At least 11 women have died and 62 were hospitalized after undergoing sterilisation surgery at a government-run mobile health clinic in India, authorities said. Those killed and injured were among more than 80 women who had come to a “camp” for sterilisation surgery in Bilaspur district in the Indian state of Chhattisgarh, said R.K. Vange, chief medical health officer for the area. The women were each paid 1,400 rupees ($23) to undergo the procedure, CNN reported.

It’s part of a decades-long, government-wide initiative to curb population growth in the world’s second-most populous nation. The program is not forced or required, but reproductive health activists say it’s unethical. The sterilisations took place on Saturday, Vange said. Many of the women developed complications by Monday, with four different hospitals taking in patients. Six of the dozens being treated were in critical condition Tuesday, according to hospital officials. District officials have ordered an investigation and the results of autopsies are expected by Wednesday, Vange added.

Four local health department officials have been suspended in the wake of the deaths and hospitalisations, according to Chhattisgarh Chief Minister Raman Singh’s office. According to Dr. R K Gupta, the surgeon who performed Saturday’ssterilisations, 83 women had the surgery in six hours at the mobile clinic. He said Wednesday he was assisted by two other doctors. While deaths as a result of these sterilisation drives are not commonplace, activists hope this incident will urge the government to reevaluate its birth control initiatives and update basic health infrastructure in the country.

Human Rights Watch has condemned sterilisation drives by Indian health officials to curb population growth. Women are often paid or coerced to undergo surgery in unsanitary conditions. The group has urged India to focus more efforts on contraception and male vasectomies, which are far less dangerous procedures. “This is devastating news and this is certainly shocking to hear, but we cannot say we are totally surprised by this,” said Kerry McBroom, director of the Reproductive Rights Initiative at the Human Rights Law Network in New Delhi. “It was almost inevitable, given the unsafe, unethical and unhygienic conditions that persist throughout India in these camps.

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