Intersectionality and women's empowerment in hysterectomy decisions: an inquiry using data from a large cross-sectional sample survey in India

Abstract

Background: Inspired by feminist theory and Durkheim's social perspective, this study used intersectionality to delve into the determinants of hysterectomy. Methods: Using data from the Demographic and Health Survey (DHS) of India, we examined the determinants of hysterectomy, focusing on three key themes: society, women's empowerment, and biological factors. Results: The overall hysterectomy rate in India increased from 31.5 per 1,000 women (age 15–49 years) during 2015–16 to 32.6 per 1,000 women during 2019–21. The results of bivariate and multivariate analyses echo the findings of the interaction analysis, indicating that, among women of the general caste, illiteracy and higher parity correlate with an increased likelihood of undergoing a hysterectomy. Illiterate women from the Other Backward Class also exhibited higher hysterectomy rates, regardless of parity. The second interaction result states that wealth influences hysterectomy, and illiteracy remains a significant risk factor across wealth statuses. The results of the third intersection indicate that higher education is a protective factor against hysterectomy, regardless of residence or parity. Conclusion: From the intersection of variables, the study observed that illiteracy, residing in rural areas, and high parity increase the likelihood of undergoing hysterectomy among women of reproductive age. There is a need to establish a mechanism for disseminating reproductive health knowledge to women in rural areas.