Married at 13 and a mother of four by 21, Ashabai Prabhaskar spent over a decade after marriage toiling in Karnataka’s sugarcane factories alongside her husband. The gruelling 16-hour shifts, lack of toilets, recurrent urinary tract infections (UTIs) from dirty menstrual rags, lack of clean water to wash the rags and heavy fines levied by mukadams (sugar cane contractors) for a missed day’s work drove the then 25-year-old to opt for a “Rs 30,000 permanent solution” — hysterectomy or the surgical removal of the uterus.
Twenty years on, Ashabai is still paying the price for the procedure she underwent at a private hospital in Beed, Maharashtra. The incision site starts bleeding at least once annually and she is forced to shell out Rs 20,000 on treatment. Sitting on a chatai of empty cement bags on the mud floor of her hut in Beed’s Kaij taluka, she says, “I thought the surgery would help me…I’ve become a burden on my family instead. I’m in excruciating pain all the time.”
Once infamous for female foeticide and low child sex ratio, this arid Marathwada landscape that yields a bounty of sugarcane had in 2018-19 earned notoriety for the unusually high number of hysterectomies, mostly among sugarcane workers like Ashabai. According to a 2018 study by the Maharashtra State Commission for Women, the rate of hysterectomies in Beed stood at 36 per cent as against around 3 per cent nationally.
Following an uproar in the Assembly, the government and the district administration cracked down on illegal hysterectomies by establishing an SOP as part of which women, especially those under 40, who were advised hysterectomies by private hospitals were required to be interviewed by the district civil surgeon.
The action had the desired impact — data accessed by The Indian Express shows that from 5,976 women who opted for hysterectomy at private hospitals in Beed between 2015 and 2018, the number dropped to 2,101 between 2019 and 2022. Despite the SOP, the hundreds of women who had already gone under the knife continue to suffer the consequences of what was, in many cases such as Ashabai’s, a largely unnecessary procedure.
Dr Sukhadev Rathod, former civil surgeon of Beed district who spearheaded the inspection of private hospitals to check illegal hysterectomies, said government hospitals receive numerous complaints of body ache, mood swings and thyroid imbalance from such patients.
Hysterectomies are usually advised as a last resort to treat fibroids, cancer, endometriosis, uterine prolapse or abnormal vaginal bleeding. However, in Beed, doctors allegedly recommended the procedure as a “permanent solution” to the debilitating menstrual cramps and recurrent UTIs that kept women from their job in the sugarcane fields — and thereby deprived them of the day’s wages.
With limited irrigation facilities and few job prospects, around 70 per cent of Beed’s population relies on sugarcane factories for their livelihoods. Many also migrate from Beed to western Maharashtra and Karnataka to work in sugarcane factories there, with women forming a significant chunk of the nearly 10 lakh people who move out.
Annual migration and a hard life
The annual migration is much harder on women. For six-odd months, they live with their husband and children in temporary sheds with poor access to toilets and drinking water. Given the backbreaking 15-hour shifts in factories and the domestic drudgery, their menstrual health remains largely ignored.
“We cannot wash our menstrual rags properly during the migration due to lack of water. So we use the same rags and get infections,” says Shital Galphade, 36.
Besides health issues, work pressure too drove many women to opt for the procedure. Sugarcane contractors prefer to hire couples for better productivity for six months during the harvest season from October to March. While singles receive Rs 35,000-Rs 50,000 per season, a couple earns Rs 1 lakh — the remuneration said to be a leading cause of child marriages in this belt. Though workers earn about Rs 200-300 daily, the contractors enforce khada or fines ranging from Rs 500 to Rs 1,000 for a single missed day of work. With almost no savings, most couples end up borrowing nearly half their annual earnings from the contractors for hysterectomies.
Then, to repay their loans, women often return to the factories within days of the surgery, foregoing the required two-month rest that exacerbates post-surgical complications.
“We keep getting sucked deeper and deeper into this quicksand. We take loans for surgery, followed by loans for treatment and end up working as bonded labourers,” says Saguna Lati, a labourer.
Besides lack of access to clean menstrual hygiene products, the women do not get weekly leaves or even short breaks during their shift.
Namdevi Singh, 35, who had a hysterectomy in 2021, recalled, “My husband and I were working in Karnataka in 2018, when I stained my sari. The mukadam did not allow me to take a break and I was forced to continue working in my stained sari. Later, my husband beat me up saying I had humiliated him.”
Six years after her 2017 hysterectomy, Shakuntala Jagtap, 27, still suffers from persistent abdomen and back pain. Swallowing a fistful of tablets, she says her incision site gets inflamed every other month, necessitating a trip to the private hospital that costs her at least Rs 2,000.
Married at 12 and a mother at 13, Shakuntala worked with her husband in western Maharashtra’s sugarcane fields. Fed up with the painful cramps that kept her away from work, she opted for hysterectomy after the birth of her two children.
Sitting in front of her hut in Kaij taluka, she says, “Since the surgery, a hernia-like swelling in my lower abdomen prevents me from bending. I mostly remain confined to bed now due to fatigue.”
Many other women report similar side-effects. While there has never been a comprehensive statewide survey by the government on the side-effects, a 2021 study by NGO Mahila Kisan Adhikaar Manch (MAKAAM) revealed that 70 per cent of Beed’s ‘wombless women’ suffered from issues like constant fatigue and pelvic prolapse (organ descent due to weakened pelvic tissues).
Jigabai Singh, 50, opted for a hysterectomy in 1994 at 21 because painful menstrual cramps meant sick leave. She says, “After the hysterectomy, every time I coughed, there would be a big vaginal bulge and a burning sensation. A doctor said it was a pelvic prolapse and that I needed another surgery. Since I don’t have Rs 45,000 for the surgery, I just have to live with it.”
Shindu Jagtap, 48, had a hysterectomy in 1995 at 20, after the birth of her third child. Lifting a 25-kg bundle of sugarcane after the procedure, she said, “made me feel like my internal organs would detach”. Persistent back pain forced her to stop seasonal migration work. Since her husband’s death, she works as a daily-wage labourer for Rs 100. For relief from back pain, she relies on painkillers.
Despite several attempts by The Indian Express, State Health Minister Tanaji Sawant was unavailable for comment. However, in response to a request seeking the minister’s comment, one of his associates told The Indian Express that a government resolution (GR) was passed in 15 districts in September calling for the implementation of the recommendations by a 2019 state committee, including formation of district-level panels to oversee unnecessary hysterectomies, among others.
The government says that after cutting down on unnecessary hysterectomies in Beed by more than half since 2018-19, the district administration will now help those struggling from the aftereffects of these procedures.
No legal action despite performing unnecessary surgeries Beed civil surgeon Dr Chavan told The Indian Express that the health department would initiate a statewide door-to-door screening of women. He said, “During these screenings, parameters such as blood pressure, sugar levels, and cancer risks will be assessed. Along with this, a survey in Beed will look at the side effects of hysterectomy. Data will be compiled of women experiencing the side-effects of hysterectomy. Subsequently, the affected women will be referred to nearby government hospitals.”
Varsha Deshpande, a lawyer and women’s rights activist, pointed out that no Beed doctor had faced legal consequences for performing unnecessary surgeries despite the irreversible harm inflicted on countless women’s lives.
“The doctors never had a conversation with the women on the potential side effects of the surgery or provided counselling. Astonishingly, no FIRs were lodged or licences suspended,” Deshpande said.
Seema Kulkarni of MAKAAM said the inhumane practice of unnecessary hysterectomies has spread to other districts of Maharashtra. “To end such miseries,” she said, “we need to educate women. This will help curb child marriages that still take place in Beed.”
Manisha Ghule, secretary of NGO Navchetna Sarvangin Vikas Kendra, which has been working with the affected women, said the state health department’s failure to recognise the long-standing trend of women as young as 20 undergoing hysterectomy was “significant and a collective tragedy, for which the authorities need to share the responsibility”.
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