“Unnecessary hysterectomies”: are India’s clinics exploiting an insurance loophole for profit?

In April 2023 India’s Supreme Court ordered all states and union territories to follow the Ministry of Health and Welfare’s guidance on hysterectomies—surgical removal of the uterus—in healthcare facilities.12 The move followed a public interest litigation case filed in 2013 by Narendra Gupta, a doctor, against the federal government. The litigation revealed a rise in “unnecessary hysterectomies” being performed on women from low income backgrounds, by clinics seeking to exploit government health insurance schemes for high payouts.

Citing media reports and Gupta’s own research data, the litigation claimed a “widespread pattern” of unnecessary hysterectomies in states including Bihar, Rajasthan, and Chhattisgarh. Women, particularly those from lower socioeconomic backgrounds, often visited private hospitals for symptoms such as “abdominal pain and general weakness,” it stated. This is often due to problems relating to diet or hunger.

But Gupta’s litigation also highlighted an increasing number of doctors in these states performing “unnecessary hysterectomies” after only cursory examinations or in some cases none at all. The procedure, the litigation stated, was often performed for benign conditions that medical services could easily manage.

Gupta says, “Hysterectomy is often the primary treatment for severe cases such as prolapse, cancer, and postpartum bleeding, but it can be avoided when addressing conditions like pain, heavy menstrual bleeding, and fibroids.” During hysterectomy additional parts of the female reproductive system may also be removed after medical evaluation, such as the ovaries, fallopian tubes, or cervix.

Gupta’s lawsuit, filed in the nation’s highest court, compelled the federal government to act, and the Ministry of Health committed to setting up …