HealthSexual Health Why Are So Many Working Women Getting Hysterectomies In Beed?

Why Are So Many Working Women Getting Hysterectomies In Beed?

A high number of hysterectomies have been reported in Beed. How is the labour market responsible for this surgical phenomenon?

Beed, an administrative district in the Aurangabad division of Maharashtra, lies in the Marathwada region bordering Karnataka and Telangana. On October 31, 2018, the government of Maharashtra declared Beed as one of the most severe drought-hit districts in the country based on indicators such as rainfall deficit, low soil quality, and decline in groundwater index.                      

Due to prolonged drought conditions, an unprecedented rise in crop failure, debt accumulation among farmers, an increase in input costs of farming alongside declining output cost of crop produce and the lack of alternative employment opportunities, a large number of farmers in the region are pushed to the verge of suicide.

In such conditions, labourers and farmers are forced to migrate from several districts of Marathwada, primarily Beed, to the sugar belt regions of Western Maharashtra and Karnataka to work on sugarcane farms during the harvesting season (October till May). Sugarcane farming is considered to be relatively more economically profitable as state-sponsored sugar cooperatives buy the produce directly from farmers at a price fixed by the government, thus guaranteeing a local market. However, sugarcane harvesting is an arduous and a labour-intensive task, involving physically strenuous tasks such as tying, loading, unloading and transportation of cane to factories.

Labourers often work in pairs; a husband and a wife are recruited and supervised by the mukadams (jobbers-cum-foremen), acting as links between the factory and the cane cutting teams. A typical working day is 12 to 13 hours long, with women devoting additional time performing unpaid domestic labour such as cooking, fetching clean water and childcare. Each migrant couple is paid an uchal, or an advance of Rs 50,000 and Rs 1,00,000 (Rs 250-300 for a day), with a fine, or khada, ranging from Rs 500 to Rs 1000 for each day of missed work.

Also Read: Does The NREGA Work For The Empowerment Of Women?

Since migration takes place for a temporary period of 7 to 8 months, labourers working as  cane-cutters reside in small makeshift huts near sugarcane fields or sugar mills. Since these are temporary shelters, there is a lack of toilets, clean drinking water and proper sanitation facilities. Such poor living conditions adversely impact the health of these labourers, especially women who are forced to practice unsafe menstrual hygiene practices that lead to rashes and infections, causing severe reproductive health-related problems.

Female Sugarcane Labourers and Rising Hysterectomies

In April 2019, a local Indian newspaper reported a staggering increase in hysterectomies in the Beed district of Maharashtra. The report began with a baffling question – ‘Why many women in Maharashtra’s Beed have no wombs?’. It was reported that the cane cutting contractors are unwilling to hire female menstruating labourers. The belief that menstruation and pregnancy are roadblocks in the everyday labour process, and hinder the physical capacity of female labourers to carry out daily wage work, drives this unwillingness.

Pushpa Rajendra Kute, from Vajrantwadi village, has a Master’s degree in Political Science and works as an Anganwadi worker. Having had a hysterectomy, after suffering from heavy bleeding and cysts, she blames the harsh weather along with tough living conditions in Beed for women suffering from uterine issues in the area.
(Credits: Devyani Nighoskar)

According to a study commissioned by the Maharashtra State Commission for Women in 2018, 36% of female sugarcane labourers in the State had undergone a hysterectomy. In June 2019, the Health Minister of Maharashtra, Eknath Shinde, stated in the Maharashtra Legislative Assembly that, in the last three years, 4,605 female sugarcane farmers underwent hysterectomies.

The mukadams claim that they have a strict time frame to achieve  production targets laid down by the sugarcane factory owners, which become difficult to achieve if and when  female labourers skip work due to menstruation and/or pregnancy. Since these labourers are unorganised, their work day is regulated and controlled by the mukadams and the factory owners. For instance, prompt delivery of freshly harvested sugarcane to the factory is highly profitable for the factory owners, for which female labourers are reportedly woken up at 3 am to load the trucks.

However, an important question arises: Do mukadams coerce the female farmers to get hysterectomies? 

The mukadams do not directly coerce women to get their uteruses removed. However, it is the fear of  mukadams extracting hefty fines in the form of khada, along with constant precarity surrounding their jobs, which pushes these women to get their pishvi (uterus) removed – since menstruation, illness and pregnancy might require them to skip labour intensive work. 

Most female sugarcane labourers in Beed are married at a young age, and they start harvesting sugarcane as young as 16. The decision to migrate is taken by the head of the household, usually the fathers, fathers-in-law and husbands. Despite the precarity of work and burden of vulnerable living conditions, women have very little to no autonomy in making decisions about the household.

Also Read: The Forgotten Female Farmers Of India: Narratives From Bihar

The female farmers find it difficult to spend money on buying sanitary napkins and therefore resort to using cloth during menstruation. Lack of sanitation facilities leading to improper disinfection of the menstrual cloths further increases the chance of reproductive diseases. Additionally, the increase in hysterectomies is also driven by a deeply rooted belief that the womb of a woman is futile once she has produced children, who are seen as a form of surplus labour force. Thus, the removal of pishvi is not an outcome of coercion. Instead, it is an attempt towards creating conditions for boosting everyday productivity, at a gruesome cost- putting their bodies at irreparable physiological and psychological risk.

The everyday lives of female sugarcane labourers are embedded in a concatenation of circumstances – poor living conditions, prolonged working hours, and minimal access to public health services. These deficits have an adverse impact on their reproductive health. Lack of affordable sanitary napkins, no toilets, unhygienic sanitation practices and open defecation often leads to multiple infections and grave reproductive problems for women, with little or no scope of skipping a day’s work due to the fear of being fined (or khada) by the mukadams. Amidst an increasing state of exploitative labour-worker relationships, along with adverse effects on reproductive health, working as seasonal migrants emerges as the only survival strategy for the distressed female labour force.   

Usha is an ASHA sister in Vajrantwadi village. She thinks that contractors encourage women to get hysterectomy for better productivity. However, she also thinks a lot of uterine diseases are caused due to lack of awareness. (Credits: Devyani Nighoskar)

Are female labourers more productive in fields after hysterectomies?

Rarely. The cost of one hysterectomy is INR 35,000 – almost equivalent to the total amount of money which a labouring couple earns in one whole year. This cost is seen as a one time investment to boost the everyday productivity to carry out labour-intensive work. However, it has been reported that the reasons for which a pishvi is removed are not very clear. The most common response which these women get from private doctors when they consult them for any gynaecological problem is that the ‘womb has gone bad’ or there is white discharge.

In most of these cases, there is a subsequent lack of post-operative care and counselling which poses severe challenges to the health of these women. Many women who get their pishvis removed in their 20s and 30s complain of backache and abdominal pain. This also increases the chances of serious psychological problems, further hindering their ability to carry out their day-to-day work. The lack of adequate public health facilities in Beed facilitates the ongoing epidemiology of hysterectomies among the female sugarcane farmers. 

According to data from the Municipal Council of Beed, as opposed to 63 private hospitals, there is only one government hospital in Beed which further increases the dependency of women on the completely unregulated private medical sector. The inadequate medical facilities for carrying out gynaecological operations, counselling facilities and post-operative care in the public medical health sector has transformed the bodies of female sugarcane farmers into ‘hunting grounds’ for the private medical sector.


The lives of the female sugarcane labourers in Beed are reminiscent of the famous lines by Faiz Ahmad Faiz, ‘ek bakhiya udheda, ek siya, yun umr basar kab hoti hai (unraveling one stitch and putting in place another, how can life be lived in this manner? Yet this is how life is lived). In Beed, hysterectomies do not emerge as weapons of manifest coercion by the mukadams. Instead, the exploitative labour relations, agrarian distress and poor public health facilities take the form of a latent coercive force.

Seasonal migration is part of a broader livelihood strategy, especially in rural districts such as Beed, where agriculture is entirely rain-fed. It is essential to point out that the constant mobility and non-permanence of the ‘captured pool’ of seasonal migrants is highly dependent on building and maintaining networks. In these networks, the pre-existing ideas about hysterectomy as ‘the only cure’ often shapes the understanding about any minor reproductive health related disease, whose symptoms could be managed through proper medication. Moreover, in terms of medical and health related practices, it is believed that an expert knows more than the patient. The asymmetrical information between women and medical practitioners makes the former vulnerable to exploitation

The exploitation of unorganised workers in the production sphere and the sporadic commercialisation of the medical sector in the consumption sphere brings to fore the deeply entrenched gender-based oppression among the female sugarcane labourers of Beed. The increase in hysterectomies in Beed should be seen not as a one-off incident but instead as a consequence of a concatenation of factors – the agrarian crisis, poor living conditions, lack of affordable public health facilities, exploitative labour relations, gender oppression and most importantly, an unfortunate and grim example of government policy failure in addressing the above-mentioned factors.

Neymat Chadha is an aspiring sociologist with a keen interest in the intersectional relationships surrounding family, health, and biomedicine in India. Currently, she is working as a researcher at a policy think tank.

Caption and pictures by Devyani Nighoskar

Originally published by Social and Political Research Foundation

Feature Image Source: The New Indian Express

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