[Siberian Fox]

The Indian women pushed into hysterectomies

Thousands of Indian women are having their wombs removed in operations that campaigners say are unnecessary and only performed to make money for unscrupulous private doctors.

Sunita is uncertain of her exact age but thinks she's about 25 years old. I met her in a small village in Rajasthan, north-west India, surrounded by chewing cattle and birdsong. She was covered in jewellery, from a nose-stud and rings to bangles which jangled when she gestured with her hand.

Her face hardens when she tells me about her operation.

"I went to the clinic because I had heavy bleeding during menstruation," she says.

"The doctor did an ultrasound and said I might develop cancer. He rushed me into having a hysterectomy that same day."

Sunita says she was reluctant to have the operation straightaway and wanted to discuss it with her husband first. She says the doctor said the operation was urgent and sent her for surgery just hours later.

More than two years have passed since that day but Sunita says she still feels too weak to work or look after her children.

When other local women crowded round, I asked how many of them had undergone hysterectomies. More than half raised their hands at once. Village leaders said about 90% of the village women have had the operation, including many in their 20s and 30s.

The doctors generally charge around $200 for the operation, which often means the families have to sell cattle and other assets to raise the money.

[...]

Once the removed uterus - and any biopsy tissue - has been destroyed, it becomes hard to prove that the operation wasn't justified.

But it is clear that something strange and deeply worrying is happening.

Reports from a handful of Indian states, including Rajasthan, Bihar, Chhattisgarh and Andhra Pradesh, suggest that an extraordinarily high number of women are having their uteruses removed, including many below the age of 40.

[...]

To ease the burden on the rural poor, the Indian government launched a national health insurance scheme, the RSBY, in 2008. Under the scheme, families living below the poverty line can receive treatment worth up to 30,000 rupees ($550) each year from designated private hospitals, which claim the costs directly from the state.

But in some states, critics say the scheme appears to be encouraging unnecessary hysterectomies, as unethical private clinics exploit the vulnerable poor, using them as a means to tap into government funds.

In Samastipur, a district in the northern state of Bihar, initial figures suggested that more than a third of operations carried out under the scheme were hysterectomies. The district magistrate, Kundan Kumar, became so concerned about these figures that he invited women who had had the operation to attend a government medical camp last August, where they received an independent evaluation from government doctors.

The report from the camp suggests that of 2,606 women who were examined, 316 - about 12% - had had their uteruses removed unnecessarily.

[ More... ]

Looks like a case of government good intentions to help the poor by working in conjunction with the private sector, gone wrong due to free-market-healthcare greed.

[Goldberk]

Looks like a case of government good intentions to help the poor by working in conjunction with the private sector, gone wrong due to free-market-healthcare greed.

Or to put it another way, the inevitable consequence of rabid neo-liberal economics combined with a culture dominated by extreme chauvinism and patriarchy.

The hyped up misogyny created in India by the combination of Hinduvatra and liberalism is one of the most troubling situations in the world right now.

[fuser]

I agree with above comments.

Our chief minister (Bihar) has said that all is okay as in Bihar the percent of women affected is less than the national average.

This nexus involves various NGOs too btw.

[republicuk]

Looks like a case of government good intentions to help the poor by working in conjunction with the private sector, gone wrong due to free-market-healthcare greed.

Or to put it another way, the inevitable consequence of rabid neo-liberal economics combined with a culture dominated by extreme chauvinism and patriarchy.

The hyped up misogyny created in India by the combination of Hinduvatra and liberalism is one of the most troubling situations in the world right now.

I'm not very good with economics, could you please elaborate a little on what you mean by free-market healthcare and neo-liberal economics and how you think its affected this, what should be done?

[Pants-of-dog]

It's simple really.

Free market health care does not work for many reasons, but the reason here is supplier induced demand. Since the average consumer is not aware of when or if they need a hysterectomy, they must rely on the doctor to tel them, but the doctor is also the one who supplies the good or service. So, you have a conflict of interests where the doctor is deciding what the demand for products is and is also supplying them. Rational self-interest dictates that the doctor will then demand more of the unnecessary services in order to enrich himself or herself.

[republicuk]

It's simple really.

Free market health care does not work for many reasons, but the reason here is supplier induced demand. Since the average consumer is not aware of when or if they need a hysterectomy, they must rely on the doctor to tel them, but the doctor is also the one who supplies the good or service. So, you have a conflict of interests where the doctor is deciding what the demand for products is and is also supplying them. Rational self-interest dictates that the doctor will then demand more of the unnecessary services in order to enrich himself or herself.

How could this be prevented?

[Pants-of-dog]

How could this be prevented?

In the developed world, the regulatory body that licenses doctors has rules against it and anyone found doing it will be punished by the regulatory body, like having their license withdrawn.

[republicuk]

In the developed world, the regulatory body that licenses doctors has rules against it and anyone found doing it will be punished by the regulatory body, like having their license withdrawn.

That doesn't sound like a complicated market economics problem they just need a regulatory body then right?

[fuser]

Any regulatory body goes against the principles of "free market", so yeah its a basic problem and as per solution, mine is abolish all private hospitals.

[Social_Critic]

I use private practice but I'm aware there's a potential conflict of interest. But I'm ok if others want to use a public system. I would use it if it delivered the right quality.

[Pants-of-dog]

Let me guess: you were dating a private doctor when you worked in the Salvadorean bronze mines as an engineer....

[republicuk]

Any regulatory body goes against the principles of "free market", so yeah its a basic problem and as per solution, mine is abolish all private hospitals.

What about an independent third party which give second opinions and worm out bad practices, that's not against free market is it?

Why not both, why abolish private practices?

[Goldberk]

I'm not very good with economics, could you please elaborate a little on what you mean by free-market healthcare and neo-liberal economics and how you think its affected this, what should be done?

I agree with the above responses, but to go further the issue is further complicated by the comodofied nature of women's bodies, especially reproductive organs, in an oppressively chauvinistic society.

[fuser]

What about an independent third party which give second opinions and worm out bad practices

Like NGOs? Well in this very case, they are part of the scam, so yeah abolish private hospitals. Basically how will you prevent the "nexus" between this third party and hospitals?

[Quantum]

Ah, the free market. Always providing the most optimal outcomes in healthcare.

[GandalfTheGrey]

but but but... its the women's fault for not telling the doctors they didn't need a hysterectomy... they should have obtained a medical degree and be able to know exactly if and when they need any given surgical procedure /free marketer

seriously though, how on earth would a free marketer think this sort of thing could be prevented in their system? Wait till all the "stupid" women die off?

[Figlio di Moros]

While the basic mechanisms at work here are worrying, it is worth keeping in mind that India is overpopulated. If the number of children women are able to birth is reduced, this could have good long-term effects in terms of population. That, of course, is not to excuse the unnecessary and disgusting nature of the operations as per ther profit motive itself.

[Rainbow Crow]

The problem here isn't a free market, it's that India doesn't have a functioning legal system that can use tort liability to deter scams.

As Figlio pointed out, there may be more at work here than the profit motive. How many Indians don't know how old they are?

[Figlio di Moros]

No, Rainbow, the profit motive itself is wholly at work here. It's the same in the US and most of the west- how many women are given C-sections because the hospital's set up for them to give birth in the lithoscopic position, or encouraged to circumcise their son?

What I'm saying is there might be a good outcome through long-term population control, but it doesn't mean the mechanisms through which it's occuring are any less despicable.

[Far-Right Sage]

The problem, Rainbow, is that when you institute a system in which greed is not only incentivized but glorified, the manifestation of that will be a whole slew of greedy people who rise to the surface like scum in a pond of stagnant water; people who build their very livelihoods on the deception and exploitation of others. If you are operating on a large number of uneducated women in rural Rajasthan, it's fair to say that the environment of naivete will be ripe for such predatory types. The problem is compounded by the fact that you then have the free market zealot types who canonize Milton Friedman and Ayn Rand who do effect policy in this country and that policy is subsequently exported to various parts of the world where the U.S. maintains either a direct or indirect influence. When there is some level of push-back, say, as in South Korea when domestic automobile producers decided to bend to local pressure and extend a ring of protection to Hyundai and other native products through the endorsement of a series of tariffs on U.S. automobile imports, the American conservative faction gets crazed and starts foaming at the mouth.

Never mind that whenever these continuously ongoing abuses are publicized, the free market liberal system is always exonerated by commentators and the media apparatus in which they operate. The transgressions are then identified as a crime rather than a natural outgrowth and logical continuation of the system they constantly advocate. What is more hilarious and tragic is that the proposed solutions are then, as you went on to say, tackling corruption head on by (presumably) stronger laws in this regard and heavier regulation, yet once again the free marketeers come down consistently against any attempt at expanding anti-corruption laws and regulation of sensitive industries.

It's a consistent pattern in the U.S., in India, in Europe, and wherever this ugly system rears its head or is imposed by force and through shock treatment. And it's a pattern which increasing numbers are waking up to and will refuse to tolerate in the future.