text: An Indian surgeon used infected instruments to sterilize 83 women in about six hours, according to a local medical official, leaving 10 of them dead and another 69 hospitalized in the central state of Chhattisgarh. 
   
   The doctor breached guidelines that limit surgeons from performing more than 30 sterilizations a day, said the official, who asked not to be named because details of the investigation are private. He also failed to disinfect the instruments before using them again, the official said. 
   
   “It’s a case of negligence,” Raman Singh, the state’s chief minister, told reporters at a news conference today, adding that the doctor, R.K. Gupta, had been suspended and a criminal investigation is under way. “It is unfortunate that such an incident occurred in a scheme of national importance.” 
   
   Related: Doctor Says Toxic Indian Pills Killed Women He Sterilized 
   
   Women often suffer most from efforts to control population growth, such as one-day sterilization drives, in the nation of 1.2 billion people. India has the world’s third-highest female sterilization rate after the Dominican Republic and Puerto Rico among more than 180 countries tracked by the United Nations. 
   
   “Chhattisgarh was a culmination of no accountability in the system and when basic hygiene conditions aren’t met,” Kerry McBroom, director of the Reproductive Rights Initiative at the New Delhi-based Human Rights Law Network, said by phone. “The most appalling and terrifying thing is that it’s so commonplace in India for women to suffer these surgeries” under poor conditions, she said. 
   
   Four women were still in critical condition after the Nov. 8 surgeries, according to Amar Singh Thakur, chief health officer for Bilaspur district. Eight died yesterday while two passed away today, he said. 
   
   15,000 Mishaps 
   
   “The deaths were due to infection causing septic shock,” Thakur said. “We are investigating but it is too early to say that it was due to sterilization.” 
   
   Prime Minister Narendra Modi asked Chhattisgarh’s leader to ensure a “thorough investigation and action” on the “unfortunate tragedy,” his office posted on Twitter. 
   
   India's Aspirations 
   
   Sterilizations are voluntary and couples choose between a tubectomy or vasectomy, Harsh Vardhan, who was India’s health minister at the time, told parliament on July 18. From April 2010 to March 2013, the government paid about 510 million rupees ($8 million) for 15,264 deaths or failed surgeries, he said. 
   
   Women are offered as little as 600 rupees ($10) in compensation for participating in the procedure, which usually takes about 15 minutes and is done under local anesthesia, according to Alok Banerjee of Advocating Reproductive Choices, a coalition of health groups. 
   
   “If they follow the guidelines, then sterilization is a very safe method of contraception and population control,” Banerjee said. 
   
   37 Percent 
   
   India’s National Family Health Survey in 2005-2006 showed that about 37 percent of married women have been sterilized while only 1 percent of men have had a vasectomy. About 29 percent of Chinese women surveyed around the same time had been sterilized compared with 4.5 percent men, according to UN data. The vasectomy rate compares with about 24 percent in Canada and 11 percent in the U.S. 
   
   India in 1952 was the first country to start a family planning program. Emergency rule in the 1970s allowed then-Prime Minister Indira Gandhi to forcibly sterilize people, according to the Population Research Institute. 
   
   Between June 25, 1975, and March 1977, about 11 million men and women were sterilized and 1 million women were inserted with intra-uterine devices, the U.S.-based group said in a report, citing Marika Vicziany’s book “Coercion in a Soft State: The Family-Planning Program of India.” 
   
   ‘Coercive Environment’ 
   
   About 47 percent of women in the survey aged between 20 to 24 said they were already married by the legal age of 18, while 16 percent of 15-19 year-olds were mothers or pregnant when the survey was being conducted. 
   
   While cash incentives are offered to couples who stay childless until prescribed ages or opt for contraceptives, the use of numerical targets has contributed to a “coercive environment for several decades,” Human Rights Watch said in a 2012 report. Although the federal government has announced a “target-free” approach to family planning, district health workers are threatened with salary cuts or dismissals if local targets aren’t met, according to the report. 
   
   “This is an exceptional case which unfortunately happens once every four or five years,” said Abhijeet Phatak, medical program specialist with International Planned Parenthood in New Delhi. “The fault lies with the person who did not disinfect the equipment on a day when 80 or 90 women are being sterilized. But also the strategy of having one-day camps for sterilization is to blame and should be reconsidered.” 
   
   To contact the reporter on this story: Unni Krishnan in New Delhi at ukrishnan2@bloomberg.net 
   
   To contact the editors responsible for this story: Daniel Ten Kate at dtenkate@bloomberg.net Jeanette Rodrigues ||||| NEW DELHI (AP) — Eight Indian women have died and 20 others were 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 in the central state of Chhattisgarh, officials said. All 83 surgeries were conducted within six hours, said the state's chief medical officer, Dr. S.K. Mandal. 
   
   "That is not usual," he said. He declined to comment further on what might have gone wrong until autopsies are conducted on the victims. 
   
   Each of the women had received a payment of 600 rupees, or about $10, to participate in the sterilization program, Mandal said. 
   
   The women were sent home Saturday evening after their surgeries, but more than two dozen were later rushed in ambulances to private hospitals after becoming ill. By Tuesday, eight of the women had died — apparently from either blood poisoning or hemorrhagic shock, which occurs when a person has lost too much blood, state deputy health director Amar Singh told the Press Trust of India news agency. 
   
   Twenty other women were in critical care, according to the district magistrate, Siddharth Komal Pardeshi. 
   
   "Their condition is very serious. Blood pressure is low," said Dr. Ramesh Murty at CIMS hospital, one of the facilities where the sick women were taken. "We are now concentrating on treating them, not on what caused this." 
   
   The state suspended four government doctors, including the surgeon who performed the operations and the district's chief medical officer. It also will give compensation payments of about $6,600 to each of the victims' families. 
   
   Chhattisgarh Chief Minister Raman Singh said "it appears the incident occurred due to negligence" by doctors. 
   
   The state's surgeons met Tuesday night to discuss whether to continue the state's sterilization schedule, with a target of 180,000 for the year ending in March set by the central government, Mandal said. He said the quota for Bilaspur district for the year was around 12,000. 
   
   A spokeswoman for the federal Health Ministry declined to confirm whether the central government was setting sterilization quotas for states. India's central government had said it stopped setting targets for sterilizing women in the 1990s. 
   
   Activists blame sterilization quotas for leading health authorities to pressure patients into surgery rather than advising them on other forms of contraception. 
   
   "These women have become victims because of the target-based approach to population control," said Brinda Karat of the All India Democratic Women's Association, while demanding that the state's health minister resign. 
   
   India's government — long concerned with fast growth in a country whose population has reached 1.3 billion — offers free sterilizations to both women and men who want to avoid the risk and cost of having a baby, though the vast majority of patients are women. 
   
   In many cases, they are offered a one-time payment for undergoing surgery of $10-$20, or about a week's pay for a poor person in India. Hundreds of millions of Indians live in poverty. 
   
   India has the world's highest rate of sterilization among women, with about 37 percent undergoing such operations compared to 29 percent in China, according to 2006 statistics reported by the United Nations. During 2011-12, the government said 4.6 million Indian women were sterilized. 
   
   ___ 
   
   Associated Press writers Indrajit Singh in Patna and Nirmala George in New Delhi contributed to this report. 
   
   ___ 
   
   Follow Katy Daigle on Twitter at twitter.com/katydaigle
target: – In a mass sterilization of 83 women in India on Saturday, a surgeon used infected instruments; now, 10 patients are dead and 69 others have been hospitalized, a local health official tells Bloomberg. "It's a case of negligence," says the chief minister of Chhattisgarh state, where surgeons are banned from conducting more than 30 such procedures daily. A reproductive rights activist in New Delhi uses starker terms: "Chhattisgarh was a culmination of no accountability in the system and when basic hygiene conditions aren't met," she says, adding that such circumstances are "commonplace." The doctor involved, RK Gupta, has been suspended amid a criminal investigation, says the state's chief minister. The district's top health officer says the deaths were a result of "infection causing septic shock" and that it's "too early to say that it was due to sterilization." All the women were poor villagers younger than 32, the AP reports. They were paid about $10 each to join the sterilization program, the state's chief medical officer says. The surgeries took place within a six-hour period. As the country works toward population control, sterilizations are voluntary. But amid events like single-day sterilization drives, India has the third-highest female sterilization rate in the world—and while 37% of married women have undergone the process, just 1% of men have had vasectomies, a national survey shows. Chhattisgarh state is aiming for 180,000 sterilizations for the 12 months preceding March, the chief medical officer says.