Tuesday, May 21, 2013

UTERUS REMOVAL SCAM: Hysterectomies across India often needless: Study

Many Link Spurt To Insurance
Mumbai: Is India witnessing a spurt in unnecessary hysterectomies? Data released by international charity organization Oxfam on February 6 says needless hysterectomies were being performed in Indian private hospitals to economically exploit poor women as well as government-run insurance schemes.

A right to information (RTI) request filed by one of Oxfam’s local NGOs in the Dausa district of Rajasthan showed that 258 of 285 women - 65% - investigated over six months had undergone hysterectomies. Many of these women were under 30, with the youngest being 18.

An editorial in the British Medical Journal quoted Oxfam’s global spokesperson Araddhya Mehtta as saying that the “trend is seen all over India but is particularly disturbing in Rajasthan, Bihar and Chhattisgarh where doctors simply abuse their power of being a doctor”. In 2010, the Andhra Pradesh government tweaked its state-sponsored insurance scheme to disallow hysterectomies in private hospitals after surveys revealed that uteruses of a number of beneficiaries were removed merely to claim higher insurance amounts (the state insurance scheme is only available for the economically poor sections).

Dr Duru Shah, former president of FOGSI (Federation of Obstetric and Gynaecological Societies of India), said modern medicines could fix 95% of woman’s menstrualrelated problems.

However, experts fear the trend of unnecessary hysterectomies possibly exists in urban centres such as Mumbai as well. Aniruddha Malpani, medical director of HELP (Health Education Library for People) in Fort, said, “If some doctors in small towns are performing unnecessary hysterectomies, why should it be any different in cities like Mumbai?”

• Indian doctors conduct unnecessary hysterectomies in private hospitals, says Oxfam
•Women in Rajasthan, Bihar and Chhattisgarh worst-hit
•In Rajasthan’s Dausa district, 65-70% of women who sought treatment underwent hysterectomy
•Women as young as 18 have lost their uterus
•A SEWA study in Ahmedabad found women with insurance were more likely to undergo hysterectomy, both in urban and rural areas

‘Hysterectomy hurts the young’
Indeed, an audit performed by insurance companies in Chennai in 2009 had shown that more than 500 women aged 25 to 35 had undergone hysterectomies. A central government study in the wake of the Andhra Pradesh scam had said that women under 45 rarely needed hysterectomy.

A 2011 research paper in medical journal Reproductive Health Matters, conducted by SEWA Health Cooperative doctors in Ahmedabad, showed that insured women had higher rates of hysterectomy. “Among insured women, 9.8% of rural and 5.3% urban women had had a hysterectomy, compared to 7.2% and 4.0 of uninsured women,’’ said the study.

The OXFAM report says India should end its public-private partnership programmes (that allow poor women with government insurance plan to undergo hysterectomy in private hospitals) till regulation improves.

Oxfam official Mehtta has been quoted as saying, “When women came with abdomen pain, doctors prescribed hysterectomy to women from poor economic backgrounds, telling them that it might be a cancer or ahole or a stone in the uterus...”

Dr Rekha Daver who heads the gynaecology of J J Hospital, said, “There may be a marginal increase over the years. But this may only be because women from rural areas who travel to referral centres in cities don’t want to prolong their suffering.”

Incidentally, Maharashtra doesn’t allow hysterectomies in private hospitals under the insurance scheme launched last year for economically weaker sections, called Rajiv Gandhi Jeevandayee Arogya Scheme. “We have learnt from the Andhra Pradesh experience,” said Dr K Venkatesam, CEO of the arogya scheme.

Not all agree that hysterectomies are on the rise. Gynecologist Dr Rakesh Sinha said,“What has changed is that we have facilities such as USG to make accurate diagnosis. Moreover, there are procedures that allow women to go home in a day or two.”

 If ovaries are removed with the uterus, the woman would reach immediate menopause

Removal of uterus would mean her ovaries don’t get enough blood, and thereby trigger early menopause

Levels of female hormones estrogen and progesterone fall and the body stops producing eggs; menstruation ceases

Without high estrogen level, the risk of heart disease and osteoporosis (brittle bones) rises

Other possible problems: Dry skin, headache or backache, insomnia, lethargy, bladder problems, loss of vaginal elasticity, mood swings, decrease in sexual desire and poor concentration.
Malathy Iyer TNN

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