Relevance: Mains: G.S paper I: Society and Social Issues: Women issues
Maharashtra’s drought-stricken district of Beed hit the headlines recently when reports emerged of an unusually high rate of hysterectomies among its women, especially those who migrate to nearby districts to cut sugar cane.
What is Hysterectomy?
Hysterectomy is the removal of the uterus and, in most cases, the cervix (neck of the uterus). When ovaries and tubes are also removed along with the uterus, the procedure is known as hysterectomy and bilateral salpingo–oophorectomy. Women who undergo hysterectomy face a multitude of physical and psychosocial problems both before and after the hysterectomy. The present study explores the
effects of hysterectomy on the quality of life of women in terms of its effect on the
social, familial, occupational and emotional aspects.
Many women, some of whom are just in their 20s, in Beed have undergone this life-altering procedure, which is otherwise prescribed only for a handful of medical conditions and often performed as a last resort.
Women with period pain, white discharges and foul smell, when they approached a doctor, were told that uterus was damaged and hysterectomy was the way out.
The drought-stricken Beed district in Maharashtra’s Marathwada region came under the scanner this May after reports came to light about the unusually high rate of hysterectomies among its women, especially among those who migrate to neighbouring districts to work as sugar-cane cutters.
State figures say that in three years (2016-2019), as many as 4,605 women have had their uterus removed in Maharashtra.
Civil rights organisations allege that the hysterectomy rate in Beed is 14 times more than that for the State or the country. In Umrad Jahagir village the number of ‘womb-less women’ now stands at 50.
Pushed into debt
Women in Survey reports conveys that the uterus-removal surgery has no doubt relieved from the menstrual cramps and vaginal discharge, but it has brought along back and joint pain. On many days, the pain is unbearable. It’s like, aging at a greater speed.
Scores of women in Beed offer a similar narrative. Shockingly, most don’t have medical reports or any papers to show the history of their treatment.
Their individual stories all follow a pattern. Women would commonly consult their doctors for health issues lasting up to a year, but then complain of recurrent infections.
Sooner or later, hysterectomy would be recommended to them as a permanent solution.
However, they were never told how the surgery could lead to hormonal imbalance, calcium deficiency and constant body ache, among other things.
In Beed, open defecation remains a ground reality. Many households do have built toilet blocks built under the government’s Swachh Bharat scheme but their members still defecate in the open due to lack of water.
For the women in the district, it is a vicious cycle as they have no sanitary facilities either at their workplace or at their homes. And the nature of work in a sugar-cane field has only worsened their situation.
An estimated 5-6 lakh people, including pregnant and lactating women, migrate from Beed to other parts of Maharashtra, and border areas of Karnataka, to work as sugar-cane cutters.
Hailing from a region that is perennially under a spell of drought and not having many avenues of employment, Beed residents continue to live in abject poverty and have to rely on sugar-cane cutting to make a living.
Traditionally, a couple is hired by a mukadam (contractor) as a single ‘unit’, known as ek koyta (one sickle). The contractor pays them uchal (a lump sum) in advance, ranging from ₹80,000 to ₹1.2 lakh, for a period of four to six months. The pairs migrate after Deepavali every year.
While a typical workday starts at around 6 a.m. for the couple, the woman gets up earlier, at 4 a.m., and cooks food for the entire family before she sets out. Children are left behind in temporary shanties near the sugar-cane farms as their parents toil under the sun.
Coaxed by contractors?
Following reports on the high number of hysterectomies performed in Beed, the Maharashtra administration launched an investigation on June 18.
Among the many aspects that the authorities are probing, one is whether the mukadams push women to undergo the procedure to ensure better returns. “There could be a nexus between profit-driven doctors and the mukadams.
A mukadam is a well-connected villager who reaches out to prospective labourers from the nearby areas. With frequent droughts and failing crops, many couples prefer to migrate for income generation, even if they have acres of farmland back home.
“The poverty is so ingrained that the advance taken by couples is exhausted very quickly. When they fail to cut sugar-cane worth the advance paid to them, we are left with no choice but to pursue them to return the remaining money,”states a mukadam from Beed’s Irla Dubba village.
Having been a mukadam for the past 15 years, he supplies up to 200 koyatas (couples) to sugar-cane factories every season.
While some labourers are gadiwale (couples with a pair of bullocks and a rented cart), some work as toliwale (groups that transport harvested sugar cane in trucks or tractors).
Some men are alcoholics and recovering money from them becomes a task. Some couples disappear midway.
But it is not always hunky-dory for the labourers, some of whom have been beaten up and even illegally detained in factories when they failed to cough up the money.
Let down by doctors?
Since news on the hysterectomies in Beed came to light, questions have been raised on the possible role of the medical fraternity in making women undergo the procedure. State data showed that 99 private hospitals in Beed district have carried out 4,605 hysterectomies since April 2016.
Eleven of these hospitals have carried out more than 100 hysterectomies in the three-year period.
‘Gross exploitation’
The top five in the list are: Pratibha Nursing Home (277); Tidke Hospital (196); Shree Bhagwan Hospital (193); Gholve Hospital (186); and Veer Hospital (179). In comparison, 2,000-odd hysterectomies have been performed in the public sector in the same period in Beed.
“Instead of getting rational treatment in public health-care facilities, the women are pushed towards irrational treatments in the private sector,” says Abhay Shukla, national co-convenor of the Jan Swasthya Abhiyan.
“It’s nothing but gross exploitation of vulnerabilities of women and a failure of the state,” he says.
Activists also rule that the official count could be under-reported as the state banks on these same hospitals to furnish the figures.
Local doctors, however, feel the criticism is uncalled for and insist that for most of the women who underwent the surgery, their health warranted it.
Poor hygiene
These women live in conditions of extremely poor hygiene. They don’t have access to toilets.
They can’t afford sanitary pads. Open defecation is rampant in their villages as near the sugar-cane farms where they work.
The core issues are poverty, illiteracy, lack of sanitation and access to water. Doctors are being made scapegoats in this issue, which is largely a socio-economic one and requires a larger solution.
The National Family Health Survey data show that the rate of hysterectomies in Maharashtra is 2.6%, while the national average is 3.2%. But when it comes to Beed, a 2018 survey of 200 women by Maharashtra State Commission for Women revealed the extent of the problem as around 36% were found to have had undergone hysterectomies.
According to Beed’s civil surgeon Ashok Thorat, there is an absence of enough data to carry out comparisons with other districts in Maharashtra. “Our primary investigations have shown that the prevalence of hysterectomies is 17 per 1,000 women in Beed. In some parts of Andhra Pradesh, Telangana and other States, the prevalence is about 50 to 60 per 1,000 women,” says Thorat, adding that a detailed survey is under way to get to the root cause.
In fact, a circular dated April 16, has made it compulsory for private gynaecologists in Beed to seek permission from a civil surgeon for every hysterectomy procedure barring emergency procedures, which have to be reported within a span of 24 hours.
The circular warns doctors against portraying all kinds of tumours, growths and swelling on uterus as cancers.
The number of hysterectomies has gone down by 50% since we implemented the SOP [Standard Operating Procedure]. Right now, all the hospitals are under our scanner. All hysterectomies in the past, especially of women who are under 35, are being scrutinised.
Activists say that the menace of unwarranted hysterectomies affects not just sugar-cane cutters but women in general.
“Early marriages and child birth, fear of cancer and the loss of wages during menstruation have all culminated in the high rate of hysterectomies.
The government has no clue about the ground reality as it has never maintained any data,” says health activist Abhijit More who terms Beed’s situation as a blatant violation of rights of women living in the district, who are uneducated and therefore ill-equipped to make the right health choices.