Incidence and determinants of hysterectomy in a low-income setting in Gujarat, India.
Incidence and determinants of hysterectomy in a low-income setting in Gujarat, India.
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DOI：
10.1093/heapol/czw099
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发表时间：
2017-03
影响因子：
3.2
通讯作者：
Cousens S
中科院分区：
文献类型：
--
作者：
Desai S;Campbell OM;Sinha T;Mahal A;Cousens S
子宫切除术是印度低收入女性使用健康保险的主要原因，但可用于制定政策的人口数据有限。本文报告了一项混合方法研究的结果，该研究旨在估计印度古吉拉特邦低收入环境中子宫切除术的发生率并确定子宫切除术的预测因素。子宫切除术的估计发生率为 20.7/1000 女性年（95% CI：14.0，30.8），远高于其他国家报告的平均年龄 36 岁。有强有力的证据表明，在育龄妇女中，收入较低且至少有两个孩子的妇女接受子宫切除术的比例较高。近三分之二接受子宫切除术的女性使用私立医院，其余则使用政府或其他非营利机构。定性研究表明，性健康和生殖健康服务薄弱、人们普遍认为生育后子宫是可有可无的，以及缺乏对副作用的了解，导致子宫切除术的正常化。子宫切除术似乎被推广为月经和妇科疾病的一线或二线治疗方法，这些疾病实际上适合微创手术。大多数女性在子宫切除术之前至少寻求两种医疗意见，但公共和私人提供者都缺乏提供替代方案的设备、技能和动力。利润和培训福利似乎也在一些提供商的行为中发挥了作用。尽管就业不稳定的女性接受手术时知道接受大手术会对经济和身体产生影响，但子宫切除术带来的未来健康和工作保障对她们来说似乎大于风险。研究结果表明，绝育可能与子宫切除术的风险增加有关，这可能是通过生物学或态度联系来实现的。卫生政策干预措施需要改善获得性健康和生殖健康服务和健康教育的机会，并进行监测和医疗审计，以促进妇女在整个生命周期的高质量选择。
Hysterectomy is a leading reason for use of health insurance amongst low-income women in India, but there are limited population-level data available to inform policy. This paper reports on the findings of a mixed-methods study to estimate incidence and identify predictors of hysterectomy in a low-income setting in Gujarat, India. The estimated incidence of hysterectomy, 20.7/1000 woman- years (95% CI: 14.0, 30.8), was considerably higher than reported from other countries, at a relatively low mean age of 36 years. There was strong evidence that among women of reproductive age, those with lower income and at least two children underwent hysterectomy at higher rates. Nearly two-thirds of women undergoing hysterectomy utilized private hospitals, while the remainder used government or other non-profit facilities. Qualitative research suggested that weak sexual and reproductive health services, a widespread perception that the post-reproductive uterus is dispensable and lack of knowledge of side effects have resulted in the normalization of hysterectomy. Hysterectomy appears to be promoted as a first or second-line treatment for menstrual and gynaecological disorders that are actually amenable to less invasive procedures. Most women sought at least two medical opinions prior to hysterectomy, but both public and private providers lacked equipment, skills and motivation to offer alternatives. Profit and training benefits also appeared to play a role in some providers’ behaviour. Although women with insecure employment underwent the procedure knowing the financial and physical implications of undergoing a major surgery, the future health and work security afforded by hysterectomy appeared to them to outweigh risks. Findings suggest that sterilization may be associated with an increased risk of hysterectomy, potentially through biological or attitudinal links. Health policy interventions require improved access to sexual and reproductive health services and health education, along with surveillance and medical audits to promote high-quality choices for women through the life cycle.
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