Wages or the Womb? The Cruel Dilemma the System Has Forced upon Sugarcane-Cutting Women…

This is not a problem of Marathwada alone; it is a problem of the whole country. According to the National Family Health Survey (NFHS-5), about three percent of women aged fifteen to forty-nine in the country have had their wombs removed. But the picture differs greatly from state to state. The proportion is about nine percent in Andhra Pradesh and about eight percent in Telangana, whereas in the north-eastern states it is around one percent. It is no coincidence that the proportion appears higher in regions with migrant labour such as sugarcane cutting and a network of private health services. About seventy percent of the women in the survey who had their wombs removed had the surgery in private hospitals. There are also allegations that unnecessary surgeries are performed to claim money from government health insurance schemes. Dr. Narendra Gupta filed a public interest petition in the Supreme Court alleging that such practices had occurred in Bihar, Rajasthan and Chhattisgarh. In 2023, the court directed all states to implement the Central government’s guidelines within three months. Under these guidelines, every district is to have a monitoring committee; private and government hospitals are to submit a list of women who have had their wombs removed every month; the reasons for surgeries on women under forty are to be recorded; and alternative treatments are to be suggested first. In Karnataka too, in 2015, a case came to light in which the wombs of about 2,200 women from marginalised communities had been removed, and four hospitals were involved.

A comparison noted by the court gives pause for thought. In developed countries, hysterectomy is usually performed on women nearing menopause, that is, those above forty-five. In India, however, studies show that it has risen even among young women aged twenty-eight to thirty-six. In the medical world, this surgery is considered a last resort. The accepted norm is that it should be considered only after medicines, hormonal treatment or less invasive methods have failed. Here, though, it is being used as a “quick fix” for financial hardship. Unless we understand that this is not a problem of health but of labour exploitation, we will not find the answer.

The subject has also drawn attention at the international level. The story of the surgeries on sugarcane-cutting women in Beed was presented to the world by media such as Britain’s The Guardian, and a social media post by a French outlet based on it was viewed by several crore people. Climate Home News travelled through the sugarcane belts of Maharashtra and Uttar Pradesh to report on the condition of these women, highlighting the link between this migration and climate change, erratic rainfall and drought. Farming stands idle for eight to nine months and there is no alternative employment, so families turn to cane cutting. When temperatures rise by six or seven degrees, the health of a woman wielding a sickle for ten to twelve hours in the sun is endangered even further. A 2020 study by researchers at Symbiosis University in Pune concluded that the living and working conditions of these women violate basic human rights. India has signed the United Nations convention on the elimination of all forms of discrimination against women, CEDAW. Under it, the state is obliged to ensure that women get safe working conditions and healthcare. The International Labour Organization’s concept of decent work also includes a safe environment, fair remuneration and non-discriminatory treatment. How the sugarcane fields measure up against these tests is a question that could embarrass India, a sugar exporter, even in the global market. Today, consumers and investors around the world have begun to scrutinise the ethics of labour in supply chains. This pressure is visible from cocoa plantations to garment factories. It could come to bear on Indian sugar as well.

So what is the solution? The first thing is to stop viewing this problem as “women’s wrong decision”. The woman who makes the decision is under pressure imposed by the system. Responsibility therefore falls on the factories, the mukadams, the private hospitals and the government. The demand to bring sugarcane cutting under a separate law and to make a written agreement between factory owners, mukadams and workers mandatory is an old one. It has been raised in the Legislative Council too. The agreement must guarantee relief during menstruation, sick leave and maternity leave, minimum wages, interest-free advances and safe housing. The government has hinted at considering a separate compensation scheme so that women do not lose their earnings. If it is actually implemented, there will be no reason left to remove the womb in order to save wages on period days. That would strike at the root of the problem.

The second thing is vigilance and accountability in the health system. We must check whether the district-level monitoring committees mentioned by the Supreme Court are actually working rather than existing only on paper. The medical reason for every surgery on a woman under forty, and the name of the doctor who advised it, should be recorded. Private hospitals should be audited for such surgeries, and claims under insurance schemes should be examined. In the hospitals where the 107 Jalna surgeries took place, it must be investigated whether every patient was told about alternative treatments before surgery, whether written consent was taken, and whether the consent was truly understood. At the village level, ASHA workers and health workers should be made responsible for following up with women during the cane-cutting migration. Just like seasonal hostels, providing mobile health teams, toilets, water and free sanitary pads in the fields is not expensive; it can be done quickly and at low cost. Some women workers have themselves become health ambassadors and guided fellow women in experiments of this kind. Such experiments should be expanded.

The third thing is awareness and education. The misconception that surgery is the final answer to period troubles must be dispelled. Women must be told, in their own language and by people they trust, that medication and less invasive options exist for period pain, heavy bleeding or fibroids. We must also break the chain in which girls’ education stops once their periods begin and they are married early. If education and alternative employment are available, the next generation will not inherit the sickle and the advance as a legacy of debt.

Finally, this question is a moral test of our society. We use sugar in our tea, in our sweets and in the sweetness of our festivals. If the price of that sugar is being paid by a woman’s body, can we stomach that sweetness? The story of the 107 women of Jalna asks us this question again. In 2019, some steps were taken in response to the call that came from Beed, but they proved inadequate. Now the same warning has come once more. This time, concrete and concerted work is needed at four levels together: investigation, law, compensation and basic facilities in the fields. Menstruation is a natural process of the body. The minimum that any civilised society must ensure is that no one loses her livelihood because of it, and that no one is forced to cut her own body out of fear of it.