Are poor and work hard. Many women in India who work in the fields suffer from their monthly bleeding and therefore have their womb removed. Activist Bharath Bhushan explains why surgery, also known as hysterectomy, is so popular among women - and why it can later lead to major social, psychological, and financial problems.

ZEIT ONLINE: Indian journalist Roli Srivastava recently uncovered that farmers are pushing their Indian workers to have their womb removed. What's up there

Bharath Bhushan: The fact that there are more and more womb removals can be heard above all from the sugar cane farms in Maharashtra. The owners want the women to be able to work without interruptions due to period problems or pregnancy.

ZEIT ONLINE: The women mostly work as day laborers. If they fail, they don't make any money. Is the financial pressure so high that they put up with this serious intervention?

Bhushan: This is just one of several reasons. Another is that they think it is a simple operation that relieves them of their monthly pain and other side effects. Most of these women are uneducated. They live in remote villages where little is said about reproductive health and believe that their symptoms are an individual problem. That makes them easy victims. Some people say: "You already have a child. If you have your uterus removed, you will get rid of your monthly pain." To put it bluntly, most of these procedures are medically unnecessary.

Bharath Bhushan comes from the central Indian city of Hyderabad and founded the non-governmental organization "Center for Research and People's Development" (CARPED) in 1989, which is committed to the sustainable and inclusive development of communities in rural areas. © private

ZEIT ONLINE: Why do doctors carry them out?

Bhushan: Because they earn from it. You have to know that two thirds of these interventions take place in private hospitals. The government determined this in 2015 through a representative health survey. Doctors who refer patients to such hospitals collect commissions. These operations are performed much less often in state hospitals because they do not make a profit. This is not just the case with hysterectomies: it is a fundamental problem in the Indian health system.

ZEIT ONLINE: What do you mean?

Bhushan: It is often like this: So-called health agencies offer health checks in villages and see who needs which treatment. Then they refer people to private hospitals. Operations become a business. This includes not only hysterectomies, but also unnecessary caesarean sections or appendectomy: hundreds of parents are made to have their healthy children have their appendix removed. The government does not regulate private providers enough. She also shoots them public money. In 2007, for example, the state of Andhra Pradesh introduced state health insurance that could also be used to treat patients in private hospitals. As a result, the number of operations increased from year to year. In the meantime, the media regularly report on the abuse of state health promotion.  

ZEIT ONLINE: Have you spoken to doctors who have prescribed hysterectomies?

Bhushan: Yes. You said it was a serious problem: period pain, for example. Some also said that women asked for it to be released from their monthly problem. As if a hysterectomy was a normal reproductive health issue.