Police in India suspect a chemical found in rat poison may be linked to the deaths of more than a dozen women. (Reuters)

Police in India suspect a chemical found in rat poison may be linked to the deaths of more than a dozen women. (Reuters)

It has been three days since Gauri Bai saw her daughter-in-law, Rashmi, who became ill after a botched procedure at a mass sterilization camp in the district of Bilaspur on Saturday.

Rashmi, a 27-year-old mother of two, started vomiting and complaining of severe pain the day after she went to the camp, where she and dozens of other women were given tubal ligations by a doctor working at breakneck speed. Her family rushed her to the hospital Sunday evening, but they have been barred from seeing her since Monday and fear the worst.

“We suspect she’s already dead,” said Gauri Bai, 54. “We thought the government is running the program for the benefit of the poor, but they have cheated us. We want the guilty to be punished. They have destroyed my family. Who will take care of these little children?”

Public anger is running high in Bilaspur, in the central Indian state of Chhattisgarh, as authorities expand their investigation of Saturday’s tragedy, in which 13 women died and dozens more were sickened. Authorities said they raided two drug companies and began examining sterilization procedures carried out Sunday and Monday at two other camps where one woman died and others fell ill. Dozens remain hospitalized.

On Friday, the state filed a formal complaint against Mahawar Pharma, a Chhattisgarh-based manufacturer of the antibiotic medicines used at the camp, and its owner and his son were arrested on fraud charges.

A woman who underwent sterilization surgery at a government mass sterilization camp. (Anindito Mukherjee/Reuters)

Investigators, who said they are now operating on the theory that the drugs given to the women were tainted, are still awaiting further testing from tissue samples of the victims. Six of the drugs used in the camps have now been banned in the state, including the antibiotic made by Mahawar Pharma at its factory in the town of Raipur, authorities said.

At the same time, investigators are continuing to examine the possible criminal conduct of the doctor who performed the initial operations. The doctor, R.K. Gupta, was arrested Wednesday and charged with attempted culpable homicide and negligence.

“We cannot conclude anything at this point, but we are not ignoring the fact that the deaths happened at multiple camps, which indicates that there is some role of the drugs. One of the aspects is the criminal role of the doctor, who violated the procedures during the operations,” said Sonmani Borah, the divisional commissioner.

The tragedy has sparked a debate about whether the women were coerced or coaxed into having sterilization surgery and whether health workers trying to meet government targets pressured the women.

Although the national government has said since the 1990s that it no longer sets official targets for the number of women sterilized, Borah said the district family planning department was trying to reach its annual goals when it organized the mass drives in recent days. Each woman was given 1,400 rupees, or about $23, for the surgery. A “motivator,” usually a local public health worker, was paid 200 rupees, about $3.25, for each woman brought to the camp for surgery.

“The district family planning departments have annual targets, and they try to convince more and more people into these camps,” Borah said. “We will see if there was breach of protocol on the part of the officials.”

Gupta, the doctor who performed 83 surgeries in about six hours, told reporters he had been pressured to meet sterilization quotas given to him by local authorities.

Bilaspur, India

Yet Amar Agrawal, the state’s health minister, denied that the state had official quotas or targets, even as he took “full responsibility” for his organization’s failure.

“We plan on the basis of fertility rate in the area,” he said. “If the rate is high in a particular area, we plan and run programs to raise awareness for the public and conduct camps accordingly . . . The arrested doctor is desperately trying to shift the blame on others as he didn’t follow any guidelines.”

Sterilization is the most prevalent method of family planning in India, government data show, and the Ministry of Health and Family Welfare has often been accused of relying too heavily on the quick fix of sterilization as a method of birth control rather than on the pill, condoms or public education. Male sterilization remains rare, with women forming the vast majority of those being sterilized, statistics show.

“The incident has exposed the dire state of public health services, particularly in rural India,” said Meenakshi Ganguly, the South Asia director of Human Rights Watch.

Lalli Bai, 34, said she did not know how her sister Chaiti ended up Monday at another sterilization camp in Bilaspur that also is being investigated after 20 women became ill that night.

The women are part of the protected Baiga tribe, which has been exempted from the government-run sterilization program.

Lalli Bai said her sister underwent surgery Monday afternoon, then started vomiting and was in severe pain. The family took her to a local hospital, where she died Wednesday.

“She has only one daughter. We don’t know why she went for the sterilization,” Lalli Bai said. “We are devastated.”

Jalees Andrabi contributed to this report.