The sugar industry is facing pressure to clean up its supply chains and improve oversight after revelations that women in India, the world’s second-largest sugar producer, work in debt bondage and are coerced into getting hysterectomies.

In the wake of the report, a group of labor leaders in India went on a three-day hunger strike recently to demand better working conditions. One of the companies that buys sugar in Maharashtra, Coca-Cola, quietly met with Indian government leaders and sugar suppliers last month to discuss responsible harvesting. And Bonsucro, a sugar industry body that sets standards, said that it would create a human rights task force.

The investigation into the sugar industry, by The New York Times and The Fuller Project, revealed a range of labor abuses, including that female sugar cane cutters in the western India state of Maharashtra were pushed into illegal child marriages so that they could work alongside their husbands. Locked into debt to their employers, the women are forced to return to the fields season after season, the report found.

Women also described facing pressure to undergo hysterectomies for routine ailments like painful periods, adding that they usually had to borrow from their employers to pay for the surgery. That often ended the women’s periods and kept them in the fields, but such procedures can also have consequences including early menopause.

Sugar producers and buyers have known about this abusive system for years, the investigation revealed. But multinational companies have done little in response. One mill that profited off abuses even received a seal of approval from Bonsucro. (Major brands like Coke, PepsiCo, Unilever and General Mills have used Bonsucro endorsements to bolster the images of their supply chains.)