Population Council, New Delhi, India.
The George Institute India, New Delhi, India.
BJOG. 2019 Aug;126 Suppl 4(Suppl Suppl 4):72-80. doi: 10.1111/1471-0528.15858.
The National Family Health Survey-4 in India provided the first nationally representative estimates of hysterectomy among women aged 15-49. This paper aims to examine the 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.
National Family Health Survey was conducted across all Indian states and union territories between 2015 and 2016.
The survey covered 699 686 women between the ages of 15 and 49 years.
Descriptive analyses and multivariate logistic regression.
Women who reported ever having a hysterectomy and age at hysterectomy.
Age-specific prevalence of hysterectomy was 0.36% (0.33,0.39) among women aged 15-29; 3.59% (3.45,3.74) among women aged 30-39; and 9.20% (8.94,9.46) among women 40-49 years. There was considerable variation in prevalence by state. 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 had formal schooling; rural residence (adjusted odds ratio [AOR] 1.36; 95% CI 1.27,1.45; P < 0.01) and higher wealth status were associated with higher odds of hysterectomy. Previously sterilised women had lower odds (AOR 0.64; 95% CI 0.61,0,68; P < 0.01) of reporting hysterectomy. Exploratory analyses suggest state-level factors associated with prevalence of hysterectomy include caesarean section, female illiteracy, and women's employment.
Hysterectomy patterns among women aged 15-49 in India indicate the critical need to ensure treatment options for gynaecological morbidity and to address hysterectomy among young women in particular.
This study was part of the RASTA initiative of the Population Council's India country office under the Evidence Project supported by USAID.
Hysterectomy patterns in India highlight the need for alternatives to treat gynaecological morbidity among younger women.
印度的全国家庭健康调查-4 首次提供了全国范围内 15-49 岁女性子宫切除术的代表性估计。本文旨在研究全国和各州特定年龄段子宫切除术的流行率、与该手术相关的个人和家庭因素，以及可能解释各州之间差异的州级指标。
横断面、全国代表性家庭调查。
全国家庭健康调查于 2015 年至 2016 年在印度所有邦和联邦属地进行。
该调查涵盖了 699686 名 15 至 49 岁的女性。
描述性分析和多变量逻辑回归。
报告曾接受过子宫切除术的女性和接受子宫切除术的年龄。
15-29 岁女性的子宫切除术年龄特异性患病率为 0.36%（0.33，0.39）；30-39 岁女性为 3.59%（3.45，3.74）；40-49 岁女性为 9.20%（8.94，9.46）。各州之间的患病率存在相当大的差异。有四个州报告的年龄特异性患病率与高收入国家相似。大约三分之二的子宫切除术是在私人机构进行的，各年龄段的模式相似。在全国范围内，年龄较大和产次较多（至少两个孩子）；未接受正规教育；农村居住（调整后的优势比[OR]1.36；95%置信区间[CI]1.27，1.45；P<0.01）和较高的财富状况与较高的子宫切除术几率相关。先前绝育的女性报告子宫切除术的几率较低（OR 0.64；95%CI 0.61，0，68；P<0.01）。探索性分析表明，与子宫切除术流行率相关的州级因素包括剖腹产、女性文盲和妇女就业。
印度 15-49 岁女性的子宫切除术模式表明，迫切需要确保为妇科疾病提供治疗选择，并特别关注年轻女性的子宫切除术问题。
本研究是人口理事会印度国家办事处 RASTA 倡议的一部分，该倡议是在 USAID 支持的证据项目下进行的。
印度的子宫切除术模式凸显了需要为年轻女性治疗妇科疾病提供替代方案。
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