|Patterns of hysterectomy in India: A national and state-level analysis of the Fourth National Family Health Survey (2015-16)|
||Sapna Desai, Ankita Shuka, Devaki Nambiar, and Rajani Ved
||BJOG: An International Journal of Obstetrics & Gynaecology, Online first; DOI: 10.1111/1471-0528.15858
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.
Cross-sectional, nationally representative household survey.
NFHS was conducted across all Indian states and union territories between 2015-16.
The survey covered 699,686 women between the ages of 15 and 49 years.
Descriptive analyses and multivariate logistic regression.
Main Outcome Measures
Women who reported ever having a hysterectomy and age at hysterectomy.
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.
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.