Sathyabhama Ganesan, 50, has had trouble with her period since giving birth to her daughter two decades ago. But matters worsened in 2010. She would bleed heavily, and her stomach would clench so tightly that medicines couldn’t really ease her pain. When her period would arrive, 15 days or 25 days or 35 days after her previous cycle, she would lie crumpled on her bed for days at home in Trichy, Tamil Nadu.
“For two days every month, I couldn’t do anything,” she recalled in Tamil. “I would have to lie down. When my daughter was younger, I’d grit my teeth and try to care for her.”
Two doctors advised Ganeshan to remove her uterus in a procedure called a hysterectomy. But a friend suggested she talk to T Ramanidevi, a gynaecologist who has a reputation for avoiding surgery. After a consultation, the doctor implanted Mirena, a hormone-releasing intrauterine device (IUD) made by pharma company Bayer, into Ganesan’s uterus. Within three months, her period disappeared. She became pain-free.
Ganesan is one in a fraction of Indian women who’ve avoided a risky surgery for gynaecological issues. In Dec 2017, the government published the first data on the prevalence of hysterectomies after news reports revealed unscrupulous doctors were pushing the surgery on women. The procedure can cost upwards of Rs 40,000 ($568). Some 700,000 women reported having a hysterectomy and more than half of them were younger than 40. Two-thirds of the procedures happened in private clinics. Extrapolating from other surveys, it is likely that 30% of them had issues related to abnormal bleeding, which may have been treatable using a hormonal IUD.
But though these devices have been available for about 18 years in India, they remain unavailable to poor, uneducated and rural women who undergo the vast majority of hysterectomies, The Ken has found. That’s despite the fact that these devices are on India’s National List of Essential Medicines, which contains 376 medicines that the government mandates must be accessible and affordable. Hormonal IUDs are also on the World Health Organization’s essential medicines list.
A controversial history of family planning, high prices and a government focus on fertility rather than women’s reproductive health has meant the devices are not widely available, said Subha Sri Balakrishnan, a doctor at the Rural Women’s Social Education Centre (RWSEC) in Tamil Nadu.
“All that is available currently in the public sector is hysterectomy,” she said. “A hormone-releasing IUD would be something that could be very useful, if it came into the public sector, for women having menstrual issues.”
In 2013, HLL Lifecare, a government enterprise in the manufacture of healthcare products, developed a low-cost, home-grown alternative to Bayer’s Mirena, called Emily.