A storm in my uterus

Carl Sagan once wrote, "Somewhere, something incredible is waiting to be known." He was referring to outer space and all that we don't know about it yet. But I think space explorations can wait. We don't know much about Earth itself. Or of its inhabitants. Especially when it comes to the female anatomy. Men think a G-spot is fiction. Doctors think women in pain are just being hysterical. Menstruation is still taboo in discussions around the world. I might have put it down to an eye for profits, but unfortunately, I believe apathy is the cause.

Take India and its recent proclivities for early hysterectomies.

A recent survey in India revealed that Indian women are getting their uterus removed at an early age. This was also the first-ever study to check the prevalence of hysterectomy. According to the survey, 3.2 per cent of women between 15-49 years had had a hysterectomy.

Hysterectomies, removal of the uterus with or without the cervix and ovaries, are carried out for various reasons, including uterine fibroids, uterine prolapse, cancer of the uterus, cervix, or ovaries, endometriosis, abnormal vaginal bleeding, chronic pelvic pain or adenomyosis. Surgeons will remove all or part of the uterus, depending on why they are doing it. Hysterectomies for non-cancerous reasons are typically considered only when all other treatment approaches have been tried.

There has been an increase in the number of hysterectomies done in recent years. There is increasing concern that doctors are removing women's uteruses too quickly without allowing themselves time to understand and fix the problem.

While the paucity of data makes it difficult to get to the true nature of the issue, the last two rounds of the National Family Health Survey (NFHS) reveal troubling patterns.

More younger women are having hysterectomies, most done in private facilities. Data from NFHS-5 shows 3.3 per cent of women aged 15 to 49 have undergone a hysterectomy.

Per a study in the British Journal of Obstetrics and Gynaecology (BJOG), women undergoing hysterectomies trend in the 44-59 age group in countries like the US, Germany, Australia, Ireland, and the UK.

In India, the median age is 34 years. Experts are alarmed as this is well below the global trends, where the surgery is done closer to menopause. If an oophorectomy (removal of ovaries) is involved, it can advance menopause by at least 15 years. Estrogen deficiency is linked to several health conditions, such as an increased risk of osteoporosis and cardiovascular disease.

With its impact on women's health, especially young premenopausal women, many medical professionals advocate alternative treatments to treat common conditions such as dysfunctional uterine bleeding and fibroids.

Studies in the past decade point to "grossly unscientific information to poor Dalit and marginalised women", misleading them into undergoing a hysterectomy, following which many suffer complications, even death. Private practitioners were found to be using highly suspicious diagnostic criteria mostly based on a single ultrasound scan. Needless to say, medical records were incomplete, erroneous, and, in several instances, manipulated.

Another investigation revealed the alarming number of illegal hysterectomies under the Rashtriya Swasthya Bima Yojana (RSBY) between 2010-2012 in Bihar. These hysterectomies constituted 37-50 per cent of all procedures in some hospitals. Similar stories have emerged from Rajasthan, Chhattisgarh, Gujarat, and Andhra Pradesh.

Marginalised and poor women are often terrorised with the fear of cancer to persuade them into having their uterus removed at a young age. In 2014-2015, another study in Karnataka found that surgery was not required in 40 out of 70 respondents.

In 2019-21, Andhra Pradesh (8.7 per cent), Telangana (8.2 per cent), and Bihar (6 per cent), while the lowest was in Meghalaya (0.7 per cent), Sikkim (0.8 per cent), and Chandigarh (0.9 per cent) had the highest prevalence of hysterectomies.

More interesting is that 70% of women nationwide have undergone hysterectomies in private institutes. Andhra Pradesh, Telangana and Bihar take top spot.

If this trend continues, it could have long-term effects on young women's health, which will spill over to children and the wider community.

Mars can wait. Let's be more mindful of women's health first. Or there won't be any uteruses to populate Mars.

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