Asha says she didn’t even tell her husband that she was going to get sterilised. The 29-year-old domestic worker from the busy New Delhi suburb of Noida says she knew her husband and family would disapprove of her having the procedure. But she says that with the couple already struggling to feed the three children they have, she just didn’t understand why they wanted her to have another baby.
‘I never understood it,’ she whispers conspiratorially, even though we’re alone. ‘But my family said “What if your sons die? You’ll be left with nothing.” I heard this a lot.’
Asha is a resident of Uttar Pradesh, India’s most populous state with a population of 190 million and growing. With a total fertility rate of 3.8 (TFR being the average number of children a woman bears during her lifetime), the state is a perfect example of everything that’s wrong with India’s health infrastructure. It’s also an unlikely place for Asha’s ‘no more kids’ resolve.
As well as a high fertility rate, Uttar Pradesh has a worryingly high infant mortality rate of 67 per 1000 live births (twice the rate of the Maldives and more than 10 times that of the United States). It’s figures such as these that encourage families like Asha’s to want more children, to in effect hedge against possible future losses.
‘It’s the biggest bottleneck for family planning, the defining disincentive for small families,’ says Poonam Muttreja, executive director of the Population Foundation of India, a leading non-profit that’s based in New Delhi.
Under the guidance of Indian Health Minister Ghulam Nabi Azad, who seems to have brought to the role a genuine enthusiasm for reform, India has in recent months shown a delayed but welcome focus on the challenge of stabilizing the population.
Still, it’s a complex and emotive issue. To begin with, the sheer scale of the task of managing population growth in a country that now has 17 percent of the world’s population is extremely daunting. The task has been complicated over the years by the changing perceptions of population and family planning.
From the 1960s through much of the 1980s, the country’s rapidly growing population was considered a major obstacle toward equitable development, with India’s population growing from 360 million in 1951 to 1.02 billion in 2001. But in the post-liberalisation years of the early 1990s, the steady supply of human resources and a young population was instead hailed as a key strength in an otherwise greying global economy.