Researchers connect hysterectomies and child marriage to climate-impacted sugarcane laborers in India

Sugarcane workers in India may begin their days as early as 4:30 or 5:00 in the morning, cutting, bundling, and loading cane, increasingly amid the pressures of droughts and floods. Now, researchers are using agricultural census data and satellite data on crops combined with demographic and health survey data to track how climate change may be affecting workers, even impacting the incidence of child marriage and reproductive health.

"The goal is to better understand how systematic the relationship between sugarcane cultivation, child marriage, and hysterectomies is in India's Western Sugarcane Belt," researchers Eliana La Ferrara and Aditi Bhowmick said in a joint email to CG. "Our findings suggest a substantial, persistent, and robust relationship between sugarcane cultivation and each of these outcomes."

La Ferrara is a Professor of Public Policy at the Harvard Kennedy School, where Bhowmick is a Ph.D. candidate. Their research — including collaboration with a "grassroots female worker collective that has been working with sugarcane harvesters for decades" — points to how climate-driven migration and agricultural systems in Western India may be taking a disproportionate toll on women and girls.

"Climate change has increased seasonal migration by shrinking local livelihood options, which in turn creates greater scope for labor exploitation," Bhowmick said in an interview with The Lakshmi Mittal and Family South Asia Institute at Harvard. 

Sugarcane harvesting has long been a livelihood in the region. But as rising global temperatures reduce the availability of work closer to home, more people may turn to this migrant work.

"As the incidence of droughts and floods in this part of the world increases, the outside options of seasonal migrant workers will dwindle further, making them even more exposed to precarious work arrangements and potentially coercive contracts," La Ferrara and Bhowmick said in their joint remarks to CG.

Married couples are often hired together and given an advance on their contracted wages "to help them survive the lean season," La Ferrara told the Mittal Institute in early March. Laborers then face pressure to work off their advance and to maximize their earnings during the six or so months of harvest — perhaps their only period of paid work during the year.

According to the Mittal Institute, "Women work long days with little rest or sanitation, making menstruation so difficult that hysterectomy can seem like a practical solution."

"Among the workers we study, hysterectomies are adopted less for contraception and more as a means to cope with menstruation-related problems (e.g., heavy bleeding, debilitating pain) and other reproductive health issues," the researchers said in response to CG's inquiry about whether the voluntary use of long-acting reversible contraceptives had come up as a potential alternative to surgery. Some experts have noted that certain contraceptives — such as hormonal intrauterine devices, or hormonal IUDs — may be used to address heavy menstrual bleeding.

"Some of these reproductive health problems are brought about by the high incidence of child marriage and early childbirth, as well as by the harsh conditions of work," La Ferrara and Bhowmick said. 

Meanwhile, past reporting from other outlets has noted that some women in the Sugarcane Belt have described their hysterectomies as forced, coerced, or performed without informed consent.

"A promising health intervention in this context would address overall reproductive and gynecological health of female sugarcane workers both in their home villages and during the harvest season at the worksite," the researchers told CG.

The team visited the worksites this winter and later told the Mittal Institute that they observed, among other things, inadequate sanitation and toilets.

Increased emphasis on seasonal migrant work also appears to correlate with a regional uptick in child marriage. Husbands and wives traveling away from home may worry for their minor daughters left behind and see marriage as a safer option for their children, according to the researchers. Girls may also face pressure to marry and enter the seasonal harvest work as part of a married couple.

La Ferrara and Bhowmick told CG that the first phase of their research, "focused on quantifying the problem," is complete. Next, they're taking steps to solve it.

"In the next phase, we are designing interventions targeting directly the debt traps that characterize our target communities," the researchers told CG, noting that their collaboration with the grassroots group has been "instrumental" to this process. 

"We are currently at the intervention design stage and hope to pilot interventions this summer onward."

La Ferrara previously told the Mittal Institute that the range of solutions might include policies to mitigate the impacts of climate shocks, development of alternative livelihoods, and improved contracts to help workers avoid debt traps.

Watchdog groups may also aim to hold any involved corporations accountable for improving working conditions and payment systems.