A state-run mass sterilization program in India has resulted in the deaths of nine women and sent another 64 to the hospital for complications.

Media outlets across India flashed graphic scenes of women being loaded into ambulances and crowding emergency rooms. A doctor and his team performed 83 tubectomies over the course of five hours in a "family planning camp" in the city of Bilaspur in the eastern state of Chhattisgarh. This led medical and women's advocates to say the procedures were negligently done and unduly rushed in conditions that were not hygienic.

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The exact causes of the fatalities have yet to be determined.

"Preliminary examinations suggested that hypovolemic shock or a septic infection may be the cause of death," said Amar Singh, deputy director of health services, adding that a detailed autopsy report would reveal the exact reason behind the deaths.

The medical staff at the camp denies any wrongdoing, but Chhattisgarh Chief Minister Raman Singh on Tuesday launched a probe, and suspended four doctors involved with the program after Indian Prime Minister Narendra Modi was made aware of the incident.

"There was no negligence. He is a senior doctor," said the chief medical officer of Bilaspur, R.K. Bhange, told the Indian Express Daily newspaper of the doctor at the center of the scandal.

All the women involved were from nearby villages and came down with symptoms within 24 hours of their procedures. In India and throughout South Asia, birth control for both women and men is often considered against their religious beliefs, particularly in rural areas. Many women, after bringing several pregnancies successfully to term and not wanting more children, quietly opt for sterilization rather than refuse their husband's sexual advances. 

According to figures from New Delhi, more than 4 million sterilizations were done in India between 2013 and 2014. Between 2009 and 2012, 568 deaths occurred from sterilization procedures.

The deaths have brought the Indian sterilization "industry" into sharp focus. While none of the patients were forced to go to the camp, the 83 women who underwent tubectomies received incentive payments of 1,400 rupees (about $23) to have the surgery, according to Bhange. Health workers also got 200 ($3.25) rupees for bringing a woman to the camp.

Concern was also expressed by the United Nations.

"If the facts are confirmed, then a grave human tragedy has occurred," said Kate Gilmore, deputy executive director of the U.N. Population Fund. "Where there is deviation from clinical standards, there must be consequences."

Tagssterilization, Bilaspur