Kushala Dadaso Sangolkar can split her 34 years into two. The first: toiling at sugarcane factory and at a farm, bearing children, taking care of household work. The second began 11 years ago, when she was 23 and underwent a hysterectomy. Life, as she had known it, changed since then, she says. “I have to work harder, longer now to repay the loan I took for the operation. But my body is giving way. My joints and back ache all the time.”
Karande Vasti, where she lives, is located in Sangola taluka, Solapur district. It is a small hamlet with barely 25 homes. But in each family is a woman, or two, who has undergone a hysterectomy. It seems almost like a family tradition; women speak of how their mothers and aunts underwent the procedure when they were young, and now they are going for it themselves.
Doctors mapping hysterectomies in India estimate that approximately 50 to 60 per cent of women in many rural parts of the country have undergone the procedure. In the developing story of the rising numbers of hysterectomies — reported from various states over the years including Karnataka, Andhra Pradesh, Telangana, Rajasthan, Madhya Pradesh — its widespread occurrence in a small taluka such as Sangola could well be anecdotal evidence of what is clearly a national concern.
What makes it different here, however, is that doctors have been prescribing hysterectomies frequently, making it almost a rite of passage, where a woman undergoes the procedure once she is through with her reproductive ‘duty’ of giving birth to children. But in this part of Western Maharashtra, hysterectomies are not rooted in medical malpractice alone. Heavy labour can also led to prolapse of the uterus — where the uterus drops into the vaginal canal — which is another reason for doctors to suggest hysterectomies, says Gautami Dadagade of Astitva, a Sangola-based NGO that has just completed a study on hysterectomies in the area along with Tata Institute of Social Sciences. And superstitious beliefs around the menstrual cycle have also made hysterectomies rather acceptable.
Dig a little deeper, however, and the key reason emerges: in this water-scarce region where women migrate to work in sugarcane factories or in road construction work, periods are a financial strain as they mean loss of wages for five days a month.
Period pains and the burden of debt
Sarika Raju Kalgurde, 23, has just come back to her village, Hatkarmangewadi, after putting in six months of work at a sugarcane factory. She says it is a labour-intensive job and the work hours are unpredictable. Last year, Sarika underwent a hysterectomy, a procedure a private doctor prescribed to cure her of irregular menstrual cycles and white discharge. She readily agreed as she had had two children. Besides, her mother, Jhimbhai (38), too had undergone a hysterectomy more than a decade ago.
Most importantly, the decision took care of the five days of being ostracised. “During periods, we are made to sit outside the hut,” she says, “and also served food outside in separate vessels. When my periods started becoming irregular, and longer, my time outside also increased.” Doing physical labour during periods was difficult. “So my parents sold their animals and pawned their jewellery for this operation that cost us Rs 43,000.”
Other women took loans from their employers and now put in more hours at work to be able to repay them.
Yesabai Kishan Karande, 60, took a loan from her employer for her hysterectomy about a decade ago and she is still working to repay it. She says the work is difficult: she cuts sugarcane, and carries piles of it to load them on to a tractor. And work timings depend on when the tractor gets there. “If the tractor comes at midnight, we have to work.”
Fertile ground for medical practices
Locals say as long as the dry weather conditions prevail, so will the trend of women taking up labour-intensive jobs. Last week, the 103 villages of Sangola taluka were among the 29,000 villages that the state government declared drought-affected. But drought here is not some recent phenomenon.
Dr Surendra Thakurdesai, head of the department of geography at Gogte Jogalekar College in Ratnagiri, explains: “While the whole of Western Maharashtra and Marathwada fall in the rain-shadow zone of the Sahyadris, a series of talukas — Sangola in Solapur, Man and Khatav in Satara, Jat and Atpadi in Sangli— fall in the secondary rain-shadow zone of the Shingnapur range. So you get deficit rainfall in these parts and they are the most severely drought prone.”
Low rainfall notwithstanding, this belt is fertile land for private medical practices. Over a dozen private hospitals dot the Sangli-Sangola belt and offer hysterectomies. Doctors there admit that over the last 20 to 25 years, the number of women undergoing hysterectomies has shot up. “It is the women who want it,” says Dr. S.A. Kulloli, who runs Kulloli Hospital in Sangli. “They want to get rid of the pain. It comes in the way of their work.” He maintains that a hysterectomy is never the first option, but is suggested only after drugs fail to work.
However, at the Rural Hospital, Sangola, medical superintendent Dr. Piyush Patil says a hysterectomy is often the first line of treatment doctors in the area prescribe. And women believe doctors, as they widely believe that white discharge could be the first symptom of cancer. That view is strangely corroborated by the Taluka Medical Officer, Dr. A.M. Qazi: “It is the right course of treatment,” he says, adding that there is a high possibility of cervical cancer. He, of course, says that proper diagnostics need to be followed.
Dr. Amita Maheshwari, gynaecological oncologist at Tata Memorial Hospital, says that even if cancer is suspected, a hysterectomy isn’t the right course of treatment; a diagnosis can’t be made without a clinical examination and tests, including a pap smear.
That awareness is conspicuously missing in the villages of Sangola. Child marriages are a footnote in the bigger concern of hysterectomies, which explains why women undergo the procedure as early as their twenties.
Like Susheela Samadhan Hipurkar, 26, who was married off at 14, had three children, and underwent a hysterectomy two years ago. She has just returned from a six-month stint at the sugarcane factory and is now working as a farm labourer. Her joints ache all the time, and she looks older than her age. She has no alternative. “I have no time to rest,” she says.
