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The women were poor, from villages in central India where the promise of a few dollars is all but impossible to resist. Many had babies so young they were still nursing at their mothers’ breasts.

The deaths of 12 women after they underwent sterilization procedures this week have raised serious ethical questions about India’s drive to curb a booming population by paying women who get sterilized. The deaths also exposed the dangerous lack of oversight in India’s $74 billion health care industry.

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“We really are not paying enough attention to the quality of care in the public health system,” said Jay Satia, an adviser to the Public Health Foundation of India.

The surgeon who performed the operations at the government-run “health camp” in Chhattisgarh state plowed through more than 80 surgeries in six hours – a clear breach of government protocol, which prohibits surgeons from performing more than 30 sterilizations in a day, a top medical official said Wednesday.