Maharashtra: Hysterectomies rise in Beed, govt sets treatment protocol

Stung into action after reports of a high rate of hysterectomies in Beed district, the state government is formulating a set of treatment protocols for gynaecological problems.

Beed, located in drought-affected Marathwada, sees distress migration by around 3 lakh people who work as sugarcane cutters for mills across Maharashtra and even other states like Karnataka. After reports of an unusually high rate of hysterectomies in these women labourers to avoid their work being affected during their menstrual cycle and as a solution for gynaecological problems, the state government announced a committee of legislators and officials to probe the issue. Hot flashes, weakness, and osteoporosis are among the effects of hysterectomies.

"These standard operating procedures (SOPs) will lay down treatment protocols for various gynaecological problems, with the surgical removal of the uterus being the last retort after others are exhausted," said a senior official from the state public health department. The objective, said another official involved in the process, is to bring down the prevalence of hysterectomies by laying down a line of treatment for problems requiring this surgery.

Dr Neelam Gorhe, deputy chairperson of the Maharashtra legislature, who heads the committee of legislators, said a team of subject experts were drafting the SOPs in consultation with associations of medical practitioners.

"We are suggesting (these protocols). (But) It will be like a recommendation. The discretion must rest with the doctor as there are times when hysterectomies have to be performed as life-saving procedures. It also depends on the patient's physical condition," she added.

The committee will submit its report to the state government this month. "Pre and post (operative) counselling is necessary," said Gorhe, adding that the focus should also be on non-surgical and minimum invasive interventions. "If they (sugarcane cutters) are susceptible to occupational hazards, we must address these factors," she noted.

Gorhe said they would recommend that sugarcane cutters get medical check-ups before they went for cane cutting and after they returned. "The study is on. If it is found that if they have been subjected to take this decision (to undergo a hysterectomy) sans proper counselling and medication, and if the women complain about it, then we will definitely take cognisance," she added.

While seeking testimonies from women, the committee also met 10 women, who were in their 20s, but had undergone hysterectomies.

A public health department official said they were using field-level workers to get feedback from women, especially sugarcane cutters, who had undergone the surgery, about gynaecological problems that they faced, the duration, and who (relatives, doctors etc) advised them to undergo hysterectomies. Departments like co-operation and labour were also involved in ensuring these workers got facilities like toilets at their work sites for women to maintain menstrual hygiene, and prevent open defecation.

Of the 450 private hospitals in Beed, around 99 facilities conduct hysterectomies. The district health authorities will analyse their records for the past three years. In this period, the private hospitals conducted this procedure in 4,605 cases.

"We must analyse if the numbers are high when compared to the population. Though hysterectomies sans any need are bad, there are some conditions where they have to be performed," the official explained.