Noni Raja did just what she was supposed to do. She married when she was 20, in 2004, and gave birth to a son a year later. In 2006, she had a daughter. And a year after that brought the second son she needed to fulfill her obligations in the eyes of her in-laws, farmers with a tiny plot in this hardscrabble hamlet in the Indian heartland.
Everyone was pleased with her. Ms. Raja proceeded to find a job as a government health-outreach worker, and enjoyed the esteem that came with the $15 or so she brought the family each month.
Then Noni Raja did something rather less expected. She got up one day, caught a bus into Mahoba, the nearest town, and presented herself at the hospital for a tubal ligation.
She spent a couple of hours recovering, took the bus home and informed her startled in-laws that she had had “the operation.”
Years later, her mother-in-law is still affronted. “I didn’t like it,” Kiran Devi says as the two women sit in the spring sun on their front stoop. “She went against our wishes.”
At the time, Ms. Raja wanted the best for the children she already had, which meant ensuring there would be no more.
Being surgically sterilized seems an extreme form of contraception for such a young woman, but India’s approach to family planning left her with no other choice.
Even worse, her defiance would come back to haunt her.
India began grappling with the magnitude of its population even before it became independent in 1947; it was labelled a crisis in the 1970s when the government of Indira Gandhi carried out mandatory sterilizations, en masse.
But since those dark days, the country has emerged as a leader in the field, adopting the language of “reproductive health and rights.”
That means, in the words of the World Health Organization, that India is committed to ensuring its people have “the capability to reproduce and the freedom to decide if, when and how often to do so” – and that their decision be “free of discrimination, coercion and violence.”
This official position – which contrasts starkly with China’s strict one-child policy – has won India international plaudits; last year, it was invited to co-chair a prestigious international summit on family planning held in London, and feted for its progressive approach.
Yet spend some time talking to women in Kamrora – and dozens of villages like it in the “Hindi belt,” the poor states that span India’s middle bulge and are home to about 450 million people – and you learn something that never came up at the meeting in Britain: The policy this country has on paper is markedly different than what happens in real life.
The reality is harsh and repressive and targets the most marginalized, often the lowest-caste, women. It is also far from effective in areas with the highest birth rates, paradoxically driving the rate up and making poverty worse in the process.
Beijing has been widely criticized for limiting families to only one child, but India has adopted many aspects of its policy. With 1.2 billion people and on course to overtake China as the planet’s most populous country in about a decade, India is taking steps many consider nearly as harsh – but cloaking them in the far more benign-sounding “two-child norm.”
And despite all the government rhetoric about how its citizens have choices and condoms are brought right to village doorsteps, the truth is that, in the northern half of the country, the Indian health service consistently delivers only one form of contraception in the rural areas, where 70 per cent of the population lives.
That is tubal ligation, often performed at “camps,” where dozens of women are sterilized in a day; more than half of them are 25 or younger, and they are often illiterate and unclear about what the surgery means.
Unlike many women, Noni Raja knew exactly what she was doing when she got on the bus to the city: She has been trained in family planning, which she is charge of delivering in Kamrora, and is responsible for distributing a government-funded supply of condoms and oral contraceptives. It is the only access to birth control people here have, as most cannot afford a trip to the city. Yet, in a situation typical of India’s badly managed social schemes, it has been two years since Ms. Raja last received anything to dole out. Today, her kit contains one desiccated packet of prophylactics and an expired pregnancy test.
So, when a village woman confides that her in-laws have given her permission to stop having babies, Ms. Raja knows that the only option is sterilization. To make sure that she promotes it, the government pays her $3 for each woman she brings in – and, if she does not deliver as many as the government expects, she stands to lose the only wage-paying job in Kamrora, other than breaking stones in the quarry.