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Noni Raja was married in 2004 at the age of 20, then gave birth to a son a year later. After having two more children – a girl and a boy – Ms. Raja did something unexpected. She 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.” (Simon de Trey-White For The Globe and Mail)
Noni Raja was married in 2004 at the age of 20, then gave birth to a son a year later. After having two more children – a girl and a boy – Ms. Raja did something unexpected. She 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.” (Simon de Trey-White For The Globe and Mail)

STEPHANIE NOLEN

Why India’s acclaim for protecting reproductive rights rings hollow Add to ...

“There is no grounds to call [Indian policy] repressive,” says S.K. Sikdar, who heads the family-planning division at the national Ministry of Health in Delhi. “We learned our lesson [in the 1970s]. … This isn’t a population issue any more; it’s a mother-and-child health intervention.”

Energetic and driven, Dr. Sikdar insists that “we don’t have a two-child norm.” He says that the only message to women from government is about the benefit of having children later and at least two years apart.

“Our only intervention is to give people free access to [child] spacing. … I know our women are quite happy with what they have,” he says, adding that the government has had great success in delivering condoms and oral contraceptives directly to rural doorsteps – that kit of Ms. Raja should be replenished every month.

Many of the more punitive policies in place today have been set by state governments, but the two-child norm also applies to a number of benefits, such as nutritional support for pregnant women, that come from the national government. Dr. Sikdar acknowledges this, but he says that “low-performing states” (the poorest ones with highest fertility) are exempt.

That news has not reached Kamrora – or dozens of other areas where poor women, often Dalit, are denied access to school meals, clean-water schemes, the female-child bonus and the maternity-home payment because they have more than two children. All state family-planning programs are run on money from the central government.

A.R. Nanda, who was once in charge of population policy for India and established its family planning department, says that not only is there a two-child policy, it was explicitly borrowed from China: “The idea of withholding benefits comes from

China ... ‘If China can do it.’”

After taking its hard line in 1979, China saw its population growth fall sharply, and many in the Indian government were impressed. But they failed to grasp the basics of population science, Mr. Nanda says: “The highest drop in Chinese population came before the one-child policy; it came from equitable access to education, health care, including family planning, and a rise in income” following the communist revolution. From 1952 to 1979, China’s fertility rate was more than cut in half, falling to 2.75 children per woman from 6.5.

“If you want to emulate, emulate the positive,” Mr. Nanda says. “We ought to focus on equity.”

In the 1990s, he oversaw the adoption of a rights-based approach – only to see it quickly and quietly usurped by politicians who still believed that the key was to move fast and stop the “backward classes” from breeding.

India’s population is rising, but because of what demographers call “momentum growth.” Sixty per cent of Indians are of reproducing age. Even if tomorrow India attained “replacement level” fertility – if people had only enough children to replace themselves when they died – the country’s overall population would keep growing because the number of people being born will exceed those dying for several decades.

Despite alarms raised regularly in the media, fertility rates are, in fact, falling, and have been for two decades. In 21 Indian states and territories – including all of the more prosperous south – average fertility is at or below replacement level of 2.1 children per couple. The problem would take care of itself, says Dr. Das of the Centre for Health and Social Justice, if people in the high-fertility areas had access to jobs, education and, in the short term, condoms, birth-control pills and intrauterine devices.

Sterilization actually pushes population growth, he notes. “The largest amount of reproduction now is young women having their first and second children; sterilization does nothing to change this.

“The message [from government] is, ‘Have your children quickly and terminate your reproduction.’ When you give that message, you speed up the rate of delivery and you speed up momentum.” You wind up with even more reproducing adults.

When India’s policy was overhauled after Mrs. Gandhi, eliminating government-set targets for contraception and sterilization was seen as key to being less repressive.

But bureaucrats and health officials did little more than change their terminology.

“Targets and camps are back with a vengeance,” according to Mr. Nanda, saying he has seen officials who meet their targets handsomely rewarded by, for example, having a government car at their disposal.

In 2011, Shivraj Singh Chauhan, the chief minister of the state of Madhya Pradesh, announced a drive to sterilize 750,000 people a year. Those who underwent the surgery or brought in new recruits were entered to win prizes, including washing machines, DVD players, gun licences and a Nano, the ultra-low-cost Indian car.

Often sterilizations are done at breathtaking speed, with a doctor performing as many as 35 a day; rates of failure and complications are much higher than the international norm.

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