Prevalence of hysterectomy among rural and urban women with and without health insurance in Gujarat, India

• Published in: Reproductive health matters 2011-05, Vol.19 (37), p.42-51
• Main Authors: Desai, Sapna, Sinha, Tara, Mahal, Ajay
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Age Distribution; Community health; Community Health Workers; Cross-Sectional Studies; Features: Privatisation; Female; Females; Gujarat; Gynaecological morbidity; Gynecology; Health education; Health Expenditures - statistics & numerical data; Health Insurance; Health Services - utilization; Humans; Hysterectomy; Hysterectomy - statistics & numerical data; India; Insurance Coverage - statistics & numerical data; Insurance, Health - statistics & numerical data; Internal Medicine; Low income; Medical anthropology; Menstruation; menstruation and menstrual disorders; Middle Aged; Morbidity; Obstetrics and Gynecology; Poverty - statistics & numerical data; Prevalence; Private Sector; Private Sector - statistics & numerical data; Public Health; Public Sector - statistics & numerical data; Reproductive health; Rural Areas; Rural Population - statistics & numerical data; Rural women; Surgery; Urban Areas; Urban Population - statistics & numerical data; Urban women; Uterus; Women's Health; Womens education; Womens health; Young Adult
• ISSN: 0968-8080; 1460-9576
• DOI: 10.1016/S0968-8080(11)37553-2

This paper presents findings on hysterectomy prevalence from a 2010 cross-sectional household survey of 2,214 rural and 1,641 urban, insured and uninsured women in low-income households in Ahmedabad city and district in Gujarat, India. The study investigated why hysterectomy was a leading reason for use of health insurance by women insured by SEWA, a women's organisation that operates a community-based health insurance scheme. Of insured women, 9.8% of rural women and 5.3% of urban women had had a hysterectomy, compared to 7.2% and 4.0%, respectively, of uninsured women. Approximately one-third of all hysterectomies were in women younger than 35 years of age. Rural women used the private sector more often for hysterectomy, while urban use was almost evenly split between the public and private sectors. SEWA's community health workers suggested that such young women underwent hysterectomies due to difficulties with menstruation and a range of gynaecological morbidities. The extent of these and of unnecessary hysterectomy, as well as providers' attitudes, require further investigation. We recommend the provision of information on hysterectomy as part of community health education for women, and better provision of basic gynaecological care as areas for advocacy and action by SEWA and the public health community in India. L'article présente les conclusions d'une enquête transversale sur la prévalence de l'hystérectomie auprès de femmes (2214 rurales et 1641 urbaines) assurées et non assurées dans des ménages à faible revenu de la ville et du district d'Ahmedabad à Gujarat, Inde. L'étude souhaitait déterminer pourquoi l'hystérectomie était une raison majeure de recours à l'assurance maladie de la part des femmes assurées chez SEWA, une organisation féminine qui gère un plan communautaire d'assurance maladie. Parmi les assurées, 9,8% des femmes rurales et 5,3% des femmes urbaines avaient subi une hystérectomie, contre 7,2% et 4,0% respectivement des femmes non assurées. Environ un tiers des hystérectomies avait été réalisées chez des femmes de moins de 35 ans. Les femmes rurales utilisaient plus souvent le secteur privé pour l'hystérectomie, alors qu'en ville, l'utilisation était répartie de manière égale entre les secteur public et privé. Les agents de santé communautaire de SEWA ont suggéré que ces jeunes femmes avaient subi une hystérectomie pour des troubles de la menstruation et différentes morbidités gynécologiques. Il convient de réaliser des recherches c