Hysterectomy, the surgical removal of the uterus, is one of the most common gynecological procedures performed worldwide, yet its prevalence and determinants vary significantly across contexts. In India, concerns about the rising rates of hysterectomy, particularly among women of reproductive age, necessitate a comprehensive understanding of its patterns and determinants. This study investigates the prevalence, regional disparities, and socio-demographic predictors of hysterectomy among women aged 15–49 years in India, using nationally representative data from two rounds of the National Family Health Survey (NFHS-4, 2015–16, and NFHS-5, 2019– 21). Data from nearly 1.4 million women across both survey rounds were analyzed. Prevalence estimates showed a marginal national increase from 3.2% in NFHS-4 to 3.3% in NFHS-5, though stark regional variations persisted. Southern states such as Andhra Pradesh (8.9% to 8.7%) and Telangana (7.7% to 8.2%) recorded the highest prevalence, while northeastern states reported rates below 2%. Logistic regression analysis revealed strong associations between hysterectomy and socio-demographic characteristics. Age emerged as the most significant predictor: women aged 40–49 years had over 15 times higher odds compared to women aged 15–29. Rural residence, lower educational attainment, multiparity, and higher body mass index were also positively associated with hysterectomy. Conversely, higher education and anemia were protective factors. Women with non-communicable diseases had significantly higher odds of undergoing hysterectomy, and the majority of procedures were conducted in private facilities (nearly 70% in both rounds), underscoring the dominance of the private sector in surgical care.
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