Gender Norms and Hysterectomies

We investigate the role of gender norms in explaining variations in the incidence of hysterectomies (i.e., removal of uterus) for benign conditions, the second most common surgical procedure after a cesarean section for women. Using data from Italy—a coun- try with a degree of heterogeneous gender norms—we show that the more traditional the perception of the female role is, the higher the incidence of hysterectomies for be- nign conditions for women in older cohorts. We attribute these results to the fact that the uterus is associated with reproductive function and not with gender identity. To support this interpretation, we show how gender norms are negatively correlated with the incidence of both mastectomies (i.e., removal of the breast) and prostatectomies for benign conditions (i.e., removal of the prostate) for men. To test the role of gender norms in explaining some of these avoidable procedures, we exploit the impact of the introduction of automatic constraints on healthcare expenditures triggered by the adop- tion of so-called regional repayment plans. Using a staggered difference-in-differences approach, we show that the introduction of a repayment plan reduced the incidence of hysterectomies for benign conditions by 4–8%, depending on the age group, but less so in regions with more conservative gender norms.