A HARVEST OF UTERUS?-THE RISING CASES OF HYSTERECTOMY AMONGST WOMEN SUGARCANE CUTTERS OF MAHARASHTRA
Author: Adv. Siddhi Gokuldas Naik, pursuing II year of LL.M. from V.M.Salgaocar College of Law, Miramar-Panaji, Goa
“The most sacred place in the world is a mother’s womb!”
We are very much aware of the exclusions attached to Menstruation in India. Menstruation is a biological process in a woman’s reproductive life that marks the existence of her sexual life. Despite being an important event in her life, the taboos stretch to the extend of calling menstruating women impure, thereby excluding them from the various socio-cultural events of life.
Menstruation is also considered a hindrance to working women especially in the labour sector to such an extent that women are compelled to work without a womb. Yes, you read it right!One such misery that has come to light lately is that of the women sugarcane cutters from the Beed district of Maharashtra. Thousands of young women are forced to undergo Hysterectomy, a surgical procedure to remove their uterus.
SO, WHAT’S HAPPENING IN THE BEED DISTRICT OF MAHARASHTRA?
Sugarcane cutters are the backbone of the sugar industry of Maharashtra. According to the Economic Survey of Maharashtra (2019-2020), 36% of the sugarcane factories in India are situated in Maharashtra. Maharashtra ranks secondin the list of sugarcane producers of the country.
Beed is an administrative district in the Aurangabad division of Maharashtra that is situated in the Marathwada region encircling the states, Karnataka and Telangana. The Government of Maharashtra has proclaimed it as a drought-prone area in the country due to scarce rainfall, low-quality soil, and a decline in the groundwater index. Due to these extended situations and an increasing pile of debts sugarcane cutters who are mostly landless labourers migrate from one region to another. In the race of producing more and more, the workers are left exploited at the hands of their employers. Women cane cutters face the hardest repercussions.
WHY ARE WOMBLESS WOMEN PREFERRED FOR THE JOB?
Thousands of women along with their husbands migrate seasonally to these regions to work as Sugarcane cutters. This task is very meticulous and requires utmost punctuality. The couple enters into a contract with the contractors (Mukadams) who act as a link between the factory and the cane cutting workers. The traditional working hours are 12-13 hours long with women working additionally for their family doing domestic chores. Every couple is paid an advance of Rupees Fifty Thousand to One Lakh (Rs. 250-300 per day) seasonally. In case of any break in the work, they are liable to pay a fine of Rs. 500-1000 per day to him.
The Mukadams insist that the workers must achieve the production targets within the time frame. Menstruation and/or pregnancy is considered a major hurdle towards achieving the target. Contractors state that during periods women tend to ask for breaks which halts the work. So, the remedy to which women resort is removing their Uterus (Pishvi). The contractors do not directly compel these women to remove their wombs but the fear of attracting heavy fines and dismissal from their jobs pushes them to do the same.
The other reasons include lack of toilets. In Beed, open defecation is a major problem. Although there are toilets built under the Swatch Bharat Scheme, however, due to lack of water people often defecate outside. The difficulty in spending on sanitary products has also added to the trouble. Early marriage, repetitive pregnancies, and lack of awareness of women’s health issues also add to the torment. Moreover, the exhaustive nature of work in the sugarcane field makes the situation worse.The process of removal of the uterus is also hyped with a misbelief that the womb of a woman becomes futile once she has produced children.
THE PROCESS OF HYSTERECTOMY
Hysterectomy is a procedure to take off the uterus in case of complications like cancer, fibroids, endometriosis, uterine prolapse, excessive white discharge, or abnormal vaginal bleeding. It is to be resorted to only when medication fails.After a hysterectomy, a woman can no longer get periods and cannot conceive.
These women cane cutters commonly consult their doctors in case of any gynecological problem. Sooner or later, removal of their Pishvi (Wombs) is proposed to them as a lasting solution without informing them about the illeffects of the same. Since most of the time these procedures are conducted illegally, women hardly possess any medical reports or papers to show the history of their treatment.
According to reports, these women are easily convinced by the private hospitals to undergo unwanted hysterectomies so that they can work for extreme hours without any interruption. The doctors are liberal in recommending hysterectomies. There is a widespread violation of medical guidelines to which these uneducated women easily fall prey.
Down to Earth, a renounced magazine spoke to some women about the same. They informed that these doctors used several strategies to scare them. For instance: When a woman delivers a baby, her uterus naturally expands. However, the doctors use this as a tactic to scare them with cancer in the later juncture of their life.
Fresh figures from the year 2016-2019 claim that approximately 4,605 women are wombless in Maharashtra. The Civil Rights Organizations contend that the hysterectomy rate in Beed is 36 percent, 14 times more than any other state in the country.
A report by the investigating committee of social workers disclosed that there were lakhs of hysterectomies done for the past 25 years in the Beed district and 50 percent of these women were cane cutters between the age of 35-40 years. A small portion of women under 25 years have also undergone the same.
The cost of one hysterectomy is around Rs.60,000/- equivalent to what the couple earns for the whole year. It is seen as a one-time investment to enhance the level of outcome.The couple takes loans from the Mukadams to undergo this procedure and eventually land up in the vicious web of debts.
A CURSE TO LIVE WITH: IMPACT ON WOMEN
In an attempt to boost everyday productivity,the bodies of women are facing an irrevocable physiological and psychological danger. Forced hysterectomy is a clear violation of the women’s right to reproduction. Women often complain of backache and abdominal pain. They find it difficult to carry out their day-to-day work.There are chances of these women suffering from deadly diseases like cancer. They face hormonal imbalance, weight gain, mental health issues, and severe complications in their reproductive life.
In contrary to the 63 private hospitals there is only one government hospital in Beed. This expands the reliability of women on these unchecked private hospitals. These hospitals have insufficient medical means to conduct these procedures. There is a severe shortfall of counseling and after-care facilities. Hysterectomy is a tough procedure that requires expertise on the part of the medical team and adequate resources. Sometimes the doctors prescribe overmedication which can have terrible sideeffects on the woman’s body.
TALES OF WOMEN WITH NO WOMBS
1. “Six years ago, there was extreme pain in my lower abdomen and excessive bleeding from my vagina which caused a lot of problems at work. It was terrible during periods. I was scared my mukadam would deduct my salary. Therefore, I was advised by a doctor to get rid of my Pishvi (Uterus)!”recites Vandana, a cane cutter.
2. “I got my uterus removed when other women from my family also removed theirs. The doctor detached my ovaries and fallopian tubes along with my uterus. I face vision loss, pain in my joints, and loss of sexual appetite. I feellike I am a burden on my family!” says Mehrunisa, 27-year-old cane cutter.
3. “I was only 20 when I underwent a hysterectomy. I had white discharge so the doctor advised, me to do so. Now that I am 32, I face body aches and cannot lift anything heavy. I have to repay so many people. I need to work!” narrates Sheela Waghmare from the Ghodka Rajuri village.
4. “I have grown in the cane fields. Cane cutting is a tiring task and we women have to bear its impact. It affected my health with a lot of infections. I had to get my uterus removed to work smoothly!”says Sushila Pawar, an 55-year-old cane cutter.
INITIATIVES TAKEN TO DEAL WITH THIS MENACE
The media has played an essential role in bringing to light the pathetic and miserable conditions of women from Beed. In 2019, the National Commission for Women issued a notice to the Chief Secretary communicating its views on the same. Thereafter, an investigation committee consisting of gynecologists, social health workers, and female politicians was set up to look into the unprecedented rise in hysterectomies in the Beed district of Maharashtra.“The reality isfar different, as there is rarely any data of such cases!” says Abhijit More, a health activist.
The health department of Maharashtra issued an order to inspect all the private hospitals of Beed and also proposed the “Guptpane Dekhrekh Mission” (secret monitoring of hospitals). The circular warns doctors against characterizing all kinds of growth, tumors, or swelling of the uterus as cancer. All the hospitals have to submit necessary documents and reports to the health officials, only then permission for hysterectomy will be granted. The procedure will be conducted only on one of the days of the week. Non-compliance with the guidelines will attract serious legal actions, including cancellation of the registration of the hospital.
“Right now, all the hospitals are under our scanner. All the hysterectomies of the past especially of women below 35 years are being scrutinized!” says Astik Kumar Pandey, Beed’s collector.
There are also recommendations made concerning the registration of cane workers. The workers are also to be given free check-ups at primary health centers and sugar factories have to set up sub-committees for the worker’s needs. There are also suggestions that the families should be given rations. However, most of these regulations are yet to be completely implemented.
MAKAAM (Mahila Kisan Adhikaar Manch)and other civil society organizations have called for severe enforcement of the Maharashtra Clinical Establishment Act to prevent unwanted hysterectomies. They have demanded antenatal and prenatal care of women. Also, they have requested the execution of the Gopinath Munde Cane Cutters Social Security Scheme, 2018, prioritizing the rights of female cane cutters i.e.equal pay, better working conditions, and health care. They have also urged a strong need to pass the Clinical Establishment Bill for the regularization of private hospitals that conduct illegal hysterectomies.
THE WAY FORWARD
No doubt there have beenconstructive advancements since the time this issue has grabbed the attention of the media. Efforts have been made to keep a check on the unwanted happening of hysterectomies. The regulations passed by the government have led to a gradual decline in hysterectomy in the Beed district. However, many women are now proceeding to other districts to get their wombs removed, which means the problem still exists at the grass-root level. Also, the denial has a reverse effect on those women who need to undergo hysterectomy due to genuine reasons.
The following recommendations can be considered to effectively deal with the peril:
a. Doctors have to follow a standard protocol for the treatment of women before recommending a hysterectomy.
b. There has to be a strict regularization of hospitals performing hysterectomies. Legal actions have to be taken against hospitals and doctors engaging inillegal procedures.
c. Hospitals are to be well equipped with all the required resources.
d. Wholesome legislation dealing with the issue is the need of the hour. Government must step in to solve the problem.
e. Awareness campaigns have to be conducted to educate women and the entire community on menstrual and reproductive hygiene.
f. Regular health checkups should be provided to women before and after the cane cutting season. Their hemoglobin levels should be checked at least twice a year.They should be provided with health cards.
g. Primary health care workers could be recruited to extend medical backing to these women.
h. The medical records of women undergoing hysterectomies in required circumstances should be maintained by the state. Timely surveys to be conducted by the state.
i. There is a need to form a board under The Unorganized Workers Social Security Act, 2008 for these sugar cane cutters to address their issues.
j. All the sugarcane cutters have to be registered under state authorities.
k. The Sexual Harassment of Women at Workplace (Prevention, Prohibition, and Redressal) Act, 2013; The Minimum wages Act,1948; andThe Maternity Benefit Act, 1961 should be implemented here.
l. The burden of providing safe working environments and basic facilities to the workers should be a responsibility of the employers.
m. The Mahatma Gandhi National Rural Employment Guarantee Program was initiated to provide 100 days of assured work to migrant families every year. As per the scheme, at least half of those works must be provided to women. However, in many villages, this scheme does not exist. Thus, there is a need for proper implementation of the scheme for creating sustainable employment opportunities for seasonal migrants in these villages.
n. There is a need to solve the problem of sanitation. Families should be encouraged to build toilets. States should provide concessions in doing the same. As far as the migrants are concerned, four to five public toilets have to be established in every village.
o. The issue of water scarcity needs to be settled. Policies and strategies on water regimes must be constructed.
p. Lack of education amongst these workers keeps them encircled in the generational trap of poverty and abuse. It is thus essential that the Right to Education of these migrants should be recognized.
q. Women’s Rights Organizations should fearlessly approach the judiciary so that such sexist practices cease to exist.
r. Also, the Human Rights Due Diligence of the sugarcane supply chain is a significant step towards recognizing and decoding these issues. The sugar millsand food and beverage companies can come together and shoulder these values as per the United Nations GuidingPrinciples on Business and Human Rights. This way these workers won’t be pressurised to work intensively.
The working and living conditions of women in Beed are beyond imagination. On one hand, our country is experiencing the serendipity of the sugar industry, while on the other hand, the fate of these women cane cutters is heart-wrenching.Utopians are woven in the form of slogans like, “Health for all!”Meanwhile the poor live and die as great as they can.This brings in questions like: How can life be lived in this manner? What is our country heading towards? What is the future of our women? The answers to which remain unresolved.