According to a recent investigation, doctors in rural areas of India may be performing unnecessary hysterectomies (the surgical removal of the uterus) on women in an attempt to make additional money. While it is difficult to obtain exact statistics regarding hysterectomies in rural Indian villages, local reports and anecdotal information suggest that private doctors are frightening a number of women into receiving the procedure.

One woman, whose experience is similar to others who have been interviewed, recalls going to a private doctor initially for heavy bleeding during menstruation. After performing a single ultrasound, the doctor told her that she might develop cancer in the future, and needed to undergo surgery immediately. Although she wanted to wait and discuss the possible surgery with her family, the doctor pressured her into receiving the procedure a few hours later. Independent doctors have come to the consensus that a single ultrasound cannot justify a hysterectomy, and that biopsies and other tests are better indicators of cancer or pre-cancer. However, a doctor at the clinic where the woman received the operation admitted that he doesn’t always schedule biopsies prior to performing hysterectomies, so if the uterus or biopsy material is discarded afterwards, there is no way to prove whether the procedures were necessary or not.

Unfortunately, the case highlighted above is not unique in India. There are reports of large numbers of women receiving hysterectomies in some Indian states, and in one village it’s reported that around 90% of women have received a hysterectomy. As these procedures can be costly, women often have to sell some of their own assets to pay for them. Hysterectomies also lead to additional health risks inherent to any surgical procedures.

There are organizations currently working to make changes that will improve the health of women in rural India. Since health clinics are necessary and helpful, campaigners are focusing on improving oversight and regulation of the doctors working in these clinics to ensure that women are not tricked or scared into unnecessary procedures. There has been legislation passed in India to regulate private health care, but it is still in the process of implementation, and is not yet effective. For now, it’s important to raise awareness about this issue, and continue to work to improve women’s health everywhere.

Source: McGivering, Jill. "The Indian Women Pushed Into Hysterectomies." BBC News Magazine. 5 February 2013

To learn more about hysterectomy, check HERE.   If you are considering a hysterectomy you might want to read this article about decision making.

A common misconception about teen pregnancy is the belief that it is a problem mainly among the urban poor teenagers.  Not true.  The teen birth rate in rural areas is nearly one-third higher than in the rest of the U.S., according to a study released on Thursday by the National Campaign to Prevent Teen and Unplanned Pregnancy.

The study examined county-level data from the National Center for Health Statistics from 2010 and defines rural counties as those with populations under 50,000 and metropolitan counties as those with populations of 50,000 or more.

Key Findings from the Report

Factors Behind Variation in Teen Birth Rates

So what does this all mean?   While teen pregnancy risk is dropping overall nationally,  it is dropping at slower rates among rural teens.   The report suggests that there is a need for more teen pregnancy prevention efforts in rural communities and that perhaps rural teens should be considered as a particularly high risk group among those who set health priorities.

In addition, rural teens' ability to access birth control "lags far behind availability for teens living in urban and metro areas," said Julia De Clerque, a research fellow and investigator at the University of North Carolina who was not involved in the study (Healy, USA Today, 2/21).

To view the whole report, click HERE.

There is growing evidence that the more engaged patients are in their health care decision, the better the outcomes.    Much research -- including several studies published in the current issue of Health Affairs -- found that patients with the lowest involvement in their care  had average costs 8% higher than those with the highest range on an activation (involvement) scale.

But doctors still aren't using that information to their advantage and better engaging patients, panelists at a recent  Institute of Medicine (IOM) workshop on patient engagement said.   More resources need to be invested in getting physicians and healthcare systems to increase patients' involvement in decisions about their care, advocates said here.

"We just haven't spent enough time helping clinicians develop these skills," Eric Holmboe, MD, chief medical officer at the American Board of Internal Medicine, said.

Despite the availability of continuing medical education (CME) courses for physician  in the topic of patient engagement, few are attending them.

Monday's IOM workshop follows a report last month that found Americans live sicker lives and die younger than those in other countries despite the impression that the US has the greatest health care in the world. Many believe there is the need to change the physician culture and convince doctors to accept a greater dialogue with patients, and a representative of GroupHealth, a health plan in Seattle, described his plan's successful patient engagement initiative.

The provider organization, which serves 600,000 Washington residents, undertook a multi-pronged program that included offering patient education on joint-replacement surgeries and alternatives. They offered a half-day CME opportunity on how to discuss options with patients and emphasized to physicians that this was a patient safety issue.

GroupHealth experienced a 26% drop in the number of hip replacements and a 12% to 21% cost reduction after 3-plus years in the program, David Arterburn, MD, MPH, of GroupHealth, said.

Jonathan Welch, MD, Harvard Medical School, said providers need to find better ways to listen to patients and their families. He said the healthcare sector, unlike other service industries, doesn't listen well to feedback from its consumers.

Excerpted from MedPage Today, Feb. 25, 2013 by David Pittman

It's generally known that women's genital tissue is more susceptible to the HIV virus that causes AIDS.  Researcher are studying the various types of epithelial cells in the reproductive tract and the possible protective role of mucus to try to determine what makes women more vulnerable to the spread of this virus.  A new study supported by the National Institute of Child Health and Human Development (NCHID) at the NIH found that an immune system protein normally found in semen may enhance the spread of HIV to tissue from the uterine cervix.  The protein interleukin 7 (IL-7) belongs to a family of proteins that regulates the immune response and is present normally in semen but at even higher levels in the semen in men with HIV.

So far, this experiment is limited to cell cultures in the lab and more work is needed to see if this is true in the living human.   "These experiments show us again how vicious HIV is," said senior author Leonid Margolis, PhD, at NICHD.   "The virus is able to commandeer an immune protein for its own benefit."