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Patterns of hysterectomy in India: A national and state-level analysis of the Fourth National Family Health Survey (2015-16)
Authors: Sapna Desai, Ankita Shuka, Devaki Nambiar, and Rajani Ved
Source: BJOG: An International Journal of Obstetrics & Gynaecology, Online first; DOI: 10.1111/1471-0528.15858
Topic(s): Contraception
Family planning
Country: Asia
Published: JUL 2019
Abstract: Objective The National Family Health Survey-4 in India provided the first nationally representative estimates of hysterectomy amongst women aged 15-49. This paper aims to examine: national and state-level age-specific prevalence of hysterectomy; individual and household level factors associated with the procedure; and state-level indicators that may explain variation across states. Design Cross-sectional, nationally representative household survey. Setting NFHS was conducted across all Indian states and union territories between 2015-16. Population The survey covered 699,686 women between the ages of 15 and 49 years. Methods Descriptive analyses and multivariate logistic regression. Main Outcome Measures Women who reported ever having a hysterectomy and age at hysterectomy. Results Age-specific prevalence of hysterectomy was 0.4% (95% CI: 0.3,0.4) amongst women 15-29; 3.6% (3.5,3.7) amongst women 30-39; and 9.2% (8.9,9.5) amongst women 40-49. There was considerable variation by state across prevalence. Four states reported age-specific prevalence similar to high-income settings. Approximately two-thirds of hysterectomies were conducted in private facilities, with similar patterns across age groups. At the national level, higher age and parity (at least two children); not having been to formal schooling; rural residence (AOR: 1.36; 1,3,1.4; p<0.01) and higher wealth status were associated with higher odds of hysterectomy. Previously sterilized women had lower odds (AOR: 0.64; p<0.01) of reporting hysterectomy. Exploratory analyses suggest state-level factors associated with prevalence include caesarean section, female illiteracy and women's employment. Conclusions Hysterectomy patterns amongst women 15-49 in India indicate the critical need to ensure treatment options for gynaecological morbidity and to address hysterectomy amongst young women in particular.