Why Is India Sterilizing Women Anyway?

India needs education and economic growth to control its population, not risky sterilization programs.

Indian fertility rates are dropping naturally.

Photographer: Chris Jackson/Getty Images

This week, 13 women in the Indian state of Chhattisgarh died while undergoing what ought to have been a routine, low-risk procedure for sterilization. The fact that these deaths -- at least 20 more women are in critical condition -- occurred in a government-run sterilization "camp" and not at the hands of unauthorized quacks has spurred understandable outrage. Chhattisgarh is ruled by Prime Minister Narendra Modi's Bharatiya Janata Party, and the opposition Congress Party has demanded the resignation of the state's chief minister and health minister.

In fact, what both opposition and BJP leaders should be asking themselves is whether the Indian government should be in the business of sterilizing women at all.

At 1.2 billion people, India is overpopulated. Among countries with more than 100 million citizens, India has the second-highest population density, behind Bangladesh. But the solution to the country's population "problem" -- which puts a stress on limited resources -- isn’t sterilization. It is education and prosperity.

Sterilization as state policy has a checkered history in India. It is associated closely with Prime Minister Indira Gandhi’s "emergency rule" between 1975 and 1977, when democracy was effectively suspended. Over 8 million Indians were sterilized during the period in exchange for money and other compensation (housing, for example). In some cases, sterilization was forced.

Though scaled back after Gandhi’s fall from power, the practice of offering incentives for women to be sterilized has persisted. For some women, especially those who suffer the burden of India’s patriarchal society, the procedure offers the only way to avoid having several children. But the financial incentives create perverse outcomes: Women are sometimes forced into undergoing the procedure so that their husbands can get the money.

In fact, India's fertility rates have been declining sharply for reasons that have nothing to do with sterilization programs. In 1971, the Indian average was 5.1 children per woman. That figure declined to 4.5 in 1981 and 3.6 in 1991; it now stands at 2.4, just above the level (2.1) at which a population stabilizes. Over that period, there has been no marked increase in sterilization programs; the government has focused more on building awareness about family planning and disseminating contraception. What has changed, especially after economic liberalization in 1991, are the living standards, rates of urbanization and education levels of the population.

The aggregate number conceals interesting statewide variations. Half of India’s 20 major states already have fertility rates under 2.1. Not coincidentally, most of these are among the country's more prosperous states: Punjab, Maharashtra, Karnataka, Andhra Pradesh, Tamil Nadu, Himachal Pradesh. Kerala and West Bengal, which have fertility rates comparable to Western Europe, are not among the richest states. But they boast indicators that suggest high educational attainment and greater empowerment of women. 

On the other end of the spectrum, the three states with the highest fertility rates are Bihar (3.5) Uttar Pradesh (3.3), and Madhya Pradesh (2.9).  (Chhattisgarh, where the tragic deaths took place, has a fertility rate of 2.7.) They are among India’s least prosperous states, with relatively poor indicators of education and women’s empowerment. Together they account for almost 400 million people, or a third of India’s total population. Unsurprisingly, they dominate the average number for the country.

The solution to India’s population problem lies in bringing education and prosperity to a handful of big states, concentrated in the northern part of the country. Even a young and growing population -- 66 percent of Indians are under 35 -- could produce a strong demographic dividend, as long as those citizens are educated, healthy and skilled. That's where the government should be focusing its efforts, not on ineffective and potentially dangerous sterilization programs.


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