Beed: High hysterectomy rate among sugarcane cutters signals unethical medical practices, poor work conditions

Asha Shinde got married at the age of 13. Like most couples in Beed district in Maharashtra, she and her husband migrated every year to other places in the Marathwada region, Western Maharashtra or even Karnataka to cut sugarcane for six months a year. The strenuous work begins in October/November and goes on till March. For women like Asha, year after year of this hard work, and bearing three children at a young age caused grave health problems. Her doctor advised a hysterectomy, as she had a prolapsed uterus and was finding it difficult to work. But her problems didn’t end there. Till recently, the exploitation of sugarcane cutters, including the women, was considered a problem of wages and poor working conditions. Sexual exploitation was another major issue. In April this year, Tathapi, an NGO, drew attention to a disproportionate number of hysterectomies performed in Beed district, on the women sugarcane cutters. The study reported that contractors who get these workers to cut cane, often urged the women to go in for the surgery so that they stop menstruating and it makes their lives easier, and they can work uninterrupted, among other reasons. After the hysterectomy, Asha, who is now about 40 years old, developed severe back problems. She couldn’t work last year, and is undergoing treatment. “I spent Rs 1 lakh to 3 lakh and now I can walk,” she said. She plans to return to work as it is difficult for her husband to do the cutting alone. The couples are paid based on the number of cartloads they can cut and load. Most of them earn Rs 30,000 to Rs 35,000 in a season. Of late, work has reduced from six months to about four months in a year. [caption id=“attachment_6809471” align=“alignnone” width=“825”]  Four among many women from Beed who have undergone hysterectomies. Photograph by the author[/caption] At a meeting in Mumbai, the women spoke of their abysmal conditions, about how they don’t even have basic amenities, water to wash themselves or a crèche for their children, apart from major health problems due to the work. During the menstrual cycle, they don’t get time to even change the cloth they use and often get rashes and urinary tract and reproductive tract infections as a result. After cane cutting for six months, those who own little land like Asha, work in the fields; there is no water and they are dependent on the rain. The parched Marathwada region is once again under a severe drought this year, and has witnessed migration year after year by these sugarcane cutters.

It is the women who are paying a heavy price for this unrelenting and back-bending work.

They barely sleep during the cane cutting season and often wake up as early as 2 am or even 4 am to start cutting. In addition, they have to do the cooking, fetching water and caring for their children. Sheela Waghmare from Ghodka Rajuri village near Beed said she was married at 12 and has two sons and a daughter. She has studied up to Class Five, unlike most of the other women who are illiterate. “I had white discharge and the doctor said it could develop into cancer, so I was advised to remove my uterus. I was 20 years old at that time,” she said. Now at 32, she has body ache, back ache and cannot lift anything heavy. Her teenaged son accompanies her at work. ” We need this work; we have no land. There are so many debts to pay off including medical expenses, I had to take my son along and couldn’t send him to school,” she said. Another labourer Chaya Dhoke had to sell off a pair of bullocks to pay for medical expenses. She too was married at 12 and after three children, she had a hysterectomy at 17 or 18. “I had a tumour, and it used to hurt a lot. When I went to the doctor, I was advised to remove my uterus,” she said. The women also don’t get much rest after the operation. If they don’t report to work for a day in case they are sick, their employers cut Rs 500 to Rs 1000 a day.

According to government reports reviewed by activists, 4500 hysterectomies were conducted in Beed in the last three years.

Dr Abhay Shukla, co-convenor, Jan Swasthya Abhiyan, said the government conducted two surveys. Of the 200 women surveyed in 2018, in Beed district, 72 had hysterectomies. The rate of uterus removal in Beed was 36 percent, compared to 2.6 percent in Maharashtra and 3.2 percent in India. In 2019, Dr Shukla said 271 women were surveyed of whom 56 had hysterectomies, that is 21 percent of them — again a high number. According to figures provided by the Beed administration, 11 hospitals conducted most of the surgeries and 85 percent of the surgeries in 2018 and 2019 were in private hospitals. One hospital which did not have a gynecologist conducted 24 hysterectomies which is grossly high, he added. The five groups which came together to highlight this issue of unwanted hysterectomies and working conditions of women sugarcane cutters at a meeting are Maharashtra Mahila Arogya Hakk Parshad, Ekal Mahila Sanghatana, Mahila KIsan Adhikar Manch (MAKAAM), Jan Arogya Abhiyan and National Federation of Indian Women. Manisha Tokle and Seema Kulkarni of MAKAAM said there were many issues affecting women workers, including wages, job security, basic amenities at the workplace, and a safe environment for their children. Many women complained of sexual assault as well. Women spend from Rs 20,000 to Rs 40,000 for surgeries and incur debts. They lacked any medical or social security cover. In the case of one woman, her husband too met with an accident and the treatment cost Rs 2 lakh - Rs 3 lakh. Activists said the women lived in makeshift houses, walked long distances to fetch water and the hard work impacted their health. Many of them regretted having their uterus removed but felt they had little choice. Sometimes the doctors instilled the fear of cancer in them and they consented to the surgery. They are not even registered as workers, and despite welfare boards set up by the government, there is no intervention for their benefit. A government official from the public health department who attended the meeting said a committee was formed to investigate the hospitals which have performed a high number of hysterectomies in the Beed district, and action will be taken against those found guilty. A protocol is also being put into place for approving hysterectomies. There is now a district-level committee in Beed which now has to approve such a surgery. However, so far the activists said there was no action against the hospitals. They demanded the passing of the Clinical Establishment Act for the regulation of private hospitals, action against the 11 private hospitals which performed many surgeries, and making all surveys conducted by the government on this issue public. Under the Social Security act of 2008, a board for sugar cane cutters should be formed and these workers should be registered. Also, sexual harassment at the workplace laws and the Minimum Wages act should be implemented. The onus should also be on the sugar factories to provide a safe working environment and all basic facilities for the workers, since they are migrants.