Prevalence and Determinants of Hysterectomy Among Women Aged 15–49 in Kerala: Analysis of NFHS-4 and NFHS-5 Data

Background: Hysterectomy, the surgical removal of the uterus, is one of the most common gynecological procedures performed globally. While its prevalence has declined in several high-income countries due to advances in conservative treatment, India has shown a gradual increase in hysterectomy rates. Kerala, known for its advanced health indicators, reports lower prevalence compared to other southern states, yet trends indicate subtle increases requiring closer examination. Objectives: This study aims to (1) assess changes in hysterectomy prevalence among women aged 15–49 in Kerala between NFHS-4 (2015–16) and NFHS-5 (2019–20), and (2) identify key socio-demographic, reproductive, and morbidity-related determinants associated with hysterectomy. Methods: Data were drawn from NFHS-4 (n = 19,270) and NFHS-5 (n = 10,969) women aged 15–49 in Kerala. Hysterectomy status was identified via self-reports among women who had not menstruated in the six weeks preceding the survey. Bivariate cross-tabulations and binary logistic regression were used to assess associations with age, education, residence, wealth, BMI, insurance coverage, parity, age at first birth, sterilisation status, and morbidity. Results: Hysterectomy prevalence increased slightly from 1.8% (NFHS-4) to 2.0% (NFHS-5). Among women reporting amenorrhea in the last six weeks, 25.6% in NFHS-4 and 24.8% in NFHS-5 had undergone hysterectomy. Fibroids and cysts were the leading causes in both rounds (49.0% and 56.8%, respectively). Mean age at hysterectomy was approximately 39 years in both surveys. Private facilities were the primary providers, increasing from 58.4% to 65.3%. Logistic regression indicated that in NFHS-4, age (AOR 1.067), children ever born (AOR 3.06 for 1–2 children), wealth, BMI (AOR 1.88), and insurance were significant predictors. In NFHS-5, age (AOR 1.10), secondary/higher education (AOR 2.5), urban residence, and higher age at first birth were significant predictors. Conclusion: Although hysterectomy prevalence in Kerala remains lower relative to neighbouring states, the marginal increase and relatively young mean age at surgery highlight the need for clinical guidelines promoting conservative treatment. Changing determinants between NFHS-4 and NFHS-5 suggest shifting access patterns from economically driven to healthcare preference-driven uptake.