Media reports highlight how it has become the norm for women to have hysterectomies1 to avail

employment as a contract worker in the district of Beed in the western Indian State of Maharashtra.2
It is unclear how long this practice has been going on and how widespread it is but there are media
reports from 2016 that have made reference to the aforementioned issue.3 The majority of these
women are sugar cane cutters that seasonly migrate to western Maharashtra during October and
March to seek employment. Due to the rigorous nature of cane cutting, menstruation hinders work
and attracts fines. The contractors are also apprehensive to hire women who menstruate. As a result
women have started undergoing hysterectomies. The contractors argue that they do not force the
women to undergo this operation. Hysterectomies can have serious impact on the health of these
women including hormonal imbalance, mental health issues etc. There have also been allegations of
sexual abuse and assault of the women labourers by the supervisors.4

The International Labour Organisation has noted that in Asian countries,“recruitment, whether
through private agencies or informal networks, is inadequately regulated, with unlawful activities
such as human trafficking all too frequent. They are also concerned about the coercive practices that
may not be explicitly against the law.”5 While getting hysterectomies is not an explicit condition to
secure employment it has become a tacit one. This is evidenced by the contractors providing the
money for the surgery which is later recovered from the wages of the labourers. General Principles
and Operational Guidelines for Fair Recruitment notes that, “the Governments should protect workers
against human rights abuses in the recruitment process within their territory and/or jurisdiction.”6

Article 7 of the International Covenant on Economic, Social & Cultural Rights recognises the right
of everyone to the enjoyment of just and favourable conditions of work which include safe and healthy
working conditions and reasonable limitation of working hours inclusive of rest and leisure.7
Committee on Economic, Social & Cultural Rights emphasises in its General Comment No. 23 that
“everyone” also includes workers in informal sector.8 The Committee also notes that adequate
sanitation facilities that meet women’s hygiene needs should be available.9 In Beed district the
labourers are made to work for long hours and every break they take is liable for a fine. The lack of
sanitation facilities make it more difficult for women to work during menstruation.

1
Hysterectomy is an operation that removes all or some part of the uterus.
2
Why many women in Maharashtra’s Beed district have no wombs, The Business Line, 8 April 2019 -
https://www.thehindubusinessline.com/economy/agri-business/why-half-the-women-in-maharashtras-beed-district-
have-no-wombs/article26773974.ece.
3
Sexual abuse plagues female workers on India's sugarcane fields, Thomas Reuters, 2 August 2016 -
https://in.reuters.com/article/india-women-sexual-abuse-agriculture-idINKCN10D177. See also In a barren land, an
epidemic of hysterectomies, The Hindu, 22 May 2016 - https://www.thehindu.com/news/cities/mumbai/news/in-a-
barren-land-an-epidemic-of-hysterectomies/article8632932.ece.
4
Sexual abuse plagues female workers on India's sugarcane fields, Thomas Reuters, 2 August 2016 -
https://in.reuters.com/article/india-women-sexual-abuse-agriculture-idINKCN10D177.
5
Fact sheet The Cost of Coercion - Regional Perspectives: Asia, International Labour Organisation, 2009 -
https://www.ilo.org/global/topics/forced-labour/publications/WCMS_106391/lang--en/index.htm.
6
General Principles and Operational Guidelines for Fair Recruitment, International Labour Organisation -
https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---
migrant/documents/publication/wcms_536263.pdf.
7
Article 7, International Covenant on Economic, Social & Cultural Rights -
https://www.ohchr.org/en/professionalinterest/pages/cescr.aspx.
8
General Comment No. 23, Committee on Economic, Social & Cultural Rights, E/C.12/GC/23, 27 April 2016 -
http://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=4slQ6QSmlBEDzFEovLCuW1a0Szab0oXTdImnsJZZV
QfoUYY19kME5pOqRbao%2bukB1Kzn1MMnQL24FFvtIIdk%2f%2fR%2fF0GthE%2bTiGSATb%2bUa3WMs0%2f
%2bfVfQFg02%2bY%2fTVuqU.
9
General Comment No. 23, Committee on Economic, Social & Cultural Rights, E/C.12/GC/23, 27 April 2016 -
http://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=4slQ6QSmlBEDzFEovLCuW1a0Szab0oXTdImnsJZZV
QfoUYY19kME5pOqRbao%2bukB1Kzn1MMnQL24FFvtIIdk%2f%2fR%2fF0GthE%2bTiGSATb%2bUa3WMs0%2f
%2bfVfQFg02%2bY%2fTVuqU.

1
Menstruation is surrounded by stigma, resulting in the ostracism of and discrimination against women
and girls. The Working Group on the issue of discrimination against women in law and practice has
recommended to take measures to combat and eliminate, in legislation and policies, cultural practices
and social stereotypes, all forms of instrumentalization of women’s bodies and biological functions.10
Women’s bodies are often used as tools and in this particular case hysterectomies are being
normalised to ensure that women don't take breaks during menstruation and can work longer.

Some sources also highlighted that it was not just the contractors but also the medical practitioners
who have vested commercial interests in carrying out these operations.11 An independent study
highlighted that private hospitals were encouraging women to go for these surgeries by allegedly
pointing out that the uterus needs to be removed to stop excessive bleeding or if they had a “white
discharge”. While the normal course of medical practice is that a hysterectomy for non cancerous
reasons is usually considered only when all other treatment approaches have been tried without
success.12 The doctors have argued that it is the women to want to undergo the surgery as they want
to get rid of the pain that hinders their work.13 The Supreme Court of India has held that for a patient’s
consent to be real and valid, the patient should have adequate information concerning the nature of
the procedure. And this implies that the doctor has a duty furnish information which would enable
the patient to make a well balanced decision. This includes revealing information on the nature and
procedure of treatment and alternatives if available.14 Media reports highlight that doctors and
hospitals are suggesting hysterectomies even when alternatives are available. A pervasive fear of
cancer has also been spread in the district coupled with misinformation regarding irregular periods
and white discharge being cancerous.15 Committee on the Elimination of Discrimination against
Women in its General Recommendation No. 24 mandates the State party to provide women with
access to heath care services and information to protect and fulfil women’s rights to healthcare.16

The National Commission of Women (hereinafter NCW) has sent a notice to the Chief Secretary of
Maharashtra17 on 9 April 2019 to take appropriate action to put a stop to this.18 NCW has also asked
to be apprised of any action taken in the rehabilitation of the victims. In response to the media
attention and scrutiny from the NCW, the Maharashtra State government has issued guidelines on 16
April 2019 to curb the unnecessary and unchecked hysterectomies being carried out in the Beed

10
Report of the Working Group on the issue of discrimination against women in law and in practice, UN General
Assembly, 8 April 2016 , A/HRC/32/44 - https://documents-dds-
ny.un.org/doc/UNDOC/GEN/G16/072/19/PDF/G1607219.pdf?OpenElement.
11
Doctors sans ethics: How medical malpractice has made hysterectomies a big business in Marathwada, The Business
Line, 10 April 2019 - https://www.thehindubusinessline.com/economy/ncw-decision-trains-spotlight-on-the-medical-
malpractice-that-enables-this-inhuman-practice/article26798359.ece.
12
Hysterectomy, WebMD - https://www.webmd.com/women/guide/hysterectomy#1.
13
In a barren land, an epidemic of hysterectomies, The Hindu, 22 May 2016 -
https://www.thehindu.com/news/cities/mumbai/news/in-a-barren-land-an-epidemic-of-
hysterectomies/article8632932.ece.
14
Para 32, Samira Kohli vs Dr. Prabha Manchanda & Anr., Civil Appeal No. 1949/2004 -
https://www.sci.gov.in/jonew/judis/30116.pdf.
15
Doctors sans ethics: How medical malpractice has made hysterectomies a big business in Marathwada, The Business
Line, 11 April 2019 - https://www.thehindubusinessline.com/economy/ncw-decision-trains-spotlight-on-the-medical-
malpractice-that-enables-this-inhuman-practice/article26798359.ece.
16
General Recommendation No. 24, Committee on the Elimination of Discrimination against Women, 1999 -
https://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=INT/CEDAW/GEC/4738&Lang=en
.
17
Top bureaucrat in the state government.
18
Doctors sans ethics: How medical malpractice has made hysterectomies a big business in Marathwada, The Business
Line, 10 April 2019 - https://www.thehindubusinessline.com/economy/ncw-decision-trains-spotlight-on-the-medical-
malpractice-that-enables-this-inhuman-practice/article26798359.ece.

2
district.19 Women’s farmers collectives have argued that these guidelines only apply in Beed district
and people would simply go to a different place to circumvent the requirements of the guidelines.
These collectives also argue that these guidelines fail to attack the root cause of the issue and don't
attempt to better the labour conditions.

19
Maha: Govt issues guidelines for private hospitals conducting hysterectomies in Beed, My medical mantra, 17 April
2019 - http://www.mymedicalmantra.com/maha-govt-issues-guidelines-for-private-hospitals-conducting-
hysterectomies-in-beed/.
3