On a typical day, Jayashree Ohwal works for 12 to 18 hours, tying sugarcane stalks into bundles, carrying them from the fields, and loading them onto tractors stationed nearby. It was while ferrying these bundles in 2017 that Jayashree first noticed her menstrual flow becoming unusually painful and heavy. “I used to always stain my saree during periods. It was so embarrassing to walk with stains. I cramped so severely,” she told the International Institute for Environment and Development. When the pain became unbearable, Jayashree visited a gynecologist who asked her to stop lifting the heavy cane bundles weighing as much as 40 to 50 kilograms each. But with cane cutting as the family’s only source of income, stopping wasn’t an option. So when the doctor suggested a hysterectomy, Jayashree agreed. Getting rid of the ‘problem’ of menstruation, she reasoned, was the only way to keep earning a livelihood for her family. As an informal farm worker, she knew that missing even a single day’s work would cost her the day’s wages and leave her saddled with fines.

Jayashree’s experience is not an exception. Thousands of female cane cutters in India’s largest sugar producing state of Maharashtra are resorting to medically unnecessary hysterectomies in order to permanently stop their periods and keep working. They are being pushed towards these surgeries by the cumulative impacts of Maharashtra’s exploitative sugarcane industry and climate change-linked agricultural disruptions, the International Institute of Environment and Development (IIED) wrote in a report published this March. The epicenter of this unexpected health crisis is the district of Beed, which is home to much of Maharashtra’s migrant sugarcane-cutting population. Compared with a national average of 3.2 percent, more than 55 percent of women in Beed’s sugarcane fields have undergone this procedure.

Historically drought prone, the impacts of climate change in Beed have been particularly devastating. The district has seen the frequency of severe rainfall deficits nearly double over the past decade, impacting the most vulnerable of its residents. Between 2011 and 2022, the district experienced one drought every three years, resulting in repeated crop failures, diminished farm incomes and growing indebtedness to moneylenders. For the district’s farming households, especially those that are socioeconomically marginalized, migration is increasingly seen as the only viable option to earn a livelihood. Most of these migrants seek work as sugarcane cutters in the same or adjoining districts, where their already dire circumstances are worsened by informal and extractive labor contracts and grueling working conditions.

During the harvest season that lasts between October and March, entire families, including women and children, migrate to sugarcane farms in search of work. Workers are hired in pairs — usually husband-and-wife teams — by local labor contractors, known as mukkadams, on behalf of sugar mills. There are no formal contracts. Instead, contractors give workers an advance payment at the time of hiring, which is adjusted against future wages.

The system is ripe for exploitative working conditions. Contractors decide workers’ wages at the end of each harvest season and have the power to make unexplained wage adjustments. “The pay structure of cane cutters is usually based on how much sugarcane they cut and load on a daily basis. That means a missed workday or not being able to work at full capacity results in lost wages and fines”, said Ritu Bharadwaj, lead author of the IIED report. Wage deductions can range from Rs 500 (US$6) to Rs 1,000 (US$12) for a one day absence, which is twice what a husband-and-wife pair of cane cutters earn from working 12 to 16 hours a day, she added. In the absence of formal contracts, workers have little bargaining power. The only way they can avoid wage deductions is by showing up every day and working without taking breaks.

Wage cuts also delay the repayment of the advances that workers receive from contractors upon hire and many workers report outstanding dues at the end of each harvest season. This forces them to return to the sugarcane fields year after year in the hope of paying off their debts.

For women, these conditions pit their livelihood against their health, especially their reproductive health. Many women work through their pregnancies, giving birth in the fields without any medical care, and returning to work one or two weeks later. With no medical health facilities in the vicinity of worksites, those with menstruation-related complications put off doctor visits till the problem turns severe.

Worksites in and around sugarcane fields lack basic sanitation facilities such as running water and toilets, making it difficult for women and girls to maintain personal and menstrual hygiene. As in most parts of rural India, menstrual hygiene products such as tampons and sanitary pads are expensive and difficult to find, forcing women to resort to unsanitary cloth. A 2020 survey conducted by the Mahila Kisan Adhikaar Manch (MAKAAM), a forum advocating for the rights of women farmers, found that 83 percent of women cane cutters in Maharashtra used cloth during their periods. “We use chumbal (a cloth kept on the head on which the cane bundles are carried) during periods. Chumbal is an unclean cloth. As sugarcane bundles are kept on it, it gets all the pesticides and chemicals stuck on it,” Jayashree told IIED researchers. Others tear off a piece of cloth from their petticoats (a garment worn below a saree) to make themselves a pad. In the absence of running water, women often go two to three days without changing their menstrual cloth. That leaves migrant female cane cutters at heightened risk of vaginal and uterine infections.

Especially in private hospitals, medical practitioners have been known to exploit workers’ fears of infections and cancer and recommend hysterectomies even when they are not medically necessary, the IIED report stated. “Women agree to these surgeries to avoid the loss of wages and also because of poor awareness of the long-term consequences,” said Dr Sudhir Deshmukh, professor at the Swami Ramanand Teerth Rural Government Medical College in Beed.

In the immediate aftermath, women report experiencing physical discomfort, mental anguish, sleeping difficulties, and musculoskeletal pain. Longer-term impacts include osteoporosis, vaginal prolapse, backaches, chronic leg pain, lower abdominal pain, loss of appetite, insomnia, depression, breathing difficulties, and menopause symptoms, according to data from Maharashtra’s public health department. . The end result is a decline in women’s quality of life, contradicting the very rationale for which hysterectomies are sought. “Women have to be made aware that this surgery won’t address their pain, but poverty and illiteracy are big impediments in spreading this awareness,” Dr Deshmukh pointed out.

The IIED study also found that over 30 percent of migrant women cane cutters from Beed who got a hysterectomy did so between the ages of 26 and 30. Over 4 percent were under the age of 25. “This is a disturbing statistic, as it implies major surgery with lifelong consequences being performed on women who are quite possibly in their early reproductive years,” the authors pointed out. While hysterectomies are not directly imposed on women by labor contractors and the sugarcane industry, the conditions they create by cutting wages for missed work and imposing fines, indirectly push them towards this drastic decision. In most cases, contractors also provide loans for the surgery, plunging women into even greater debt.

Instances of medically unnecessary hysterectomies among Beed’s female sugarcane workers first came to public attention in 2019, when the news publication Hindu Business Line reported that 50 percent of women in Beed district’s Vanjarwadi village had undergone such surgeries. The report triggered a government-led investigation that surveyed thousands of women cane cutters but led to no concrete outcomes or policy changes. Since then, MAKAAM has been pushing for women cane cutters to be registered. “The lack of registration means they are not recognized as rights-bearing workers for whom policies and programs need to be formulated,” said Manisha Tokle, a state coordination committee member of the coalition. “Till that happens, women will remain camouflaged as ‘partners’ in the cane cutting task,” she added.

Already, climate change is pushing women into precarious and exploitative working conditions, with wide-ranging impacts on their health. If women continue to be made invisible in the agricultural workforce, and the gender-specific impacts that climate migrants face remain unaddressed, more and more women like Jayashree will be pushed into increasingly precarious livelihoods that put their health and well-being at ever greater risk.

Photo Credit: A group of cane cutters in India/ Photo by ILO_ Vijay Kutty_Flickr.jpg