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Wombless Women: The Rise Of Unnecessary Hysterectomy, The Cost Of Working In The Informal Economy – IMPRI Impact And Policy Research Institute

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Wombless women: the rise of unnecessary hysterectomy and the cost of working in the informal economy

Policy Update
Khushboo Dandona

Background

Half of the population consists of women. Traditionally, there is an opposite binary between nature and culture. Women are associated with nature and men with culture. Women’s bodies are seen as leaky and unproductive, like nature. Women are excluded from the workforce as their bodies are considered leaky, weak, and unproductive. Women were barred from certain occupations, such as painting, and were excluded from access to training and qualifications, such as medicine. During the second wave of feminism, there was much emphasis on women’s employment rights and the barriers women faced in the employment sphere. Over time, women began to participate in male-dominated occupations.

However, they remain underrepresented and underpaid. To overcome this, the government launches various schemes, policies, and laws to increase women’s participation in the workforce. This has a very limited impact. According to the Periodic Labour Force Survey (2023-2024), the female labour force participation rate stands at 41.7%, a positive trend over the last six years. Despite this, organisations are still gendered in nature. The masculine qualities are considered appropriate for bureaucratic hierarchies. While the feminine qualities are considered less appropriate in relation to it.

According to Gottfried, bureaucratic organisations validate men over women. For women, their bodily autonomy and biological essentialism assume more importance compared to their qualifications. Women are seen as sexualised beings due to that remains excluded from power or are only allowed in roles like receptionist or assistant, etc. These give roles are more about appearance and not power or decision-making. So even if they present, they are seen as decorative positions. This shows that organizations only call them gender neutral, while in reality, they recognize the socially situated practices in which gender is constructed. There is also an overwhelming use of gendered cultural assumptions in the hiring or recruiting process.

Even today, women’s worth is reduced to their bodies. Their social value is associated with how they look, perceive themselves. Bodies and their reproductive capabilities are used to maintain social control over women. The medicalization of infertility and menstruation made women subject to medical diagnosis and intervention. While medicalization offers women choice and options, however, medicalization is still constrained by the power. Research has shown that in most workplaces, people believe that women behave irrationally during PMS. They are considered unreliable workers and unstable during that time of the month. Thus, menstruation is a factor that contributes to the control of women by men.

This control over women’s bodies extends to medical interventions like hysterectomy (removal of the womb). In recent years, the rise of hysterectomy has become a major concern. According to the National Family Health Survey (NFHS-5) 2019-21, 3.3 percent of women in the 15-49 age group underwent hysterectomy.

The median age was 34.6 years. However, a survey conducted by the local NGOs in 2019 found that the rate of hysterectomies among women from Maharashtra’s sugarcane workers, Beed district, was 36% as compared to the national average of 3%. The most astonishing fact is that most of the surgeries are done on women under the age of 25. In this paper, I will discuss the rise of unnecessary hysterectomies and the politics around it.

The alarming rise of hysterectomy

The sudden rise of hysterectomy raises several pivotal questions, such as who are the women undergoing these surgeries? Why do they do that? What is their background?

The major reasons behind it are cancer, cases of severe prolapse, and postpartum bleeding. With the development of technology and the development of screening and preventive programmes, and availability of minimally invasive techniques such as myomectomy (a surgical method to remove only the fibroid), endometrial ablation devices, levonorgestrel intrauterine system (LNG-IUS), and uterine arterial embolization (which blocks the blood supply to the fibroids and causes them to shrink).

The recent media reports highlight that more young women are undergoing this surgery. According to the Journal of Medical Evidence, 32% agricultural women workers were likely to undergo the surgery compared to other occupations. Women living in rural areas who are illiterate, obese, and have health insurance are likely to undergo it compared to urban working women.

A large number of women working in sugar cane fields are pushed to undergo this surgery. Traditionally, menstruating women were excluded from the fields as it was believed that they would destroy the growing plants. Women play a major role in agricultural activity from sowing to harvesting. Despite this, it raises a pivotal question: why are they opting for a hysterectomy? To understand this, in the next section, I will focus on the sanitation and hygiene practices in rural India and interventions.

Sanitation, exploitation, and the womb

The government launches a campaign like Swachh Bharat Abhiyan to make India free of open defecation. However, the actual impact is limited. According to a survey, six out of every ten of those who build the toilets don’t have a proper water supply, making them unusable. Most of the families are reluctant to use the toilets due to stereotypes and social norms, such as purity and pollution notions. Similarly, there is no facility for water in the community washroom, and it remains dirty.

Women’s bodily autonomy and sanitation needs are different compared to men’s. Many women control their urine throughout the day and deliberately limit their fluid intake due to a lack of clean and household toilets, which often leads to health issues such as Urinary tract infections. However, the problem is exacerbated during menstruation.

The lack of sanitation is not limited to the private sphere (homes), but it often extends into the work environments where women are employed, especially in the informal economy. Lacking these basic facilities results in absenteeism, which impacts both physically and financially. For instance, Poonam, a 34-year-old construction worker, in an interview with Business Standard, even spoke of the difficulties of using the temporary toilet facilities that are common for men and women. She says that during menstruation, using such facilities leads to stress work for her throughout those days.

The fear of loss of work, exploitation by the contractor, and the threat of women having to pay a fine or penalty for extra leave push them to use the pills to delay their periods and undergo surgery. The case of poverty intensified this. For instance, in the Beed district of Maharashtra, women believe that surgery would relieve them monthly issues and allow them to work for longer hours. The preference for work over health turned several villages into the “villages of womb-less women”.

Many of them undergo unnecessary surgery even if their problem can be treated with medicine. This resulted in the deterioration of their health and faces both physical and psychological anxiety, pain in the back, knees, and neck, risk of cardiovascular diseases, etc. There is no proper follow-up after the surgery.

The prevalence of hysterectomy is mostly seen in rural, illiterate women. For instance, in Andhra Pradesh, cases of tribal women, even young women who underwent surgery. Doctors in rural areas do not prescribe antibiotics. They prescribe the removal of the womb. The motive behind this is profit-making, as a surgery costs between Rs 10000 to Rs 50000.

To curb these unnecessary surgeries and protect women from exploitation, the Maharashtra government set up a vigilance committee to ensure that no unnecessary surgeries are performed. The government at the macro level could ensure the implementation of the Occupational Safety and Health Bill, which focuses on the safety and health working environment.

To increase women’s economic participation government should adopt policies such as menstrual leave. It acknowledges and recognises the biological differences and helps in creating an inclusive workplace.

Conclusion

The hysterectomy, which is used to save the life of women become a tool of exploitation and a public health concern. Rather than being offered alternative treatments, women are often pushed by poverty, exploitation, and lack of access to sanitation facilities into undergoing unnecessary surgeries. Addressing these issues is important as this helps in prioritizing women’s reproductive health, autonomy, and dignity. 

Referenes

About the Contributor

Khushboo Dandona, a research intern at IMPRI India and a postgraduate student of Gender Studies at the Dr BR Ambedkar University, Delhi.

Acknowledgment: The author sincerely thanks the IMPRI team for their valuable support.

Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organization.

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