The Union health ministry has asked all states to conduct “compulsory audits” on hysterectomies to determine if the surgery was justified, after a Supreme Court order directing the nationwide adoption of guidelines to prevent unnecessary hysterectomies.

Health secretary Rajesh Bhushan, in a letter citing concerns about “unnecessary” or “unjustified” hysterectomies performed in certain medical institutions, has asked states to collect data on and audit hysterectomies under the health ministry’s guidelines released in 2022.

Bhushan’s April 28 letter followed a Supreme Court order on April 5 that asked the ministry to ensure that the guidelines are “adopted expeditiously”.

The order came in response to a public interest petition by a Jaipur-based doctor and health rights’ advocate, Narendra Gupta, expressing concern that doctors were performing unnecessary hysterectomies in many women and needlessly exposing them to risks associated with surgery.

Gupta’s 2013 petition, he said, reflected long-standing concerns among sections of doctors and patients’ rights advocates — based on nationwide health surveys and anecdotal accounts — that some doctors ask women to undergo hysterectomies without offering non-surgical options, allegedly for financial gain.

The National Family Health Survey (NFHS) 2019-21 had found that three in every 100 women aged between 15 and 49 years had undergone hysterectomies. The median age at hysterectomy ranged from 34 years among the least-educated and poorest women to 37 years among the highest-educated and richest.

“The low median ages for hysterectomies raise suspicion,” Gupta, coordinator at Prayas, a non-government public health organisation based in Chittorgarh, Rajasthan, told The Telegraph.

The NFHS data and anecdotal accounts, he said, suggest that many women who visit doctors with uterine bleeding, vaginal discharge, or lower abdominal pain are “pushed towards” hysterectomies without appropriate efforts to address those symptoms through non-surgical treatment.

The NFHS data also showed that private hospitals accounted for nearly 70 per cent of the hysterectomies in the country.

“We’re now hoping the adoption of guidelines, including at least some audits, will over time curb unnecessary hysterectomies,” Gupta said.

The guidelines will require all states to establish state and district-level hysterectomy monitoring committees collecting from all private and public hospitals a line list of all women who underwent hysterectomy every month.

The district committees will need to audit hysterectomies in women below 35 years, hysterectomies along with the removal of fallopian tubes and ovaries in women below 40 years, and hysterectomies in cases where there are no medical records for treatment prior to the hysterectomies.

The audits to be conducted by two individuals — a person with technical expertise and a person with social sciences expertise — will probe whether alternative treatment was possible and if it was offered, how long it was offered before hysterectomy.

“Audits are justified, especially for hysterectomies in women below 40,” said Manish Machave, a Pune-based gynaecologist and chair of the ethics panel of the Federation of Obstetrics and Gynaecological Societies of India. “But audits and data collection from all over the country will be a challenge.”