Unregulated and unaccountable: how the private health care sector in India is putting women’s lives at risk

New evidence revealed by Oxfam shows that women in India are being exploited and facing serious health problems, due to under-investment in healthcare by the Indian government and the proliferation of private for-profit clinics. The international agency says that many private clinics are being driven by financial incentives to carry out dangerous and costly procedures regardless of whether or not there is any benefit to the patient.

Women, particularly from poor communities, are being left with crippling debts and health problems after being made to have unnecessary hysterectomies and Cesarean births. These are procedures that come with huge price tags and high medical risks.

In one rural district of Rajasthan, thousands of women have been deliberately misled into believing they need hysterectomies^[1]; women from the most discriminated low castes and poor economic backgrounds are being targeted because access to free government healthcare is very limited and illiteracy rates are high.

Misled to undergo hysterectomies

Durga Prasad Saini, an advocate for a local NGO^[2] in the area, said: “Whatever abdominal stomach problems they are coming to doctors with, the doctors make them scared that they have cancer and are going to die. They mislead them to undergo surgery even though it is not necessary and scare the women in their greed for money.”

The NGO filed an RTI (right to information) case to try to get to the bottom of the problem. Only three of the five clinics provided him with the information but the results were shocking. Nearly 70 percent of the women investigated had had their uterus taken out.^[3] The RTI also revealed a large number of the women who had undergone the procedure were under the age of 29, with the youngest being just 18 years old. Despite the fact complaints have been made to the police and local government, no action has been taken to investigate.

38 year old Kaushalya, like most of the women in the district, works as a farm laborer. She was told she must have a hysterectomy when she visited the clinic with stomach pains. She was charged 30,000 rupees for the operation (around $540).

“I went to get medication and have a check up. Because the government hospitals are far away I went to a private clinic. They didn’t check me, they didn’t give me any medication. But they gave me an injection and performed an operation. Even though I only had a tummy ache, they took my uterus out. I still have the same stomach pain I had before. I can’t work, I can’t lift heavy things. Being a poor farmer I don’t have any money, so I had to borrow money. So far I have not even been able to pay just the interest.”

Unnecessary Cesareans prescribed for profit

Private doctors are also over-prescribing unnecessary Cesareans, to increase the money they get from patients. Chandra Kala, a mother of two in her late twenties, was told she must have a Cesarean by a private clinic for both of her deliveries. She was charged 20,000 rupees ($360) for the delivery of her first child (who is nine) and 15,000 rupees ($270) for the second baby she delivered recently.

“I said I don’t want an operation done to me, but they said I had to have one and they charged me. We are only villagers doing farming, but I managed to borrow some money from here and there. But being a farmer now I can’t work, I can’t lift anything heavy or bend too low, I don’t feel well enough to work. I only finished off paying my debts two months ago from my first child who is now nine years old.”

Dr Satyaveer Singh, who works as chief medical officer for a government hospital near Bharatpur, said the situation was widespread. “For private doctors to do a normal delivery, what will they get? Only 5,000 or 6,000 rupees ($90–$110). But whenever they perform a Cesarean they will charge 18, 20,000 ($320–$360). And they will add a bed charge, a consultation charge, with all these included it’s about 30,000 (approx $540). Most of the women having a Cesarean face problems financially. They have to sell their assets, or lend money.”

India's crumbling health system

Dr Narendra Gupta from Prayas, a partner organization working with Oxfam India, said: “Subjecting women to unethical and unnecessary hysterectomies or Cesarean sections for financial gain is a violation of human rights and most awful form of gender based violence.

“The mass hysterectomies by private clinics in Dausa is a wicked act, but such malpractice is happening in other areas as well.”

Decades of appallingly low investment in the public health sector has left India with a crumbling health system and despite efforts in recent years to strengthen it – most notably through the National Rural Health Mission – India has one of the lowest levels of government investment in health in the world. The gap left by the public health system combined with a government policy of proactively promoting the private sector has led to the proliferation of private health providers which are unregulated, unaccountable, and out of control.

Oxfam is calling for immediate action to regulate private health care providers in India and for the Indian government to prioritize the strengthening and scaling up of government health care, which is universally available to all citizens, so women in rural areas will be able to access free care.

Oxfam cautions donors against private sector healthcare

Araddhya Mehtta, Oxfam’s global health campaigner, said: “In many poor countries we are seeing people trapped in poverty because of healthcare fees, or dying through lack of treatment because they are too poor to pay. The real solution is to make sure government health facilities are offering free, decent medical care, available to everyone.”

Oxfam is also warning international donors to be more cautious about investing in private sector healthcare. Mehtta said: “It is clear that all of the negative implications of charging people for healthcare, such as these shocking cases of exploitation, are disproportionately borne by the poorest and most vulnerable.”

In India, a recent high-level expert panel report^[4] recommended that user fees of all forms be dropped as a source of government revenue for health in favor of more investment into the public system.

Dr Singh believes if India had universal free healthcare they could reduce maternal and child mortality rates by over 30 percent and even reach the same standards of healthcare as Europe. “If each and every health facility is providing to each and every person in India, we could have European standards of healthcare within three years.”