The Indian Women Pushed Into Hysterectomies
Thousands of Indian women are having their wombs removed in operations that campaigners say are unnecessary and only performed to make money for unscrupulous private doctors.
Sunita is uncertain of her exact age but thinks she’s about 25 years old. I met her in a small village in Rajasthan, north-west India, surrounded by chewing cattle and birdsong. She was covered in jewellery, from a nose-stud and rings to bangles which jangled when she gestured with her hand.
Her face hardens when she tells me about her operation.
“I went to the clinic because I had heavy bleeding during menstruation,” she says.
“The doctor did an ultrasound and said I might develop cancer. He rushed me into having a hysterectomy that same day.”
Sunita says she was reluctant to have the operation straightaway and wanted to discuss it with her husband first. She says the doctor said the operation was urgent and sent her for surgery just hours later.
Sunita: “When I went to the clinic the doctor got me admitted on the same day and did the operation that evening”
More than two years have passed since that day but Sunita says she still feels too weak to work or look after her children.
When other local women crowded round, I asked how many of them had undergone hysterectomies. More than half raised their hands at once. Village leaders said about 90% of the village women have had the operation, including many in their 20s and 30s.
The doctors generally charge around $200 for the operation, which often means the families have to sell cattle and other assets to raise the money.
I tracked down the small private clinic where Sunita and some of the other women in the village said they had been advised to have hysterectomies, after suffering from symptoms such as heavy periods and period pain, bladder infections and backache.
The owner, a doctor, was in the middle of an ultrasound scan when I arrived. When I put the women’s allegations to him, he shook his head and smiled. They weren’t telling the truth, he said. Unlike others in the area, his clinic was genuine and ethical.
When I asked him how he could diagnose a pre-cancerous or cancerous growth on the basis of an ultrasound scan, he admitted that he sometimes didn’t do biopsies before removing the uterus, only afterwards.
Once the removed uterus - and any biopsy tissue - has been destroyed, it becomes hard to prove that the operation wasn’t justified.
But it is clear that something strange and deeply worrying is happening.
Reports from a handful of Indian states, including Rajasthan, Bihar, Chhattisgarh and Andhra Pradesh, suggest that an extraordinarily high number of women are having their uteruses removed, including many below the age of 40.
It’s hard to compare Indian hysterectomy rates with other countries, as only one generation of reproductive-age women has had access to the procedure
A study in Andhra Pradesh state concluded that women under 45 rarely needed the operation
Canada has one of the highest rates in the world - 346 per 100,000 women in 2006-7 - double that of the UK, the Netherlands, Sweden and Norway
Data from the UK suggests a hysterectomy rate of 150 per 100,000 women
The women often say the doctors frightened them into surgery by saying the uterus was cancerous. But in many cases, the diagnosis was made on the basis of a single ultrasound scan - which, according to independent doctors, cannot justify a decision to operate.
Dr Narendra Gupta, of the health charity, Prayas, a local partner of Oxfam, is one of many activists convinced that some private doctors are engaging in blatant malpractice.
“People say that in some places, there are whole districts without uteruses,” he says.
“It seems that private doctors see this as an opportunity to make a fast buck. They’re making money on ailments which could be treated in a simpler, less invasive way.”
I met Dr Vineeta Gupta, a gynaecologist, in her consulting rooms in Rajasthan’s state capital, Jaipur, her stethoscope dangling round her neck. She says she sees seven or eight women a week from villages in the region, who’ve been told they need hysterectomies but want a second opinion.
“In rural areas, doctors give a diagnosis of cancer very readily,” she says.
“That’s very wrong. When patients come to me, I tell them that an infection doesn’t cause cancer. We’ll cure the infection, I tell them, and you will be completely all right. Some are convinced but some are not convinced because they’ve been told: ‘If you don’t get your uterus removed you will get cancer and die.’”