Desai Sapna, Sinha Tara, Mahal Ajay
SEWA Health Cooperative, Ahmedabad, Gujarat, India.
Reprod Health Matters. 2011 May;19(37):42-51. doi: 10.1016/S0968-8080(11)37553-2.
This paper presents findings on hysterectomy prevalence from a 2010 cross-sectional household survey of 2,214 rural and 1,641 urban, insured and uninsured women in low-income households in Ahmedabad city and district in Gujarat, India. The study investigated why hysterectomy was a leading reason for use of health insurance by women insured by SEWA, a women's organisation that operates a community-based health insurance scheme. Of insured women, 9.8% of rural women and 5.3% of urban women had had a hysterectomy, compared to 7.2% and 4.0%, respectively, of uninsured women. Approximately one-third of all hysterectomies were in women younger than 35 years of age. Rural women used the private sector more often for hysterectomy, while urban use was almost evenly split between the public and private sectors. SEWA's community health workers suggested that such young women underwent hysterectomies due to difficulties with menstruation and a range of gynaecological morbidities. The extent of these and of unnecessary hysterectomy, as well as providers' attitudes, require further investigation. We recommend the provision of information on hysterectomy as part of community health education for women, and better provision of basic gynaecological care as areas for advocacy and action by SEWA and the public health community in India.
本文展示了2010年一项横断面家庭调查的子宫切除术患病率调查结果，该调查涉及印度古吉拉特邦艾哈迈达巴德市及辖区2214名农村和1641名城市低收入家庭的参保及未参保女性。该研究调查了子宫切除术为何是自营职业妇女协会（SEWA）参保女性使用医疗保险的主要原因，SEWA是一个运营社区医疗保险计划的妇女组织。在参保女性中，9.8%的农村女性和5.3%的城市女性接受了子宫切除术，相比之下，未参保女性的这一比例分别为7.2%和4.0%。所有子宫切除术中约三分之一是35岁以下的女性。农村女性子宫切除术更多地选择私立部门，而城市女性在公立和私立部门的选择几乎持平。SEWA的社区卫生工作者表示，这些年轻女性接受子宫切除术是由于月经问题和一系列妇科疾病。这些情况以及不必要子宫切除术的程度，还有医疗服务提供者的态度，都需要进一步调查。我们建议，作为针对女性的社区健康教育的一部分，提供有关子宫切除术的信息，并更好地提供基本妇科护理，这是SEWA和印度公共卫生界进行宣传和采取行动的领域。
