Women in India forced to have hysterectomies

BMJ 1994; 308 doi: (Published 26 February 1994) Cite this as: BMJ 1994;308:558
  1. G Nandan

    Women with learning disabilities in India can be forced to have hysterectomies, said Maharashta's state government last week. The ruling follows a nationwide controversy that erupted last month when gynaecologists carried out hysterectomies on 11 women with learning disabilities at a hospital in Pune in Maharashta.

    The women, aged between 18 and 35, are residents of an institution run by the government. Health authorities claim that consent was given by the women's parents or other lawful guardians and that the operations were done to maintain the women's hygiene during menstruation and to prevent pregnancy.

    Staff at the institution say that, of their 48 residents, only 11 of the women with the most severe learning disabilities were selected. Staff argued that the women's inability to keep themselves clean during menstruation increased their chances of infection and made their management difficult.

    Gynaecologists who conducted the operations say that there is nothing unusual about such operations. “This is a routine practice in India among families who look after mentally retarded women in their own homes,” said Dr Achyut Vaman Umranikar, the consultant gynaecologist who organised the operations.

    The local branch of the Indian Medical Association also supports the operations. It said that pressure groups should have no jurisdiction in this matter - it should be decided by parents, the women's guardians, and their doctors.

    The government ordered a temporary halt to the operations when the controversy first broke. But last week, prompted by what seemed to be overwhelming support from the medical community, it approved the operations but asked health authorities not to organise any more “hysterectomy camps,” where large numbers of women are operated on. At least five more women are due to be operated on this week.

    Organisations and doctors protesting at this decision describe the hysterectomies as “inhuman” and the justification for the operations as “unacceptable.” “This should never be a routine solution in the management of women with even severe mental retardation,” said Dr Shekhar Saxena, professor of psychiatry at the All India Institute of Medical Sciences in New Delhi. “It looks as though the operations were primarily done for the convenience of the people looking after these women.” Legal experts say that the issue has raised the subject of the rights of people with learning disabilities.

    Opponents of the operations also claim that eliminating the risk of pregnancy will just make the women more prone to sexual assault. They are not, however, calling for an outright ban on such operations. Hysterectomies might be justified in some cases in which parents look after such women.

    “But it should never come as part of a package for institutionalisation,” said Dr Saxena. “In this case the institutional authorities seem to be avoiding the responsibility of looking after these women through an inadequate number of trained staff.”

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