A hysterectomy is a surgical procedure in which a woman's uterus is removed. There are several varieties of hysterectomy, including partial, complete, and radical. In many parts of the world, hysterectomy, or the surgical removal of the uterus, is the second most common non-obstetric surgery after caesarean section [1, 2, 3, 4]. Furthermore, prophylactic oophorectomy, which involves the removal of the ovaries, is sometimes suggested in conjunction with hysterectomy to lower the risk of ovarian cancer in the future [5].
Gynecological conditions such as fibroids, dysfunctional uterine hemorrhage, and uterine prolapse are common medical reasons for hysterectomy [6]. The surgical removal of a woman's uterus and ovaries can have major physical and psychological implications. According to research, there are both positive and negative consequences. On the one hand, hysterectomy has been shown to reduce anxiety and depression in women and thereby enhance their quality of life, particularly 6 to 12 months after surgery, by alleviating gynecological disorders such as irregular bleeding and pelvic pain [7, 8, 9].
Due to differences in uterine pathology, provider and patient characteristics, and socio-cultural factors, the frequency and prevalence of hysterectomy vary substantially across different geographic locations [3, 10, 11]. Because most hysterectomy research is conducted on inpatient hospitals and community-based studies, sample demographics and techniques might make worldwide comparisons of hysterectomy rates difficult. Nonetheless, research reveals that hysterectomy rates in developed countries are substantially greater than in low-income countries [10]. Hysterectomy rates are declining in many regions of the developed world, according to new research, as less invasive alternatives to hysterectomy, including as endometrial ablation and uterine artery embolization, become more commonly available. Hysterectomy rates have fallen in recent years in the United States and Canada, for example [2, 3]. Hysterectomy, on the other hand, appears to be on the rise in some developing countries [12, 13].
In recent years, hysterectomy has garnered more attention in India's health policy debates. A series of media reports have highlighted an unexpected jump in the number of women receiving hysterectomy in several parts of the country, with a considerable proportion of instances involving young and pre-menopausal women from poor households as the catalyst for heightened attention [14, 15, 16]. According to a study by Kameswari and Vinjamuri (2013), 60 percent of hysterectomies were performed on women under 30 in Andhra Pradesh between 2008 and 2010, and 95 percent of the operations were performed in private hospitals; the hospital discharge summaries for these operations were mostly blank, with no information regarding the procedure or follow-up instructions [17].
In many countries, including India, a number of research have looked at the socioeconomic, demographic, and residence-related factors of hysterectomy [18, 19, 20, 21]. The risk factors for peripartum hysterectomy were studied in a cohort research. The study showed that placenta praevia/accreta is linked to a higher incidence of peripartum hysterectomy, based on data from 193 hospitals in 21 countries across Africa, Asia, Europe, and the Americas. Asian women had a greater rate of hysterectomy (7%) than African women (5%). The study also discovered that advanced maternal age, caesarean section, and giving numerous births in Asia are all risk factors [18].
Hysterectomy was more common in women over the age of 35, according to a study conducted in three villages in Haryana's Panchkula district. The most common reason for hysterectomy was excessive monthly bleeding (52/70; 74 percent); other reasons were uterine prolapse and fibroids [22]. Uikey, Wankhede, and Tajne (2018) discovered that fibroid uterus (65.33 percent) was the most common reason for hysterectomy In Maharashtra state of India. They concluded that in a developing nation like India with limited healthcare resources, non-descent vaginal hysterectomy outperforms abdominal and laparoscopic aided vaginal hysterectomy and should be the treatment of choice for benign uterine diseases [23].
In India, knowledge on hysterectomies is limited, in part due to a paucity of data from large-scale national representative surveys. Women with poor income, those who are older, rural women, married women, and women with more surviving children were all found to be at a higher risk for hysterectomy in two mixed method studies conducted in Gujarat, India. The average age of hysterectomy was 36 years, and the majority of the women had their hysterectomies at private health institutions, according to this study [10, 19].Some researchers and activists have raised concerns about unnecessary hysterectomies being performed in some parts of India for commercial reasons rather than medical necessity, especially at a considerably younger age in places such as Andhra Pradesh [24, 25, 26]. There has also been a lot of debate concerning the effectiveness of elective hysterectomy, because women's reproductive health difficulties don't stop there [27]. Many health concerns arise after a hysterectomy, including: i) early menopause, ii) increased risk of cardiovascular disease, iii) increased risk of stroke, iv) urinary incontinence, v) loss of sexual desire, and vi) other health problems [19, 10].
The majority of the literature on hysterectomies comes from research conducted in developed countries or clinic samples. The scope and nature of the literature accessible about India are restricted. To our knowledge, no large-scale nationally representative dataset has been used to undertake a population-based study that can encompass India as a whole. Having noted the gaps in the previous literature on hysterectomy in India and the availability of a new large-scale population-based nationally representative dataset (NFHS 5) the current study explored the prevalence and predictors of hysterectomy in women aged 15–49 years in India.
The following questions are addressed in this paper:(i) to determine the national, state, UT, and regional prevalence of hysterectomy among women aged 15–49 years in India, (ii) to examine the socio-demographic determinants of hysterectomy, and (iii) to investigate the reasons reported by women for hysterectomy (iv)To assess the choice of hospitalization (Public vs Private) for conducting hysterectomy.