premature hysterectomies in IndiaThe stigma surrounding menstrual periods continues to plague India. Due to the frequent lack of sex education and conversation about periods, many Indian girls grossly lack education about their cycles.  Local period taboos and social media moral police trolls widely shame girls about their menstruation. In fact, period taboo is leading to premature hysterectomies in India.

These period taboos significantly impact poorer women living in rural areas including Bend and  Sangli. These women migrate to the more affluent western “sugar belt” districts to work for six months as cutters in the sugar cane fields.  Cane cutting contractors hesitate to employ women who menstruate because they assume that they will miss a day or two a month due to their periods.

Because sugar cane cutting is frequently a family’s primary source of income in rural India, thousands of menstruating women have been electing to have hysterectomies, which are irreversible surgeries, to eliminate the “problem” of their period.

Indian Period Taboos

Menstruating women are frequently banned from religious, social and work environments during their cycles.  Indian society considers periods impure and girls who have their periods dirty.  Uneducated parents rarely prepare their daughters for their menstrual cycles, so when they arrive, fear and anxiety plague young women. Due to unsanitary lavatories and lack of access to sanitary products, 23 million Indian girls drop out of school after they get their periods. They also fear mocking from classmates for staining.

What is a Hysterectomy?

A hysterectomy is a surgical procedure that results in the removal of a woman’s uterus and, in some cases, her ovaries and fallopian tubes. In doing so, a woman loses the ability to become pregnant, will not menstruate and may experience a reduction in hormone production.  After undergoing a premature hysterectomy, many women must undergo hormone therapy to stay healthy and prevent further health complications.

Premature Hysterectomies in Rural India

In rural India many women feel as if they must eliminate their menstrual cycles entirely in order to work. Furthermore, due to the lack of education on the subject of menstrual cycles, doctors at private hospitals easily persuade women to undergo the expensive procedure in order to continue working as cane cutters.  A large percentage of those women are in their 20s and 30s, far younger than the age when experts usually recommend hysterectomies.

Roli Srivastava, author of the column. “Pushed into Hysterectomies” in The Hindu, describes a distinct pattern:  Private hospital doctors coerce poor illiterate women into a premature hysterectomy. These women, who present with easily treatable symptoms such as white discharge, an irregular period or bad cramps willingly elect hysterectomies so they won’t miss work. As she also explains, “their willingness to undergo the procedure stems from the fear of cancer (which doctors convince them of) to the belief that their uteruses are of no use once they have had children.”

A “Moneymaking Racket”

According to Srivastava, hysterectomies are a “moneymaking racket” in India for private hospitals. When illiterate rural women with menstrual cramps and heavy bleeding go to clinics, the doctors don’t give them options.  They don’t even let them consult their families, and they are not told the cause of their problems or informed about the procedure.  They often don’t know if their ovaries have been removed as well as their uterus.  The operation is expensive, and many rural clients’ insurance does not cover the operation.  Families need to go to moneylenders to get the funds for the operation.  In Maharashtra, the average cost of a hysterectomy is $598 and the average daily wage for a female worker is $2.98.

The Numbers

According to Indian Media, over a three-year period, more than 4,500 young women had premature hysterectomies in the Beed district alone. And the numbers are going up.  A 2018 government survey found that 22,000 women between 18 and 49 had hysterectomies. In one study that interviewed 200 women, 69% were unsure or uninformed of the nature of whether their procedure had removed their whole uterus or just their ovaries.

The Solution

Education about menstruation and personal hygiene is the key lever to reducing period taboo and premature hysterectomies in India. Education will enable more women to exert their rights in many other areas as well such as choosing contraceptives and making their own informed health decisions.  Photographer Niraj Gera, writes, “It is time we realize that menstruation is just a biological process and the secrecy surrounding it must go. It is important to normalize menstruation and destroy taboos around this natural process” As a strong advocate for period education he concludes, “Talking is all it takes to begin a transformation and it’s time we did it.”

– Opal Vitharana
Photo: Wikimedia Commons

Informal Female Workers in IndiaAccording to a Foreign Policy podcast called “Hidden Economics of Remarkable Women,” despite the rapid expansion of India’s economy in the last 10 years, about 82% of women in India still work in the informal economy. WIEGO classifies the informal economy as “the diversified set of economic activities, enterprises, jobs and workers that are not regulated or protected by the state.” Workers in the informal economy, therefore, lack job security, benefits and protections. According to its website, SEWA Bharat, formed in 1972, is “a federation of women-led institutions providing economic and social support” for India’s informal female workers and is part of the greater SEWA movement established in 1984. SEWA stands for the Self-Employed Women’s Association.

Mission Statement

The primary goal of all SEWA endeavors is to establish “Poorna Swaraj,” or “full freedom” for female informal workers in India. The association views freedom as a concept that can only be achieved through “full employment.” SEWA Bharat defines “full employment” as the ability of a family to afford adequate nutrition, clean water, housing and garments. In addition, the household should have access to “health care, child care, insurance and pension.” SEWA strives to help people achieve full employment through collective yet peaceful organization and action. In fact, harmony is one of the key principles SEWA subscribes to, in combination with integrity, simplicity and social justice.

With this ethical framework in mind, SEWA Bharat focuses its assistance on four main areas:

  1. Entrepreneurship Support. SEWA Bharat recognizes that women’s participation in the economy has an impact on their “position in the household” as well as the local community and the economy at large. This participation leads the way for women to involve themselves in political affairs. These impacts are even more pronounced when women establish their own businesses.
  2. Skill Development. SEWA recognizes that women require skills training that will translate into employment opportunities. Further than “technical and managerial skills,” women require “personality development, life skills and the knowledge of the competitive and ever-changing environment.”SEWA runs skills development programs in livestock rearing, retail management, e-rickshaw driving and more.
  3. Social Security and Health. The organization ensures “social security and health services are delivered equally and fairly to women in the informal sector.” SEWA accomplishes this through “information dissemination, awareness generation and service delivery mechanisms.”
  4. Research. SEWA conducts research, typically via survey, and actively finds areas of weakness among India’s informal female workers and advocates for their remedy accordingly.

Goals in Practice

As part of its services to empower female informal workers in India, SEWA Bharat provides support to microenterprises. These are small enterprises that typically do not receive adequate assistance, attention and support to expand and thrive. Microenterprises can range from an individual to a family-wide endeavor and make up the majority of Indian firms. Microenterprises are highly susceptible to market fluctuations and external shocks, yet lack the resources to bounce back from such disruptions.

SEWA supports microentrepreneurs by “enabling access to capital, [explaining] market demands, [procuring] raw materials, [teaching] product design and development,”  according to its website, and by connecting these women-led operations to the online marketplace. In total, nearly 125,000 new and/or potential microentrepreneurs have received assistance from SEWA.  Further, slightly less than 14,000 individuals accessed digital and financial literacy classes and SEWA helped connect more than 6,000 microentrepreneurs to formal credit services.

A Story of Empowerment

Aarifa is a 19-year-old traditional lac jewelry artisan whose livelihood faced hard hits after the introduction of chemical lac alternatives. Lac is a natural resin left behind on trees by insects, which is then used to create jewelry. Aarifa and similar artisans do not have proper market access, which limits their profits as the artisans usually only sell to local shops and vendors. Through SEWA Rajasthan’s Digital Beti program, Aarifa has advanced her craftsmanship skills and is able to work with lac on a more advanced level.  This teenage entrepreneur can now complete the entirety of her work independently. Aarifa aims to become self-sufficient and finance her own studies.

Impact in Numbers

A 2005 assessment of SEWA’s impact shows significant advancements in female employment in India. With regard to “full employment,” up to 75% of SEWA members noted more regularity and security in their work and up to 82% of members saw a rise in income. During that same time period, a woman involved in SEWA was 10 times more likely to have health insurance than the average female.

SEWA gives attention to the most marginalized women with a multifaceted plan of action in mind, using the concept of freedom as a guide. Moving forward, continued success looks hopeful given the organization’s ability to adapt assistance in the wake of the COVID-19 pandemic. SEWA’s research also informs its projects, ensuring that aid is research-driven to enable the greatest impact.

Jacob Lawhern
Photo: Flickr