Hysterectomies are being carried out in rural communities in India at an unprecedented rate, reports Devyani Nighoskar in Al Jazeera. The medical definition of a hysterectomy is the surgical removal of the uterus (womb) but can sometimes lead to the removal of the ovaries, cervix or fallopian tubes. The procedure is often advised in the latter stages of a woman’s life because it can come with health risks if performed too young or without proper medical consultation. A 2018 Indian government survey found “more than 22,000 Indian women aged 15 to 49 out of 700,000 surveyed—3 per cent—had undergone a hysterectomy.” What is most worrying about this statistic is the age range. In one village, in rural Rajasthan, village leaders told a BBC reporter that about 90% of the women in the village had had the operation, “including many in their 20s and 30s.” The National Women’s Health Network states that in the U.S. “approximately 600,000 hysterectomies are performed annually in the United States,” so it is relatively common practice, but usually the last resort. Therefore, why does there appear to be a steady increase in the number of hysterectomies carried out in rural Indian communities?

Many have argued, that in rural areas women have a lack of access to proper medical advice around menstruation and are often restricted to manual labour on farms, such as cane-cutting, that are controlled by corrupt contractors who place a huge strain on these women’s bodies. For these vulnerable women, a hysterectomy is seen as an easy way to counter the supposed negative effects that menstruation has on work productivity whereas, in actuality, a rise in the procedure is more a reflection of exploitative and laborious working conditions imposed by patriarchal contractors, than anything to do with an individual’s working efficiency. For women in the rural areas of the Beed district, in the Indian state of Maharashtra, more than 4500 women “have had potentially unnecessary hysterectomies over the past 3 years.” This number is already 20% of the 22,000 women interviewed in the official government survey; therefore, women in rural areas are more than likely constituting a large proportion to the national average, which is something that cannot be ignored.

Bajinder Maan, a labour rights lawyer in Delhi, told Al Jazeera that women could appeal to the labour laws, regarding contractors showing bias toward women who have had a hysterectomy; however, it would be “challenging” for women to prove it within such informal lines of work. Bharath Bhushan, founder of Centre for Action Research and People’s Development (CARPED), reinforces the idea that the rise in unnecessary hysterectomies is a reflection of the lower socio-economic status of rural working women—“it has to be recognized as a cause of indebtedness and bonded labour.”

Unfortunately, this has been a known problem for over a decade with Jill McGivering publishing a report on the issue in 2013 from her work with rural communities in rural Rajasthan. Clearly, if this problem persists six years on, then solutions have been slow to take effect and rural women still do not have access to education or resources to help them properly understand their bodies. The sad fact is that currently in Beed a 12 pack of sanitary pads costs 100 rupees, which is half the daily wage of 202 rupees that women earn from farm work. Solutions are being put in place by local governments and third parties to counter the negative perception of menstruation, such as Menstrupedia and Girls Glory, but the geographical size of India means it is difficult to ensure total coverage of educational campaigns. Nonetheless, these campaigns are the most effective in giving these women the power and resources to take control of their bodies and workers rights. Therefore, I believe the long-lasting change could be guaranteed if district farmers’ unions were formed and if these unions then cooperated with educational campaigns and NGOs. Vulnerable women would then have protection and support from multiple platforms and organisation but, most importantly, it would connect rural communities to one another so that women know they are not alone in their experiences.

Al Jazeera, BBC, Reuters, activists and the rural women themselves all mention two major factors that increase susceptibility to unnecessary hysterectomies: exploitation by opportunistic doctors and a false perception that menstruation hinders work. I do not want to discredit all doctors; rather, highlight how certain doctors perform hysterectomies to turn a quick profit without proper consultation with women and partners. Subha Sri, the head of Commonhealth (a Chennai-based coalition of health charities), said that some procedures—in reference to cases in southern Karnataka state— were being “arbitrarily” done by doctors and they were “not treating women for what they had come for.” This factor is worsened by a perception held by contractors, families and doctors that menstruation is a burden, whereas this problem stems from a lack of adequate education, resources and a cultural misconception of menstruation in general. Roli Srivastava, writing in Reuters in May 2019, states that doctors often cash in on “ignorance,” making matters much worse for susceptible individuals, who often attend consultations with partners or family members who greatly influence these women’s decision. Another issue that makes the situation worse for rural women is the contract work on farms. The contractors pay them in advance for a stint of work, so they are then obliged to carry out work without question. This rigid structuring of work puts these women in a difficult position because this type of employment is often the only work that is available, and they need it to provide for families. Therefore, they are trapped in a toxic work environment, where they feel the need to have invasive surgery to continue work. No single factor is causing women to have unnecessary hysterectomies, but when family and work pressures allow women to be exploited or fed misinformation, then it is a problem that needs to be swiftly addressed.

Ultimately, women should be entitled to do what they want with their bodies, but this should come from a position of understanding regarding menstruation and from a dialogue with others about the best course of action, especially in regards to life-changing procedures such as a hysterectomy. To reiterate my previous point, education and solidarity provide marginalized women, in rural communities, the chance to formulate an informed opinion about their bodies and their individual rights. However, larger actions must be taken to deconstruct patriarchal misunderstandings of menstruation, particularly among employers, doctors and politicians if we are to see sustained change within India. Actions are being taken to quell this problem but at a slower rate than one would hope; fortunately, many women in these rural communities know the importance of education and are calling for people to help. A 40-year-old cane-cutter Dwarka Sandeepan, speaking to Al Jazeera, is matter of fact about it all, “we need more employment schemes for women,” she said. “Education is a must, too. How else will we know of our rights?”