COMMENTARY FEBRUARY 3, 2024 vol lIX no 5 EPW Economic & Political Weekly 18 Manjari Sinha (manjari@sihspune.org) is with the Symbiosis Institute of Health Sciences, Symbiosis International University, Pune. Mathew George (mathewg@cukerala.ac.in) teaches at the Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod. Hysterectomy as a ‘Magic Bullet’ for Gynaecological Morbidities Commercialisation of Health Manjari Sinha, Mathew George The increasing prevalence of hysterectomies among young women in various states of India over the past decade has raised significant concerns. The study on hysterectomy among rural women from weaker socio-economic backgrounds in a district in Maharashtra examines the factors that shape the choice of healthcare facilities. Existing studies and news reports indicate that among the various stakeholders, private practitioners unnecessarily prescribe hysterectomy for monetary interests. H ysterectomy is the most fre- quently performed major gynae- cological procedure, wherein the uterus is surgically removed (Prayas 2013; Sardeshpande 2014). It is performed for benign (not fatal) and malignant (can- cerous) indications (Aarts et al 2015). The National Family Health Survey (NFHS)-5 data states that 3% of women under the age group of 15–49 years had undergone hysterectomy in 2019–21 (Kumari and Kundu 2022). Studies show that approxi- mately 90% of hysterectomies are per- formed for benign conditions, such as fibroids causing abnormal uterine bleed- ing (Aarts et al 2015). In April 2023, the Supreme Court of India ordered all states and union terri- tories to follow the guidelines formulat- ed by the Ministry of Health and Family Welfare to monitor “unnecessary” hys- terectomies being performed in the country (Hamid 2023). This was the re- sult of a public interest litigation (PIL) initiated by the health activist Dr Naren- dra Gupta in 2013, who had then carried out a study to document how women were being subjected to hysterectomies without being offered an alternative treatment, jeopardising their health in the process. The petition also highlight- ed the involvement of private hospitals in performing such hysterectomies (Perappadan 2023). Due to several serious instances, hysterectomy has received enormous attention in the health policy debates in India in the past few years (Desai et al 2016). The trigger has been the increased focus by a series of media reports that highlighted an unusual surge in the number of women undergo- ing hysterectomy in many parts of the country, with a significant number of cases involving young premenopausal women from poor families (Ray and Sonnad 2017; Rao 2016; Iyer 2016; Desai et al 2011). In India, community-based cross-sec- tional studies, conducted mostly in rural settings in different age and population groups, estimate the prevalence of hys- terectomy between 1.7% and 7.8% (Singh and Arora 2008; Desai et al 2011; Sard- eshpande 2014). Some studies conduct- ed in Andhra Pradesh and Karnataka re- vealed that the majority of hysterecto- mies were done in private hospitals (Prakasamma 2002) and doctors pro- vided inaccurate information, to under- privileged Dalit women, misleading them to undergo hysterectomy, following which many suffered complications and died. A large proportion of the hysterectomies performed were medically unwarrant- ed; private doctors were using highly suspicious diagnostic criteria based on a single ultrasound scan; and medical records were incomplete, flawed and, in several instances, manipulated (Xavier et al 2016). The issue extends beyond the finan- cial strain, encompassing the challenges and consequences experienced by the families, which has a notable impact on women’s well-being. The study is based on the qualitative interviews of 38 rural agricultural women in Pune district, Maharashtra and a few doctors. The