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    Incidence and determinants of hysterectomy in a low-income setting in Gujarat, India

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    Author
    Desai, S; Campbell, OMR; Sinha, T; Mahal, A; Cousens, S
    Date
    2017-02-01
    Source Title
    Health Policy and Planning
    Publisher
    OXFORD UNIV PRESS
    University of Melbourne Author/s
    Mahal, Ajay
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
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    Document Type
    Journal Article
    Citations
    Desai, S., Campbell, O. M. R., Sinha, T., Mahal, A. & Cousens, S. (2017). Incidence and determinants of hysterectomy in a low-income setting in Gujarat, India. HEALTH POLICY AND PLANNING, 32 (1), pp.68-78. https://doi.org/10.1093/heapol/czw099.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/256518
    DOI
    10.1093/heapol/czw099
    Abstract
    Hysterectomy is a leading reason for use of health insurance amongst low-income women in India, but there are limited population-level data available to inform policy. This paper reports on the findings of a mixed-methods study to estimate incidence and identify predictors of hysterectomy in a low-income setting in Gujarat, India. The estimated incidence of hysterectomy, 20.7/1000 woman- years (95% CI: 14.0, 30.8), was considerably higher than reported from other countries, at a relatively low mean age of 36 years. There was strong evidence that among women of reproductive age, those with lower income and at least two children underwent hysterectomy at higher rates. Nearly two-thirds of women undergoing hysterectomy utilized private hospitals, while the remainder used government or other non-profit facilities. Qualitative research suggested that weak sexual and reproductive health services, a widespread perception that the post-reproductive uterus is dispensable and lack of knowledge of side effects have resulted in the normalization of hysterectomy. Hysterectomy appears to be promoted as a first or second-line treatment for menstrual and gynaecological disorders that are actually amenable to less invasive procedures. Most women sought at least two medical opinions prior to hysterectomy, but both public and private providers lacked equipment, skills and motivation to offer alternatives. Profit and training benefits also appeared to play a role in some providers' behaviour. Although women with insecure employment underwent the procedure knowing the financial and physical implications of undergoing a major surgery, the future health and work security afforded by hysterectomy appeared to them to outweigh risks. Findings suggest that sterilization may be associated with an increased risk of hysterectomy, potentially through biological or attitudinal links. Health policy interventions require improved access to sexual and reproductive health services and health education, along with surveillance and medical audits to promote high-quality choices for women through the life cycle.

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