In many parts of rural India, women are facing a grim choice: keep their uterus and lose wages every month due to painful, heavy periods—or undergo a hysterectomy, a permanent surgery to remove the uterus, sometimes even in their early 30s. This quiet but serious epidemic has been unfolding for years.According to the National Family Health Survey (NFHS-5, 2019-21), nearly 10% of Indian women aged 40–49 years had already undergone a hysterectomy. In states like Andhra Pradesh (22.5%), Telangana (21.2%), Bihar (17.2%) and Gujarat (11.7%), the numbers were far higher. More worrying is the median age, just 34 in rural India, more than a decade before natural menopause.The Link Between Periods, Wages, and SurgeryFor many rural women, particularly agricultural workers, menstruation is not just a health event but an economic setback. Migrant sugarcane workers in Maharashtra’s Beed district provide a stark example: here, hysterectomy prevalence was found to be as high as 56% in 2024, with women opting for the surgery at an average age of 35.The reason is brutally pragmatic. Agricultural contractors often penalize women who take time off for menstruation. Period pain, excessive bleeding, and taboos around hygiene in the fields make working conditions even harder. In such an environment, hysterectomy is sold as a “permanent solution”, a way to eliminate menstrual problems and keep working without interruption.A recent study published in Social Science & Medicine also notes that this pattern is echoed in Telangana and Bihar, where women agricultural workers also show higher hysterectomy prevalence. Studies reveal that many women are advised surgery by private doctors even for common issues like abdominal pain or white discharge, often without being informed of alternatives.The Price of Early HysterectomyWhile hysterectomy can be medically necessary in certain cases, such as large fibroids, severe prolapse, or cancer, it is far from harmless when performed at a young age. The removal of the uterus, especially when combined with ovary removal, induces early menopause, triggering a cascade of health risks.Research has linked early hysterectomy to:Cardiovascular diseases and metabolic disordersBone density loss, raising fracture riskPelvic organ prolapse and urinary tract issuesThyroid and urinary tract cancersMental health concerns, including depression and anxietyIn essence, what appears to be a short-term fix to save wages ends up cutting into a woman’s long-term working life and overall quality of life.A System That Encourages SurgeryPart of the problem lies in India’s healthcare structure. As per NFHS-5, about 70% of hysterectomies were carried out in private clinics. Research in Andhra Pradesh found that women as young as 20 were recommended hysterectomy for routine gynecological complaints, reflecting both a profit motive and lack of awareness.Insurance schemes also play a role. Data shows that women with health insurance were more likely to undergo hysterectomy. Reports suggest that some private hospitals encourage the surgery because insurance covers it, making it financially attractive for providers.The National Health Authority has flagged suspiciously high hysterectomy claims under Ayushman Bharat, which at one point accounted for nearly 2% of all female claims. In response, stricter pre-authorization rules were introduced, including mandatory second opinions for women under 40.Why Women Agree: Pragmatic Agency, Not Just VictimhoodWhile it is easy to frame rural women as victims of predatory healthcare, research tells a more nuanced story. A 2015 study in Social Science & Medicine highlighted how women often exercised “pragmatic agency.” They weighed their options, continued monthly suffering, missed wages, social stigma of menstrual restrictions, against the perceived relief of hysterectomy. With limited non-surgical options offered by doctors and little awareness of long-term side effects, many saw it as their best way forward.In interviews, women described themselves not just as patients but as workers and caretakers. Their health decisions were shaped less by medical advice and more by economic necessity, gendered expectations, and the absence of supportive healthcare alternatives.
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