Photograph by Bryan Lever / Getty Images
WORDS BY RUCHI KUMAR
In early 2021, Bhanubai Madhulkar Shinde went to a local clinic in her village in Beed, a small district in western India, with complaints of heavy menstrual bleeding. “There was lots of pain during the monthly cycle. It was extremely painful, and [I] would bleed heavily for days,” she said.
After an initial diagnosis, Shinde—only 32 at the time—was informed her uterus was “damaged” and that she might need to undergo a hysterectomy to resolve her ailment. Medical professionals warned her family that forgoing the surgery could prove lethal. “They told us that if she didn’t remove her uterus now, she would catch cancer,” said her husband, Madhulkar Shinde.
As Shinde mulled over the life-altering decision, the nurses at the clinic argued that the operation would not only “cure” her pains, but also release her from the “monthly problem” women face, allowing her to work longer hours in the fields alongside her husband.
“They told me, You already have two children. What do you need your uterus for now?” Shinde recalled. Although she wanted more kids, Shinde consented to the surgery because she feared death.
Shinde is among the thousands of women farm workers in Maharashtra, a drought-prone agrarian state, who over the past decade were persuaded into undergoing hysterectomies after receiving questionable advice from medical professionals, family members, and even employers.
Surveys commissioned by local NGOs in 2018 and confirmed by a government committee investigation in 2019 found that the rate of hysterectomies among women from Beed was 36%—14 times higher than the national average of 3%.
Atmos interviewed nearly three dozen women from across five villages in Beed who had their uteruses removed in the last decade. In one of the villages, every family interviewed had at least two women who had a hysterectomy in the last five years. In most Beed towns and villages it was one woman per household.
The women interviewed had approached doctors for various gynecological ailments ranging from uterine cysts and irregular periods to urinary tract infections, among other issues. All were advised the surgery as a one-stop solution to their problems.
While many women no longer had their medical documents, Atmos was able to verify several of their medical histories leading to the surgeries. For instance, the official diagnosis on Shinde’s “operation card” issued during her treatment showed she had a uterine cyst. But nearly every one of the women interviewed said they were told that they could “catch cancer” if they didn’t remove their uteruses.
The motive? The women are being exploited for labor.
The region is known for sugarcane production—a physically demanding business. Workers toil for hours in the outdoors heaving heavy bundles of crops. Menstruation and pregnancies make work more challenging and at times impossible, so the contractors who supply farm owners with laborers encourage hysterectomies, offer loans to pay for them, bury these women in debt, and then force them to work to pay it off. Medical doctors, who think these women can’t afford prolonged medical care, do the same to secure that substantial payment. Now, as the demand for sugar rises and climate change makes those working conditions even more extreme, these malicious labor practices could become even more widespread.
India has long been one of the largest sugar producers in the world, often sharing the top space with Brazil, and Maharashtra is one of its biggest sugar-producing regions. As one of the largest sugar consumers, about 90% of the produce is used domestically. However, a significant portion—nearly 4 million metric tons per year—is exported, with United States companies among the top clients.
Each year, about 1.5 million migrant workers come to sugarcane-producing regions in Maharashtra seeking work. However, a lack of protection mechanisms has allowed exploitative labor practices to run rampant. Those concerns were formally confirmed by a 2019 report from a government-appointed committee in Maharashtra.
The committee investigated the claims that women were being forced or coerced into getting hysterectomies, often under false medical pretexts. They found over 13,500 cases of hysterectomies conducted in the last decade among 80,000 women surveyed. Activists believe the actual numbers could be significantly higher.
Sugarcane harvesting can be a labor-intensive job, especially for women who are required to gather together and lift large stacks of cane and load them onto the trucks and tractors, explained Trupti Malti, a researcher and social activist at Makaam Network, an NGO working on labor rights in the region.
“On any given day, these women make bundles of sugarcane, weighing up to 50 kilograms at a time, carry them on their heads, and climb up the stairs to load them onto a truck,” she said. “It puts severe pressure on their bodies, and it isn’t unusual for them to suffer from aches and pains.”
The migrant nature of the work adds to their woes. India’s sugarcane workers typically travel hundreds of miles for work. “This is a community that travels across the region for labor-heavy work. It is important for them to remain fit,” added Dr. Abhijeet More, a medical doctor and health activist from Maharashtra who has been advocating for better rights for migrant laborers in the state. “If someone falls sick, gets… cancer, then that family loses a working hand. Their income is lost.” It’s no surprise, More added, that women seeking reprieve from chronic ailments can be easily coerced or intimidated into consenting to these surgeries.
“Women are expected to work even when pregnant,” Malti said. “They are not provided with food or housing or any health or hygiene facilities. They carry food rations with them when they migrate for work, and live in tents in very unhygienic conditions. Much of the money they receive is spent on survival during this period.
“For most men, they get drunk at the end of the work day and pass out—alcoholism is another problem—but for women, they have to not only care for the family and children, but do so without access to proper hygiene, toilets, or even water,” said Bhau Ahir, a social worker who works on health care research. “Menstrual management is a challenge, as most women use unwashed pieces of cloth that can cause infections and other diseases that result in diseases and pain.”
“Not only do we suffer the pain and indignities, but our lives, our bodies don’t matter to anyone. We are simply a way to make money for them.”
Shinde confirmed, adding that frequent ailments and even regular menstruations were more than just about physical discomfort; they cost women working days. Missing or incomplete days of work can result in docking of payment, which is paid in advance and the family is expected to work off the debt on the fields.
“We are expected to work for 14 hours, even when we are sick, and even on our monthly periods,” Shinde shared.
All this is for meager compensation: A couple receives a lump sum of just 100,000 to 150,000 rupees (about $1,200 to $1,600) for the entire harvesting season, which lasts for four months from December to March.
Worst of all, Malti said, is that women in these communities “don’t have much agency over their bodies” and are rarely the decision-makers.
“It is their husbands or even the in-laws who depend on her for this income,” she said, adding that the demands of the sugarcane industry factor heavily in a decision on the reproductive rights of the sugarcane farm laborers.
Harvesting sugarcane becomes more demanding as temperatures rise and global precipitation patterns shift. This region of Maharashtra is known for droughts, which reduce sugarcane productivity. The area is also prone to extreme heat. As sugarcane grows less abundantly—and what remains becomes more physically taxing to harvest—exploitative labor practices are likely to proliferate.
“Droughts are becoming more and more intense and prolonged, and for countries like India and Bangladesh with large agrarian societies, it is upending farming and production,” said Dr. Shouro Dasgupta, an environmental economist at Università Ca’ Foscari Venezia in Italy who studies the link between climate change and labor in South Asia.
Yet, despite the droughts, sugar production over the years has largely remained unchanged, if not increased. Indian sugar production from 2023 to 2024 reached 34 million metric tons—even though 2023 marked the country’s driest August in more than a century. What scarce water India got was earmarked for irrigation over public consumption. Why? Because sugar translates to profits.
Putting profits over people, even during dangerous droughts and heat, has exposed farmworkers to an array of exploitative practices. In a recent paper on the subject, Dasgupta documented a 25% decline in high-exposure labor such as agriculture and construction due to increasing heat. “Outdoor workers, particularly agricultural workers, are increasingly complaining of symptoms such as heat rashes, heat cramps, dehydration, weakness, reduced cognitive functions, and dizziness,” Dasgupta said. “In the worst-case scenario, they can develop cardiovascular and respiratory issues as well.” In 2022, Maharashtra saw nearly 800 cases of heat-related illnesses and 18 deaths caused by heat stroke.
“Women are not only more vulnerable due to heat stress at work, which puts their physical and mental health at a higher risk compared to men, but also to exploitation. Workers’ rights need to be looked at with the climate lens.”
“This further reduces their productivity and the number of hours they can work, which leaves them vulnerable to exploitation from employers,” Dasgupta added. “For women, the numbers and risks are higher. Women are not only more vulnerable due to heat stress at work, which puts their physical and mental health at a higher risk compared to men, but also to exploitation. Workers’ rights need to be looked at with the climate lens.” Indeed, a study published in 2021 suggested climate change increases the risk of forced labor and modern slavery around the world.
In India, that could mean more women being tricked into hysterectomies and forced into debt bondage against their will.
Families in which women have already had children are often convinced that the uterus is a vestigial organ that can be disposed of. That’s far from the case, said Dr. Ganesh Tondge, head of the gynecology department at the Civil Hospital in Ambajogai. “It serves a larger function than just childbirth, and removing it triggers surgical menopause, which can reduce the overall life expectancy of the woman,” he said.
“When ovaries don’t have a target organ, the estrogen production in the body is reduced, and the woman will start to age sooner,” Tondge explained. He said doctors at public hospitals strongly advise against hysterectomies for women under 40.
Women who undergo hysterectomies are also advised hormone replacement therapies, Tondge said. However, few actually receive such aftercare.
Tondge’s hospital came under fire when activists raised concerns over the high number of hysterectomies in the district. Since recommendations were issued in the 2019 committee report, however, “guidelines have been established that make it compulsory for even private clinics to seek approvals from the public hospitals before conducting any hysterectomies in the state,” Tondge said.
While the move significantly reduced the number of surgeries in the last year, “it isn’t fully implemented,” Tongde admits, leaving gaps for continued exploitation, often by smaller private clinics where hysterectomies remain unregulated.
“There are rudimentary legal frameworks in place to monitor and improve the quality of services, but they are neglected,” said Dr. More from Maharashtra. Instead, women in the region remain exposed to bodily exploitation because of a deeply entrenched patriarchal culture, minimal regulations, and the privatization of medical services.
“We are seeing an increase in commercialization in the sector with doctors advising irrational surgeries, unnecessary prescriptions, and even medical diagnostic investigations to increase their income,” More said.
Such predatory medical practices were evident in the recent case of Shailaja Gandhle, a female sugar worker who woke up one winter night three years ago with searing pain in her abdomen. It was harvest season, and Gandhle’s family was working and living in a makeshift settlement of huts in a sugarcane field. Her aching screams carried across the farm and woke families of laborers living nearby.
“I tried to help her, but she was in so much pain, and we could not take her to the clinic,” which was 20 kilometers away, said Usha Balasaheb Awhad, another female farm worker who was with Gandhle that night. “She was crying in so much pain… all night… in the morning, we loaded her on one of the tractors and drove to Ambajogai.”
Gandhle received a sonograph from a private clinic in the town, and was informed that she had a tumor in her uterus. As was the case with countless other women, Gandhle was advised to get a hysterectomy. Like most farm workers in Maharashtra, Gandhle’s family borrowed money for the emergency procedure. However, the surgery didn’t go as planned.
“The private clinic discharged her, but even 24 hours after the surgery, she wouldn’t stop bleeding,” Awhad said.
“If a person falls and hurts themselves in a plane, they can sue the airline and get paid, but we lost an organ because doctors don’t care about us. So why shouldn’t we be compensated for that too?”
Gandhle was eventually brought to the Ambajogai Hospital—a government facility—where she underwent another surgery to save her life. “The surgeons [at the public hospital] said the first surgery had severely infected my organs and that I could have died,” she said.
The entire treatment cost the family 40,000 rupees ($459), about half of what they made that harvest season. The experience has left her bitter and distrustful toward the medical system that exploited her. “Not only do we suffer the pain and indignities, but our lives, our bodies don’t matter to anyone,” Gandhle said. “We are simply a way to make money for them.”
Atmos approached three private clinics in the districts where Gandhle and other women had undergone hysterectomies, but was turned away by their proprietors. Although Gandhle hasn’t pursued a legal case against the clinic that botched her surgery, she has joined the small but expanding movement of female laborers in Beed to demand government compensation for her loss.
“If a person falls and hurts themselves in a plane, they can sue the airline and get paid, but we lost an organ because doctors don’t care about us,” said Awhad, who is also part of the movement. “So why shouldn’t we be compensated for that too?”
Malti suggests a more radical approach—one that not only provides reparations for medical harm but prevents it from happening in the first place. She said the sugar production system is “inhumane,” and in its place, she proposed that the government provide work to farmworkers through alternative avenues of employment.
Put simply, Malti said, “This kind of work needs to be entirely eradicated.”
This reporting was supported by the International Women’s Media Foundation’s Howard G. Buffett Fund for Women Journalists.
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The Forced Sterilization of India’s Sugarcane Farmworkers
