At the intersection of gender, health and migration, there is a dangerous trend picking up
What is the first thought that comes to your mind when you think of trends? Is it the apparel collection from so and so brand you saw online recently? Or some music genre getting popular? Or people going crazy over products tagged as organic? You must have heard from a shopkeeper saying “Madam, aajkal iski kaafi demand hai!”, “ye falaana herioine ne us movie me pehna tha” and you buy it, thinking it is trendy and fashionable. But everything we buy isn’t necessarily our first choice. We often get influenced by our company, role models, the place where we live or the kind of exposure we get. You will find numerous such examples in your day to day life.
These days choosing a fancy career such as a YouTuber, celebrating the festivals from different cultures as our own, studying or settling abroad, pre-wedding photoshoots are all considered as “in”. If we look at them carefully, we would see that all these choices are a result of gap-filling. Someone saw potential or maybe created a need for it and people started following.
How hard is it to manipulate a human mind? Some business models flourish because they very carefully address such voids.
Coming from a city background, the rural context was something that always amazed me. I had some pre-conceived notions. As a fellow, the first thought that came to my mind when I heard the word grassroots was that unlike city people, people living in villages love to preserve their culture and traditions. But it was foolish of me to not consider that we all are evolving and are a part of the same system. A lot of trends are blindly being followed by us, everywhere. With T-series remixing old tracks and the whole nation grooving, the tribal people are not behind in following the footsteps and remixing their folk Wagdi (regional language) songs with a DJ beat. Sadly, I haven’t gotten a chance to listen to the authentic tribal folk music.
Businesses would not have flourished, if nobody followed trends. Therefore, it becomes crucial for growth. But how likely do you think people would risk their lives under an influence? Only a few, who are unaware of the outcomes might follow, you would say, right? To my shock, I encountered one such trend picking up in this region among tribal women. Hysterectomy – uterus removal operation.
Recently, my organization, Aajeevika Bureau conducted a baseline study in Kushalgarh to understand the health, entitlement and social status of women migrants. Kushalgarh, is a small town located 65 kilometers towards the south of Banswara district, Rajasthan. It shares boundaries with Gujarat and Madhya Pradesh. The prime location makes it more unique in terms of living patterns and diversity among people. You will find Jains, Brahmins, Borahs, Muslims, Patels, Telis, Patidaars and tribals who are further divided into Christian tribals and Hindu tribals. As per our prior understanding, the tribal blocks of Kushalgarh, Sajjangarh and Gangadtalai witnessed the highest number of out-migration from the district. Over decades, the region has seen an increase in the number of women workers migrating toward Ahmedabad, Kota, Dahod, Malwa and Surat.
With migration exposing them to all kinds of vulnerabilities in cities, we decided to explore the health status of women migrants especially in their reproductive stage. Through the study, we came to know that women in Kushalgarh and other regions of Banswara are opting for hysterectomy operations in huge numbers, that too at an early age. The word “fashion” used for its acceptance among tribals was astonishing.
In one of our Focused Group Discussions (FGDs), 5/20 women said that they had got their uterus removed and a few shared stories about someone known who got it done. You will find women in every corner who either had or are willing to get it removed. They address it as “Bada Operation”, which led us to further enquire if there was a “Chota Operation”. The data in our survey shows that 90% of the women opted for female sterilization which they call as chota operation. It is a preferred medium of contraception over others. The condom usage, as reported, is nil.
Aanganwadi workers are given incentives per sterilization operation. They usually book the person in advance and make sure that they get the operation done only through them. Men do not prefer to get operated (Vasectomy) as they fear losing their strength and libido.
The growing trend of increase in the number of female sterilizations is due to lack of awareness and access of other mediums, target based approach and belief system. This also shows how the onus of having/not having a child lies on women more than men. But there was a deeper issue at hand. Our findings show that all those who got their hysterectomy done had gotten female sterilization earlier. Scientifically, doctors say that women who get sterilized don’t need to get a hysterectomy. But some of them started having problems of white water discharge, excessive bleeding and fever while some believed that their sterilization operation failed due to which they had to get their infected uterus removed. They go to bigger towns to get their bada operation done. Idar in Gujarat and Ratlam, in Madhya Pradesh have hubs of uterus removal clinics where they charge Rs. 25,000 per operation.
Read: Why female sterilization is common in India
As a part of a case-study, I asked Kavita*, a 35 year old lady, if she could show me her reports. Her sonography report said that her uterus was perfectly normal. She shared that the doctor in Banswara refused to perform the hysterectomy. Therefore, she went to Ratlam where she got it removed in a private clinic. She said that one of her distant relatives suggested her to get it done and then she recommended it to her daughter in-law, Rita*. With a heavy heart, Rita, who is just 28 year old now, got her uterus removed within two years of her last delivery. Now, she is not able to go to cities for work. Even the domestic chores have become a burden. She doesn’t have any reports and still suffers from abdominal pain, fever, weakness, and white water discharge.
“Didi, ek lakh rupaye lag gye hai isme, udhaar liya tha. Ab dawai band kar di hai. Aur paisa nahi laga sakti is bimari par” (I have spent 1 lakh rupees on this disease which I took as a loan. I can’t spend more, so I have stopped my medication)
Rita* exclaims at her plight
I’ve heard many such stories in the last six months. Some said that it was patidar (community) women who first started this trend of uterus removal operations long back. Some believe that they had a genuine problem and doctor suggested them to get operated while some admit that they got influenced by bhopas or their relatives. A few women also confessed that their uterus was a big jhanjhat and removing it had solved many problems like getting work daily as no uterus means no periods. While all women have their reasons for getting such a surgery done, they are also aware of its physically and economical drawbacks. It brings forth the question as to why women still choose to take this step. For these pravasi (migrant) women, this step is quite like choosing the lesser of the two evils. If they don’t get operated, they will end up having more kids, spend more money and work less. But for those who decide to go ahead with this operation, the ill-equipped health centers and the unhygienic environments which they are exposed to, when they migrate, result in their health deteriorating, at the same time increasing their expenses.
It is easy for one to proclaim that women should make wiser choices but the unenviable situation of ‘damned if you and damned if you don’t’, is more a failure of all the systems around them. Just like how most trends are manufactured by the system.
*Names changed to protect identity
This is well articulated Prerna. When it comes to trends, after a certain point, people blindly start following a trend because that’s the “it thing” without really understanding whether or not it works for you. From your blog, I understand that most women you spoke to, if I am not wrong, know what hysterectomy and/or sterilization are and their consequences as well (to the best in their capacity). There are not blindly getting these surgeries done yet (this makes me think that there’s still the time to prevent this trend from becoming more widespread). It is a rather unsettling trend and I hope through Aajeevika Bureau and your work, these women could get a better understanding about the big-picture effects of this issue.
Thanks for your feedback Amulya. The organisation is trying to bring up this issue in front of authorities through advocacy, as the problem is just not unawareness among the community. The women do know what hysterectomy and female sterilization are and also most of them do know that they will face consequences. The unawareness part is when sometimes they misinterpret their infection to uterus infection and get it removed. I see it as a trend as in a way it is coming out of following blindly and getting influenced to such an extent that any technical advice from a qualified Doctor doesn’t stop them from taking this step. Now, one can also look at it as their own choice, but the bigger picture also shows their distrust towards doctors which is again failure of our health infrastructure. There are many complicated layers to it which I am trying to understand.
Insightful and disturbing!
Really well written Prerna. Gained a lot of insight. Who would have even guessed that something like this was afoot?This is such a disturbing trend. But at least it sounds like the women understand the consequences to a certain extent? So like Amulya mentioned, maybe there is time to prevent this trend from spreading more rapidly. And if not, maybe safer ways can be developed for it so that the infections at least can be avoided.
Thanks Aakanksha! I don’t know if there is time or not as it was a preliminary study that I did. To understand the extent we need to look into it deeply with a much focused approach. For now we are trying to approach the authorities with this issue along with few recommendations. Let’s see where it goes.
Thanks for your feedback Amulya. The organisation is trying to bring up this issue in front of authorities through advocacy, as the problem is just not unawareness among the community. The women do know what hysterectomy and female sterilization are and also most of them do know that they will face consequences. The unawareness part is when sometimes they misinterpret their infection to uterus infection and get it removed. I see it as a trend as in a way it is coming out of following blindly and getting influenced to such an extent that any technical advice from a qualified Doctor doesn’t stop them from taking this step. Now, one can also look at it as their own choice, but the bigger picture also shows their distrust towards doctors which is again failure of our health infrastructure. There are many complicated layers to it which I am trying to understand.
Thanks Aakanksha! I don’t know if there is time or not as it was a preliminary study that I did. To understand the extent we need to look into it deeply with a much focused approach. For now we are trying to approach the authorities with this issue along with few recommendations. Let’s see where it goes.