In India’s Sugarcane Belt, Thousands of Women Workers Undergo Forced Hysterectomies
MAHARASHTRA, India – In the summer of 2009, Rajushri Vaudiv Gite was a teenager. She was pregnant, and thrilled. After grueling 18-hour shifts cutting sugarcane in the blistering heat in the Beed district of this western state of India, she found comfort at night, stroking her belly.
“I would dream of holding my baby in my arms,” she told More to Her Story, sitting inside her sweltering home made of tin sheets.
As Coca-Cola announces plans for a new sugarcane product, Gite, now 34, is one of thousands of informal sugarcane workers employed by contractors in Maharashtra. She labored until her ninth month of pregnancy. One day, while cutting cane, she collapsed. Her blood sugar had spiked. At a private hospital, she delivered twin daughters, Vaishnavi and Vaidika.
During birth, her doctors kept a secret from her: They had removed her uterus — without her knowledge or permission.
“I spent 25 days in the hospital and no one told me what was done to my body and why,” she said “By the time I could sit up, I had already lost a part of myself forever.”
Gite is not alone. For years, women in the Beed district have documented that physicians have performed hysterectomies on them without their informed consent, with researchers estimating that about 4,605 women in the district were forced or coerced into having hysterectomies between 2016 and 2019.
Rajushri Vaudiv Gite shows a photo of her twin daughters, who died as newborns. Her uterus was removed the day they were born — when she was just 18 — leaving her unable to conceive again. Photo: Suhail Bhat for More to Her Story
Maharashtra has about one-third of India’s 506 sugar factories, according to the latest data from the Indian Sugar Mills Association. About 1.5 million laborers, including many women from drought-prone regions within India, migrate seasonally for cane work, often between September and March. Most often, contractors pay the workers in advance, creating a cycle of debt. The sugarcane supplies companies like Coca-Cola and Pepsico. After an investigation published in the New York Times in 2024, Coca-Cola said that it was “deeply troubled” by the phenomenon of forced hysterectomies and was “committed to looking into” the issues raised. Yet women laborers and advocates say the problem persists today.
Originally from a small village in Beed district, Gite is among the many seasonal laborers who form the invisible backbone of Maharashtra’s sugar economy. Most come from marginalized castes and tribal communities, living in makeshift shelters near fields, without healthcare, sanitation or food security.
In many villages across Maharashtra’s sugarcane belt, women long hours of physical work and poor healthcare options, often succumbing to pressure from contractors and families to undergo risky medical procedures without adequate information.
Many of these same women, like Gite, are left to deal with the consequences alone.
In Maharashtra, the National Family Health Survey shows a hysterectomy rate of 2.6 percent, below the national average of 3.2 percent. Yet Beed district reports a much higher rate — 17 percent — exclusively among sugarcane workers, who make up 13,861 of 82,309 total women who are field laborers, according to 2019 government data. A separate study found the hysterectomy rate as high as 36 percent in a sample of 200 women.
Last year, researchers published a peer-reviewed journal article, raising the alarm about the rate of hysterectomies for women in the states of Andhra Pradesh, Telangana, and Bihar, battling many of the same dynamics of poverty and illness as women in Maharashtra, and they advocated for “better hysterectomy surveillance” nationwide. Despite the findings, victims and advocates say authorities have offered little in the way of meaningful action.
Rukmini Vithal Varouri, 48, stands outside her home in Beed district. She was married at 15 and began working in sugarcane fields soon after. At 26, she had her uterus removed after years of pain and bleeding, without being told what it truly meant. Photo: Suhail Bhat for More to Her story
“We don’t get rest.”
India’s Ministry of Labor and Employment recommends daily working hours of eight to nine hours to ensure workers get adequate rest and fair compensation. However, thousands of women sugarcane cutters in Maharashtra often work grueling 18-hour days for a meager pay of 300 to 400 rupees, or $3.88 to $4.64, sometimes unloading trucks through the night, according to a report by the Society for Promoting Participative Ecosystem Management, a nonprofit based in Pune, India. These excessive hours put physical strain on the women and highlight the gap between official labor standards and reality.
Shanta Ashraram Namdas, now 60, has worked in the sugarcane fields for over four decades, carrying sugarcane bundles of about 40 kilograms, or about 88 pounds, on her head in the blazing sun, often without rest or regular access to toilets or clean drinking water.
Married at 15, it wasn’t an option for her to take a day off, even during pregnancy or illness, she recalled. It “meant double penalties from the contractor,” she said. Eventually, her children joined her in the fields. She remembers one particular day at work that changed her life.
A decade into her marriage, she began bleeding heavily. “I thought I had peed…but when I checked, it was blood,” she told More to Her Story. She tore her headscarf and used that to control the bleeding.
By the time she had reached the hospital, doctors told her she needed an urgent hysterectomy. Namdas’s employer, pressuring her to comply with the doctors, leant her money to afford the cost — roughly 30,000 rupees, or about $360. It would take her nearly two years of hard labor to repay the debt.
After the surgery, she was never told about its side effects. Today, she suffers from chronic pain, anxiety and weakness but continues working because her family depends on seasonal work to pay bills throughout the year.
"We don’t get rest, even if we’re sick or bleeding. Work has to go on," she said.
Climate change has only made conditions worse in rural communities in India, shortening the work season and prolonging the debt cycle. Unpredictable rainfall, long droughts and depleted water tables have disrupted traditional agricultural cycles. Women bear the brunt.
“The sugarcane season sometimes extends beyond six months, but also shrinks when drought spells are more severe,” said Seema Kulkarni, senior fellow at the Society for Promoting Participative Ecosystem Management and a national facilitation team member at Mahila Kisan Adhikaar Manch, the Forum For Women Farmers' Rights, a nonprofit based in Secunderabad, India.
Since 2018, nonprofit advocates have worked to expose the widespread number of often-unnecessary hysterectomies performed on women laborers. Their advocacy has led to critical policy shifts, including mandatory reproductive health check-ups, regulated medical procedures and a growing number of health camps before and after migration seasons.
“Poor nutrition and lack of access to basic healthcare severely impact women’s ability to work,” said Kulkarni.
She added, “They are victims of exploitation by the sugar industry, a complicit state and medical profiteering.”
“One day, I was playing with kids, and the next, I was someone’s wife.”
Child marriage compounds the problem. According to the National Family Health Survey, over 23 percent of women aged 20-24 in India were married before 18. In Maharashtra, early marriage is common, especially among seasonal workers, many of whom wed before the age of 15 and travel with their families to work on farms during the sugarcane season.
“I didn’t even know what marriage meant. One day, I was playing with kids, and the next, I was someone’s wife,” said Satibhama Narayan, 36, from Ashti taluka, an administrative region that includes many villages, in Beed district. She was married when she was just nine.
Her family, like many others in the sugarcane cutting community, worked as migrant laborers. There was no one to care for her when they migrated away from home for sugarcane work. So, marriage was seen as the easiest solution.
Narayan said, “Everyone said it was safer this way. I wasn’t asked anything.”
Within a month after getting married, she began working in the sugarcane fields. By the time she turned 11, she started her menstrual period. By 13, she gave birth to her first child. She told More to Her story she didn’t understand her changing body, and had no time to rest.
She described her daily life: “I had to cook, carry a cane, feed a baby and bleed all at the same time.”
She started working before sunrise and ended late into the night. Privacy was nonexistent in the fields. When she had her period, she often only had the cloth she wrapped around her head to use as a makeshift sanitary pad, as menstrual products were unavailable.
One day, at the age of 22, her bleeding was so heavy she went to a private hospital where she underwent a hysterectomy. “When the pain got worse, I was told my uterus had to be removed,” she said. “I didn’t know what a uterus was, only that it had to be taken out.”
Even after the surgery, her pain didn’t stop. She suffered from backaches and weakness but had to return to work immediately to repay the medical debt.
“No one mentioned what would happen after the uterus was removed. I just went back to work, because the debt had to be paid and no one rested in the fields.”
Narayan reflected, “I think I lost my body long before the womb was taken.”
Confronting Taboos
Menstruation and reproductive health are rarely discussed in communities like Maharashtra. Periods are treated as shameful and inconvenient, rather than a natural process, and most women lack access to clean sanitary products. “Sometimes we don’t get time, so we keep wearing the same piece [makeshift sanitary pad] for days,” said Narayan
“Hysterectomy should be the last resort. With timely treatment and awareness, most pelvic infections can be managed without surgery,” said Dr. Yasmeena Abdullah, a gynecologist at Jamia Hamdard Hospital in New Delhi.
Women who undergo hysterectomies at a young age are more likely to experience anxiety, depression and sudden menopausal symptoms like hot flashes and pelvic pain, health experts say. Women also face a 33 percent increased risk of heart disease, with the rate rising to 250 percent if women get a hysterectomy before turn 35.
"The psychological and physical toll of early hysterectomy is often overlooked. Young women need better support and informed care,"Abdullah said.
Radha Paudel, a Nepalese nurse, author and human rights activist, is a leading voice in the global movement for what she describes as “dignified menstruation.” In 2019, she established the Global South Coalition for Dignified Menstruation, a nonprofit based in Kathmandu, Nepal, and she has dedicated her life to challenging menstrual discrimination and advocating for policies that uphold the dignity of women and girls.
“Thousands of women face menstrual discrimination, especially in Asian countries,” she said. “By promoting dignified menstruation through international conferences,” she hopes to spark global awareness and policy-level change for menstrual equity.
In Beed district, there are about 120 private hospitals, and advocates say many of them rely too heavily on performing hysterectomies, raising concerns that these hospitals are exploiting vulnerable women by charging hefty amounts for surgeries that they claim aren’t always medically necessary.
Rukmini Vithal Varouri, 48, told More To Her Story, “Doctors often create fear among us, warning that if we don’t remove the uterus, it could damage the kidneys or lead to cancer.”
Varouri was married at 15 and began working in the sugarcane fields soon after. At 26, when her health started deteriorating due to the heavy farm work, she was advised to undergo a hysterectomy at Sanap Hospital. “They charged me ₹30,000 [about $360], and I took this amount from the contractor,” she said.
To make matters worse, women working in sugarcane fields often face discrimination and sexual harassment from farmers where they work and from men in the villages where they live temporarily. Many suffer in silence without support or knowledge of their rights.
Varouri said, “We also face harassment, inappropriate comments and abusive language from male workers. We [women] don’t feel safe in the fields, so we work in groups to avoid such harassment.”
In response to these challenges, a group of women established the Mahila Ustod Kamgar Sanghatana, or Women's Sugarcane Workers Union, in 2019 to advocate for women workers’ rights and probide legal help, counseling, and moral support.
“We make women aware of their rights and what to do when such things [injustices] happen,” said Manisha Tokle, a women’s rights activist from Beed and a member of the union.
The union works to secure the rights of women sugarcane laborers, starting with helping them get official identity cards. The organization has led advocacy efforts around hysterectomies, spreading awareness and pushing the government to take action. It has also trained women in first aid, wage calculation and the rights to get payments directly – no longer through their husbands.
“Our goal is to get every laborer insured, link them with government health and nutrition schemes, and push for paid maternity leave and hostel facilities for migrant children,” said Tokle.
“They Say I’m Lucky.”
Still, life in the fields remains far from safe for many women.
Decades ago, Gite brought her twin baby girls home as a teen mother, struggling quietly with the hysterectomy that had been done on her without her consent. Eighteen months after giving birth to her twin, tragedy struck: Both daughters died within a week of each other.
Rajushri Vaudiv Gite stands at the doorway of her tin-roofed home, gazing into the distance. Her husband remarried, believing she could never conceive again after her hysterectomy. Blamed by her in-laws as "unlucky," Rajushri now faces life’s burdens in solitude. Photo: Suhail Bhat for More to Her Story
“They were underweight and weak, and I could not breastfeed them properly due to poor health and lack of nutrition. They were just too weak to survive,” she said.
Still dependent on work to stay financially afloat, Gite quickly returned to work in the fields. Five years later, her husband left her and remarried. Her in-laws still blame her for the marriage’s failure.
Gite hasn’t menstruated since the hysterectomy, and suffers from chronic pain in her back, joints and hands as she continues to do the only job she has known since she was a girl: working the sugarcane fields.
“They say I’m unlucky,” she said.