Aarya Dubey*
Introduction
Recently, an alarming concern has arisen in Maharashtra’s Beed district, one of the major suppliers of female labourers to sugarcane farms in the states of Maharashtra, Karnataka, Telangana and Andhra Pradesh. As per the reports, over 13,000 women employed as seasonal sugarcane cutters are estimated to have undergone hysterectomies at ages when they should still be able to bear children. What is more troublesome is the fact that the reason behind such surgeries is not always a genuine medical necessity, but the harsh economic and labour conditions under which these women work.
These women, bearing the brunt, migrate for six to eight months every year along with their families, working under private labour contractors, locally known as mukadams. While the work is strenuous and brutally physical, demanding longer working hours, the labour conditions are harsh, with makeshift shelters near the fields and little access to clean water, sanitation, or regular healthcare. Since payment is directly dependent on uninterrupted work, taking leave, even because of illness related to reproductive health, poses a threat of imposition of a monetary penalty, and sometimes even loss of employment altogether. This economic pressure forces female workers to remain fit for work under all conditions, as even a few days off can cost them their livelihood.
With this context at hand, a hysterectomy ceases to be an informed medical decision. Instead, it becomes a means of economic survival as women are reportedly told that the surgery will resolve common menstruation-related issues like period cramps, back pain or white discharge, leading them to consent to it for better productivity, raising serious concerns about the voluntariness of such consent.
This blog is an attempt to delve into the question of the nature of such consent and also examines the broader constitutional concern regarding the right to life, while also exposing the glaring loopholes in the existing labour laws, which consistently fail to shield female workers from the clutches of labour exploitation.
Is The Consent ‘Real’ In Its True Sense?
Before we delve into the question of violation of fundamental rights of the concerned female workers, it is important to address the nature of consent given by them to undergo the procedure of hysterectomy, i.e., removal of the uterus, as it will help us shape the further discourse.
As discussed by the Supreme Court (henceforth, SC) in Samira Kohli v. Dr. Prabha Manchanda & Another, consent, in medical jurisprudence, is the wilful grant of permission by the patient authorising the doctor to carry out acts such as diagnosis, surgical or therapeutic procedures. Known as “real consent” in the UK, it is valid and ‘real’ only when the patient, having the capacity and an adequate level of information about the nature of the medical procedure, gives it out of volition, without any force.
In the instant case, while one may argue that consent given by female workers for the removal of their uteruses is indeed voluntary, as they are not forcefully led into the surgical clinics, a closer look might suggest otherwise. In India, a person may be forced, even without being beaten, threatened with a weapon, or dragged into a hospital. Legally speaking, the ambit of “force” is quite wide and it includes “economic compulsion” and may often operate through poverty, dependence, and unequal bargaining power.
The SC, in People’s Union for Democratic Rights v. Union of India, while interpreting “other similar forms of forced labour” under Article 23 of the Constitution, also discussed what constitutes “force” in general. It was rightly observed by the judges that the term “force” “must be construed to include not only physical or legal force but also force arising from the compulsion of economic circumstances which leaves no choice of alternatives to a person in want”. In other words, “force” does not only mean physical force but also includes those situations where an employer leverages their institutional power to effectively deprive a worker of legitimate choices. This logic applies directly to the case of Beed female workers at hand.
Sugarcane cutters receive an advance from the contractors before the season starts, creating a relationship of dependence. Once the season begins, female workers are not granted menstrual leave or even allowed to slow down. If they do so, the contractors, often in a superior position of legal relationship, threaten them with monetary penalty, loss of future work, or complete debarment from employment, making their livelihood extremely challenging and difficult. In this context, asking them to choose between removing their uteruses so they can be free from menstrual illness, and thus, more productive, and risking the imposition of a penalty and loss of employment presents no real choice at all. It is as illusory as telling a worker to either work for less than minimum wage or forego work at all.
Therefore, consent given by such women to undergo hysterectomies cannot be viewed in isolation, as such a decision is not taken by them as a free agent with a choice between two feasible alternatives but under the compulsion of exploitative economic circumstances. Such consent is no consent and should not be viewed as an exercise of bodily autonomy. It is, in fact, the result of economic hardships forced upon by a more privileged system that has made the sustenance of the livelihood of the less privileged contingent upon the sacrifice of their reproductive well-being.
Constitutional Violation of the Right to Life
The Constitution guarantees to every person the right to Life under Article 21, the ambit of which has been expanded by the SC in a catena of cases. It is not merely restricted to bare survival but includes privacy, dignity, and decisional autonomy over one’s own body.
Bodily autonomy generally means having ultimate control over choices that affect one’s bodily health. It is not merely a fundamental right but also a basic human right and is inclusive of reproductive autonomy, as interpreted by the SC in Suchita Srivastava v. Chandigarh Administration. However, despite it being an inherent right, it is an apathy that Beed female workers are being stripped of the same.
Hysterectomies are performed under forced consent, as has already been discussed before. Further, the women, mostly illiterate and uneducated, are, at times, not even informed and counselled about the nature, risks, and consequences of the procedure, rendering their consent uninformed. Some of them do not even understand that their uterus is being fully removed or that menstruation and childbearing will permanently cease. Such suppression of essential information violates their reproductive autonomy as they are rendered incapacitated to decide whether, when or under what circumstances they wish to undergo a life-changing medical procedure. Moreover, the technically involuntary and unnecessary removal of a healthy uterus often makes them vulnerable to lifelong physical and psychological side effects, stripping them of agency over their own person. As per Dr. Avinash De Sousa, a Mumbai-based psychiatrist, hormonal imbalances caused by a hysterectomy may also trigger depression and anxiety, apart from physical side effects. This undermines the Right to Health of these women, another facet of the Right to Life, as interpreted by the SC in Bandhua Mukti Morcha v. Union of India.
It is indeed a sorry state of affairs that women who sustain one of the largest agrarian industries in India are deprived of the very autonomy that the Constitution guarantees them in letter, but fails when it comes to its protection in letter and spirit.
Loopholes in the Existing Labour Law Framework
The mass hysterectomies in Beed are also a direct result of the significant gaps in India’s existing labour law framework. While the Maternity Benefit Act, 1961 recognises the right to paid maternity leave during pregnancy and after childbirth, and also penalises employers if they fire female employees for the sole reason of their getting pregnant, the law does not apply to sugarcane farms as they are not covered under the definition of “establishment”. This keeps sugarcane cutters with neither any legal right to maternity benefit nor any protection against dismissal due to pregnancy leave.
Further, women have no statutory right to period leave even when severe pain and heavy bleeding make the field work impossible. This allows the mukadam to impose a monetary penalty or remove her permanently for taking leave, compelling them to get her uterus removed to remain productive at all times.
The Occupational Safety, Health and Working Conditions Code, 2020 (henceforth, OSH Code) also keeps the sugarcane field outside its purview, as it applies only to establishments like factories, mines, and plantations. This keeps the contractors free from providing safe working conditions and conducting regular health check-ups for workers, thus enabling the mass unnecessary hysterectomies to continue with minimal, if any, state oversight.
The Way Forward
Addressing the apathy of the Beed female workers requires acknowledgement and targeted reforms.
The definition of ‘establishment’ across labour laws should be expanded. This can be done by including ‘sugarcane’ under the ambit of ‘Plantation’, which currently includes only tea, coffee, rubber, cinchona, and cardamom. This will then bring sugarcane cutters within the scope of the Maternity Benefit Act, 1961 and the OSH Code. Maternity benefits could then be availed by female workers as a right, without fearing loss of wages or employment, or having to undergo the removal of their uteruses. Further, this would also ensure occupational health safeguards and routine medical examinations of field workers. Regular health screenings conducted by independent government medical practitioners would identify genuine medical needs and ensure that women receive adequate counselling before consenting to any procedure. This would also enable authorities to detect patterns of mass hysterectomies in a particular region, facilitating timely intervention, accountability, and oversight over contractors and healthcare providers.
Further, a statutory right to menstrual leave should be introduced for female workers, irrespective of their workforce. Menstruation is a natural biological process, delicately intertwined with the reproductive health of a woman. In fact, the SC, in a recent case of Dr. Jaya Thakur v. Government of India, has interpreted the Right to Menstrual Health as a facet of the Right to Life. However, without concrete legislation protecting it, the right remains a mere constitutional promise, with no enforceable protection, as vividly seen in the case of Beed female workers.
Conclusion
The mass hysterectomies in Beed are a stark reminder of how structural inequality can strip someone of basic fundamental rights. When a woman is compelled to choose between removing her uterus and losing employment, her consent is neither free nor informed; it is a result of systemic coercion. The Constitution promises bodily autonomy and the right to health to every individual, yet these guarantees remain hollow unless supported by effective labour protections, accessible healthcare, and meaningful state oversight.
Until law and policy recognise and remedy these structural injustices, the fields of Beed will continue to bear witness not only to agricultural labour, but also to the silent erosion of women’s fundamental rights.
* The author is a final-year B.A. LL.B. (Hons.) student at Maharashtra National Law University, Aurangabad. They may be contacted at aarya.dubeyyy@gmail.com.
This blog reflects the personal views of the author and does not necessarily represent the views of The Policy Chronicle.