre study involving women of all ages.…”

A Systematic Review on Uterine Leiomyoma: From Pathogenomics to Therapeutics

“…Stress plays important role in pathogenesis of uterine fibroids. Greater risk of fibroid development depends on larger count of vital life incidents and stress intensity [36]. The NHS II found a higher uterine leiomyoma prevalence in between women who are long-serving to ill-treat in their early-stages of life.…”