Relatives mourn the death of women who died after undergoing sterilization surgeries, at a village near Bilaspur, in the central Indian state of Chhattisgarh, Tuesday, Nov. 11, 2014. Eight Indian women have died and more than a dozen others in critical condition Tuesday after undergoing sterilization surgeries in a free government-run program to help slow the country's population growth. A total of 83 women, all poor villagers under the age of 32, had the operations Saturday in a hospital outside Bilaspur city. Each of the women had received a payment of 600 rupees, or about $10, to participate in the program, said the state's chief medical officer, Dr. S.K. Mandal. (AP Photo/Press Trust of India)
Sterilization procedure kills 11 in India
01:48 - Source: CNN

Story highlights

Wife had pain, vomiting a day after surgery before dying at hospital, husband says

Eighty-three women sterilized in a six-hour span Saturday at a mobile clinic, doctor says

Doctor says post-operation drugs to blame; authorities are investigating

Activist: Deaths "almost inevitable" given unsafe conditions at sterilization camps

New Delhi CNN  — 

Chhattisgarh is one of India’s most impoverished states, a place where 1,400 rupees (about $23) counts for a lot.

That’s what 83 women received to undergo sterilization surgeries over a six-hour period at a government-run mobile health clinic.

Days later, 11 of them had paid with their lives.

Roopchang Sriwas’ wife was one of them. He told CNN that she developed severe pain and started vomiting the day after her surgery.

“I took her to the hospital, and she died half an hour later,” said Sriwas, a barber who added that his wife underwent the procedure because their family couldn’t afford to get bigger. “… It’s very difficult for me. I have three very young children.”

All of these deaths, and the fact 62 others have been hospitalized, have shined a bright spotlight on India’s decades-long initiative to curb population growth.

There’s no mandate, but those inside and outside the program say there’s plenty of encouragement to sterilize as many women as possible.

State health officials pressure doctors to perform as many surgeries as they can, said Dr. R. K. Gupta, who is out of a job and under investigation for his role in the Chhattisgarh state deaths. A few years back, he said the government awarded him and his team for the large number of sterilizations they’d performed.

In fact, Kerry McBroom, a New Delhi-based advocate with the Human Rights Law Network, says that most everyone involved in the process gets cash – from the sterilized women to field health workers to the surgeons.

“The entire system is geared towards funding women towards sterilization,” McBroom said.

Implicated surgeon blames post-op drugs

Gupta suggested to CNN that Saturday’s sterilizations alone may not have sickened the women in Chhattisgarh state and that it had something to do with the expired drugs they received afterward.

“After the surgery, the women took painkillers, antibiotics and so on from the local village medical distributors which is the main cause of this incident,” said Gupta, whose license to practice medicine has been suspended pending an official investigation.

Whether authorities agree with him on the cause of the deaths is another matter.

Some resolution could come Wednesday, when the results of autopsies of some of the deceased women are expected back, said R.K. Vange, chief medical health officer for the area.

Still, according to central government guidelines, medical teams aren’t supposed to conduct more than 30 sterilization surgeries a day. Then there’s the matter of the conditions at the “camp” for sterilization surgery in Bilaspur district.

Gupta said that his team – which consisted of two doctors and six nurses – followed all necessary safety procedures during the surgeries.

Yet McBroom said that, too often, such clinics are not sanitary.

“You might find that there is no electricity, there is no running water, there is not enough staff in these facilities,” added McBroom, who heads the division of her non-profit group focused on reproductive rights.

Because of that, the activist said she isn’t totally surprised by the recent deaths.

“It was almost inevitable,” she said, “given the unsafe, unethical and unhygienic conditions that persist throughout India in these camps.”

Demand for sterilizations

That said, for all the payments and incentives, India’s sterilization program is not required. Yet many women in India see it as a good option.

India is the world’s second most populated country, with around 1.25 billion people. There’s not only a limited number of resources and current opportunities, there’s also very limited access to contraceptives – particularly in poorer, more remote areas, as in the part Chhattisgarh state where Saturday’s surgeries took place.

Ideally, sterilization surgeries offer a safe and effective way to address that issue.

An Indian government official, G.C. Chaturvedi, wrote in 2008 that such procedures were then “the most popular (family planning) method adopted by our people to limit their family.”

“As the demand for sterilization services remains very high with a large unmet need, the country has continued with the camp mode to reach … people in under served and under reached areas,” he said. “However, the camp approach throws out challenges.”

Even after Saturday’s incidents, those challenges – and dangers – remain. Dr. Kamal Kishore Airy, a Bilaspur district health officer, said another woman has died and 14 others are hospitalized after 55 operations Monday in three locations in Chhattisgarh state.

McBroom said government data on payouts to victims suggests that hundreds of people have died as a result of sterilization procedure, though she thinks this is actually “a gross underestimate of the actual number of deaths.”

She hopes the Chhattisgarh state deaths serve as a wake-up call, be it to promote better safety procedures or rethink the sterilization program more generally.

“We haven’t seen this much carnage in the wake of a sterilization camp (before),” said McBroom. “And it is incredibly devastating because activists throughout India have been ringing the bell on this for years.”

Read: India hospital under fire after sterilized women left to recover outside

CNN’s Sugam Pokharel and Sumnima Udas reported from India, and CNN’s Greg Botelho wrote this story from Atlanta. CNN’s Sania Farooqui, Elizabeth Joseph and Catherine E. Shoichet contributed to this report.