Non-therapeutic hysterectomy in Mexican young females with intellectual disability: a problematized reality

Edith Valdez-Martínez, Unidad de Investigación Médica en Epidemiología Clínica, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Ciudad de México, México
Horacio Márquez-González, Servicio de Investigación Clínica, Hospital Infantil de México “Federico Gómez”, Ciudad de México, México
Miguel Bedolla, Investigador independiente, San Antonio, Texas, Estados Unidos

Background: Non-therapeutic hysterectomy in girls and adolescents with intellectual disability (ID) is an acceptable practice, even when there is a lack of prescriptive ethical reason. Objectives: To determine the magnitude of the practice of hysterectomy in girls and adolescents with ID, and explore the emic factors associated with this procedure. Material and methods: Multicenter, intersectoral study with a mixed methods design. Results: The quantitative results showed that 50 of 234 reported hysterectomies corresponded to females with ID. Average age at the time of surgery was 15 ± 2.9 years. Prophylactic abdominal hysterectomy was the most common procedure, and the justifications for it were “fertility control”, “menstrual hygiene management”, and “risk of sexual abuse”. A qualitative analysis of 15 focus groups revealed that parents’ main concern was how to manage their daughters’ index disease and reproductive health; they perceived menstruation positively; they expressed their fear of dying and leaving them without support, and emphasized fertility control; none of them approved hysterectomy. Conclusions: The bodies that define health policies need to create a new philosophy that avoids the reductionist approach of current biomedical model, which separates (in the health-disease process) our interdependence with other humans.

Keywords: Adolescent. Bioethics. Intellectual disability. Hysterectomy. Medicalization.

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