Paper short abstract:

Study analyses hysterectomy's impact on domestic violence in India using NFHS-5 data of 63,851 women. Findings show increased violence risks post-hysterectomy, underscoring the need for inclusive sexual health awareness campaigns.

Paper long abstract:

This study empirically investigates whether undergoing a hysterectomy is causally linked to an increased likelihood of women's exposure to domestic violence in India. Utilizing data from the National Family Health Survey (NFHS-5), specifically the domestic violence module comprising 63,851 women. First, we looked at the determinants of hysterectomy in India. Our analysis reveals that critical determinants for hysterectomy include the proportion of hysterectomies in the district, the sex of the first child, the number of children, and other socio-demographic factors. Subsequently, we explore the potential role of hysterectomy in influencing domestic violence in India. However, establishing a causal link is challenging due to unmeasured confounding factors and reverse causality. To address these concerns, we employ an instrumental variable approach, using the exogenous variation in the distance to health facilities. In our conditional mixed processes estimation, we find that the likelihood of physical, sexual, and emotional domestic violence increases for women who have undergone hysterectomy compared to those who have not. Our estimates remain robust across alternative estimation techniques and various robustness checks. Our findings emphasize the importance of conducting informative sessions on sexual and reproductive health, particularly focusing on providing accurate information about hysterectomies. Furthermore, our results suggest that policies aimed at promoting gender equity may inadvertently increase women's exposure to domestic violence unless they involve men in such awareness campaigns.