Preventing Violence Against Women’s Bodies Due To Greed And Prejudice

-Prerna was in her mid-thirties. She had started showing what looked like a baby bump. On investigation, they detected a large uterine fibroid. Complete hysterectomy was recommended. She didn’t have kids, and resisted the removal of her reproductive organs. Eventually, after a year’s search, she found a young gynaecologist who removed only the fibroid. The fibroid was 5 kg at the time of its removal.

-Pritha had a 8-inch uterine fibroid, and they too asked for a full hysterectomy for her. She was undergoing fertility treatment at the time and was not willing to let go of her dreams of motherhood. She found a sympathetic doctor who agreed to remove only her fibroid, and she had her daughter a year later.

Not all wanted to keep their reproductive organs, though.

-Maitrayee had hysterectomy when she was 35, and to her it was good riddance. She said she could afford the expensive hormone replacement therapy of her time, which involved imported skin patches.

-Anita, on the other hand, struggled to understand who she is if she had what she called an empty vessel, with nothing of her womanhood remaining. In three years after the surgery, she lost so much weight that she was three-fourth of what she used to be. She is 46 now.

-Alankrita made the decision to have a hysterectomy in less than a day. She said her reproductive organs don’t define who she is as a woman. The one ultrasound she had diagnosed endometriosis, and even if one cell wasn’t cleaned up, it could devour her other organs, she was told. That was two years back; she is now 46. An active gym enthusiast, she struggled to keep her weight under control. Sometimes she cried when none of her blouses fit her, her mood swings were frantic, pain in her feet unbearable, and at times she would burst out in tears when the clothes she wore were left in a mess of soggy sweat.

A recent collaborative autoethnographic study in India explores the concept of intimate violence against bodies transitioning towards menopause. The neoliberal healthcare system, shaped by gendered and ageist agendas, subjected the patient-author to a dehumanising clinical gaze and pushed for a full hysterectomy, the surgical removal of the uterus, fallopian tubes and ovaries.

Studies show that gynecologists are significantly more likely to recommend hysterectomies for women who are beyond childbearing age, or do not intend to have children. Oftentimes, hysterectomies are recommended for heavy bleeding from uterine fibroids that are usually benign and can be treated by minimally invasive procedures like embolization of the uterus that stop the bleeding without removal of the reproductive organs.

In India, approximately one in eight women over 45 years have undergone a hysterectomy, a figure that rises to one in five in states such as Andhra Pradesh and Punjab. India also has a higher hysterectomy prevalence among women over 45 years (11.4 percent) compared to China (seven percent for those aged 45-54 years). Notably, urban women from higher socioeconomic backgrounds above the age of 45 report a higher incidence of hysterectomy. Does their financial capacity make them prime targets for an over-medicalised, profit-driven reproductive healthcare system?

Hysterectomy decisions are often based on a single ultrasound, incomplete or manipulated medical records, and subjective interpretations. Even among experts, diagnostic discrepancies are common. A Mayo Clinic study analysing fibroid diagnoses found that gynecologists and radiologists agreed on only 14 percent of cases. In 86 percent of cases, at least two different conclusions were drawn, and in 10 percent, there were four entirely unique classifications. Disturbingly, more than one-third of these variations had direct implications for surgical planning.

The most cited justification for hysterectomy is removal of benign muscle tumors in the uterus that supposedly prevent cancer. However, evidence suggests that hysterectomy neither protects against nor promotes cancer. While some studies indicate a reduced risk of ovarian and breast cancer, others highlight an increased risk of thyroid and kidney cancers. If oestrogen-progestin therapy is administered, post-hysterectomy breast cancer risk rises. Additionally, studies indicate there is no support for the protective effect of hysterectomy on ovarian cancer and attribute older studies showing such effect to the fact that many women remain unaware of whether their ovaries have been removed—a reality that is both shocking and troubling.

Historically, aging women’s bodies have been prime targets for experimental abdominal surgeries, with the removal of the uterus and ovaries framed as necessary medical interventions. These organs were described as “shrivelled and useless at best, often perverting, cancerous, or degenerate at worst” and labeled “monstrous and troublesome throughout women’s lifespan,” allegedly causing nervous disorders, mental illnesses, and various gynecological pathologies. Globally, 40 percent of women will undergo a hysterectomy by age 64.

While hysterectomy rates are declining in developed economies, they are rising in the Global South and remain the second most common surgical procedure for women in the US. Shockingly, fewer than 10 percent of these surgeries are performed due to cancer or precancerous conditions. Instead, many are done pre-emptively, without pathological diagnoses, solely to prevent ovarian or uterine cancer.

The Indian context

Hysterectomy is particularly prevalent in India, often driven by fear-based medical practices. Sometimes, research on hospitalisation patterns for hysterectomy in India has largely focused on women under 50, implying that reproductive organs of those above 50 are expendable. A 2013 study in Rajasthan found that rural women who had undergone government-run tubal ligations —  a sterilisation method that involves blocking or cutting the fallopian tubes — later developed abdominal pain and irregular bleeding. When they sought medical care, they were given only an ultrasound — no serum tests, vaginal swabs, or internal examinations. They were told their uterus was “sick” and required immediate removal to prevent deadly cancer. No alternative treatments were offered; they were admitted the same day for radical surgery.

This is not an isolated incident. In Karnataka, a significant number of hysterectomies have been found to be medically unnecessary. A 2024 study on socioeconomically disadvantaged rural women in Maharashtra quoted a doctor stating: “The unethical and greedy behaviour of medical practitioners—exploiting ‘information asymmetry,’ ‘power asymmetry,’ and ‘fear psychosis’—is driving the surge in unwarranted and unethical hysterectomies across the country.”

A systematic review of 29 studies found links between hysterectomy (with or without ovary removal) and increased risks of cardiovascular disease, cancer, depression, and dementia. Hospital audits indicate that 38-59 percent of hysterectomies also involve ovary removal, accelerating the onset of non-communicable diseases. One study underscores the urgent need to curb unnecessary hysterectomies, revealing that while menopausal symptoms affect 66-79 percent of women, those who underwent hysterectomy before menopause experienced significantly more severe symptoms. For women who reached menopause naturally, symptoms diminished with time, but those with surgically induced menopause saw no such relief.,

Public policy to curb unnecessary hysterectomy

The Supreme Court of India in its 2023 judgement on a public interest litigation, ruled that unnecessary hysterectomies that result from an unscrupulous exploitative agenda to further economic gains were a serious violation of fundamental rights. The Federation of Obstetric and Gynecological Societies of India (FOGSI) and Integrated Health and Wellness Council report in their white paper that 66.8 percent of hysterectomies in India are done in the private sector and 95 percent of these might be unnecessary. On the advice of the Supreme Court of India, the Union Health Ministry instructed the governments of the states and union territories to implement its guidelines on curbing unnecessary hysterectomies.

If the marketisation of menstrual and reproductive health is fueling this trend by exaggerating cancer risks, academic research calling for an urgent necessity for mandatory reporting of all hysterectomies, or even the Supreme Court order may not suffice. Healthcare institutions ought to be held accountable through mandatory audits and transparency measures. If hysterectomy is being overprescribed based on profit motives and systemic bias, then it is not just a medical concern — it is a human rights issue.

(Published under Creative Commons by 360info™. Read the original article here)