By Madhura Kadaba
In an interview in Arun Gadre and Abhay Shukla’s book Dissenting Diagnosis, Dr Rajendra Malose says with striking matter-of-factness, “I might say with a little exaggeration that nowadays one rarely sees a woman over the age of 35–40 years who still has her uterus. Doctors have converted patients into commodities. Today’s young general practitioners understand the process of commercialisation. They conduct camps and perform unindicated hysterectomies.”
There have been several cases of private hospitals conducting mass hysterectomy drives (invasive surgeries to remove a woman’s uterus) – Scroll.in reported the death of two women in Chapla Naik, a village in Karnataka, after they underwent hysterectomies because they were told by doctors that, uterus “kharab hua.” While hysterectomies should be performed to treat serious conditions like endometrial hyperplasia, to remove benign or malignant growths, or to treat several pre-cancerous conditions, hospitals have instead created a culture where a hysterectomy is a casual procedure. It is now almost like a rite of passage after a woman has given birth, and is mostly done to maximise profits.
A part of the problem is that currently, there are no proper guidelines or regulations for hysterectomies, about when they should be conducted, or for whom. This lack of guidelines extends even to making complex decisions in such situations, of whether, for instance, a woman’s ovaries need to be retained or removed when a hysterectomy is done. In such cases, it was previously believed that women over the age of 45, or those who have reached menopause, would be better off if their ovaries were removed after a hysterectomy because of a risk of ovarian cancer. Similarly, this was not to be done in younger women unless there was an existing family history of cancer.
A recent study, however, has found that in the long run, women are better off keeping their ovaries in the event of hysterectomies. The researchers in the study used 20 years of previously published medical data to understand the risks of ovary retention/removal during hysterectomies on other potential problems of osteoporosis, heart disease and cancer. It was found that retaining ovaries decreased risk of heart disease in women, which is a more potent killer than even cancer. There was also decreased risk of osteoporosis and hip fracture. From this, and from other subsequent studies, it becomes obvious that removal of ovaries during hysterectomies should only be done when absolutely necessary, keeping in mind the age of the woman, risk factors, and after detailed counselling.
The attitudes of private sector doctors who indiscriminately authorise hysterectomies mirror those of doctors involved in forced sterilization as part of family planning in the 1970s. As Deepa Dhanraj’s documentary film Something like a War showed, this is another ingress on the reproductive rights of women in India.