Correlates of hysterectomy in low- and middle-income countries: a systematic review.

BACKGROUND

Hysterectomies for benign conditions have declined in recent decades in most high-income countries (HICs); however, it remains a common surgical procedure among women of reproductive age in low- and middle-income countries (LMICs). Although an expanding body of evidence has examined the factors associated with hysterectomy in HICs, evidence remains limited in LMICs. Therefore, we systematically reviewed and synthesised the existing evidence on correlates of hysterectomy in LMICs.

METHODS

We comprehensively searched PubMed, Embase, CINAHL, Scopus, and Web of Science for eligible studies published up to 28 April 2025. We included quantitative studies with population-based samples that examined the correlates of hysterectomy in LMICs. Findings were synthesised using a narrative synthesis approach.

RESULTS

We included 22 studies in this review. All studies were published from 2016 onwards, and three-quarters were conducted in India. Evidence from multiple LMICs, including India, suggests that older age at survey (in reproductive ages), having health insurance at the time of survey, being currently married or having a partner, and belonging to higher wealth quintiles are associated with an increased likelihood of having had a hysterectomy. Studies from India consistently indicate that women with lower levels of education, those who are employed, residing in rural areas, classified as overweight or obese at the time of survey, and having a higher number of children were more likely to have undergone a hysterectomy. Evidence regarding adolescent age at first birth was limited and inconclusive, while evidence on tubal ligation was mixed across studies from India.

CONCLUSIONS

We identified several sociodemographic and reproductive correlates of hysterectomy in LMICs. Prospective and mixed-methods studies, as well as studies examining health system factors, including provider incentives and facility-level variation, are needed to inform targeted interventions in LMIC settings.

REGISTRATION: PROSPERO: CRD42022335706.