Provide Data on Hysterectomies conducted in Private, Public Hospitals: Health Ministry directs States

New Delhi: Soon after the Supreme Court order to implement the Union Government guidelines to prevent unnecessary hysterectomies, now the Central Government has directed the States for providing data on hysterectomies conducted in private as well as public hospitals.

Aiming at preventing certain medical institutes from carrying out the procedure even when it is unnecessary and unjustified, the Union Health Secretary Rajesh Bhushan has advised all states and Union Territories to undertake compulsory audit for all hysterectomies as is being done for maternal mortality in all healthcare institutions, both public and private.

Writing to all the States and Union Territories on April 28, Bhushan said in a letter, "The matter is regarding the prevention of unnecessary and often unjustified hysterectomies performed by certain medical institutions. This issue is being closely monitored by the Ministry of Health and Family Welfare."

This comes after recently the Supreme Court passed a judgment strictly asking for the implementation of the guidelines released by the Union Ministry of Health and Family Welfare (MoHFW).

Also Read: All Hysterectomies to be reported for women below 40 years of age: SC directs strict implementation of Centre's guidelines

Hysterectomy is a surgical procedure to remove the uterus after which a woman can neither conceive nor can have menstrual periods regardless of her age. The issue of unwanted hysterectomies has been highlighted in various medico-legal cases pending from lower courts to the Supreme Court.

Medical Dialogues had earlier reported that one of the salient features of the guidelines released by the Union Health Ministry was that all Hysterectomies below 40 need to be reported and the guidelines also define the monitoring committees at the district, state, and national levels and existing agencies that can help build awareness in the community in this regard.

Apart from this, other issues addressed in the guidelines include common indications for hysterectomy, the role of different levels of public health facilities, the issue of community awareness, basic facts about hysterectomy, communication strategies and principles for community awareness on prevention of unnecessary hysterectomies, various management modalities available for hysterectomy, post-hysterectomy follow-ups of women who had a hysterectomy before 45 years, guidance on conducting audits of hysterectomies, various modalities of treatment available for AUB/DUB among others.

The Union Health Ministry framed the comprehensive guidelines to regulate "unnecessary hysterectomies" after a PIL had been filed before the Supreme Court by a medical practitioner Narendra Gupta, who alleged a "widespread pattern of doctors performing medically unnecessary hysterectomies to reap high insurance fees from the government" in states such as Bihar, Rajasthan, and Chhattisgarh.

PTI adds that a copy of the guidelines prepared by the Health Ministry along with the data collection format was circulated to all States earlier. "The states are requested to share the hysterectomy status/data pre and post-implementation of these guidelines. They are also advised to undertake compulsory audits for all hysterectomies, as is already being done for maternal mortality in all healthcare Institutions (both public and private)," the letter stated.

The ministry last year stated that community-based studies have consistently found rising hysterectomy rates among young women aged between 28 and 36 years.

According to it, the prevalence of hysterectomy was 3.6 per cent among women in the age group of 30 to 39 years and 9.2 per cent among those between 40 and 49 citing the National Family Health Survey-4 (2015-16) estimates.

In the PIL before the Supreme Court, it had been alleged that women, aided by heavily-subsidized state-funded health insurance schemes, usually go to private hospitals for medical care for symptoms such as "abdominal pain and general weakness" and doctors resort to "unnecessary hysterectomy operations after cursory, or in some cases, no medical examinations".

During the last hearing of the case, the Union Government had submitted, "We propose a strong and robust mechanism of monitoring and evaluation of the issue. There has to be reporting of the hysterectomies, causes especially for women below the age of 40 years."

Taking note of this, the Apex Court bench had disposed of the PIL noting that "Since sufficient steps have now been taken by the Union government in framing the guidelines, we see no reason to keep the petition alive. The Union government will now take necessary steps in accordance with the guidelines."

Also Read: Performing Hysterectomies in India: Here is what SC mandated GOI Guidelines say