CREDITS: (PHOTO ARUN SANKAR/AFP/GETTY IMAGES; (GRAPHIC K. FRANKLIN/
SCIENCE
; (DATA NATIONAL FAMILY HEALTH SURVEY 4 2015 16/INTERNATIONAL
INSTITUTE FOR POPULATION SCIENCES; NATIONAL FAMILY HEALTH SURVEY 5 2019 21/INTERNATIONAL INSTITUTE FOR POPULATION SCIENCESSCIENCE science.org 17 DECEMBER 2021 • VOL 374 ISSUE 6574 1423China, where the population may be at its
peak, official figures put the fertility rate at
1.7 children per woman.
State-sponsored family planning re-
mains “the single most important
driver” of India’s drop in fertility, says
Srinivas Goli, a demographer at Jawaharlal
Nehru University. More than 55% of
couples use modern contraceptives, the
latest NFHS survey found. Of these, one-
fifth use condoms and one-tenth the pill.
But sterilization of women, generally in
government-run clinics, accounts for two-
thirds of all contraception.
Sterilization has a checkered past in In-
dia. During the mid-1970s, Gandhi allowed
states to operate compulsory sterilization
camps. An estimated 19 million people
were sterilized, three-quarters of them
men. The program’s unpopularity helped
bring down Gandhi’s government in 1977,
says Monica Das Gupta of the Maryland
Population Research Center.
Das Gupta says sterilization was com-
pulsory for only 2 years, after which the
government relented and “never went
back.” Today, government sterilization clin-
ics are chiefly aimed at women; just 0.5%
of contraceptive use is male sterilization.
On average, sterilization is performed on
women in their mid-20s who have already
borne children, says epidemiologist Tim
Dyson of the London School of Economics.
Some states offer payments of up to $15 for
women to be sterilized, and Das Gupta says
“mindless allegations” of coercion still sur-round sterilization. But she argues finan-
cial incentives are not coercion, noting that
such incentives “are routinely used across
the world for innumerable purposes.”
Dyson says declines in death rates in chil-
d r e n u n d e r a g e 5 — f r o m 2 4 1 p e r t h o u s a n d i n
1960 to 34 per thousand today—have made
women more receptive to family planning.
That allows all families, including those
who are poor and uneducated, to assume
that every child is likely to grow up.
And education is playing an ever big-
ger role in encouraging smaller families.
In the 1960s, about 90% of Indian women
were illiterate, but by the 2011 census il-
literacy had fallen to 35%, concentrated
among older women. In the decade after2005, better education contributed 47%
of the fertility decline, according to an
analysis by Milan Das, a research scholar
at the International Institute for Popula-
tion Sciences. “Women’s aspirations have
changed,” Muttreja says. They look beyond
the home for job opportunities and delay
marriage and childbearing. “Education is
the best contraceptive.”
The strikingly different fertility rates
in different regions of India reflect the
role of education, says EM Sreejit of the
International Planned Parenthood Fed-
eration in South Asia. Kerala in the south,
which has the country’s highest literacy
rate, achieved replacement fertility back
in 1988. Bihar in the east, with the lowest
literacy rate, won’t get there until 2039,
the government’s National Commission on
Population predicted last year.
Some Indian politicians still talk of a
population explosion and have proposed
banning people with more than two chil-
dren from government employment or, in
Uttar Pradesh, even withholding welfare
benefits. Critics say such rhetoric is of-
ten subtly aimed at the country’s Muslim
minority. Muslim women on average had
0.5 more children than Hindus, according
to the 2015–16 NFHS survey.
But religion is a small factor in fertil-
ity today, Muttreja says. “Hindus in Uttar
Pradesh, for example, have a much higher
fertility than Muslims in Kerala. There is
no Hindu fertility or Muslim fertility.”
How low could India’s fertility go? Goli
says the Indian states that reached low fer-
tility first have “stalled at 1.6 to 1.9 children
per women.” In contrast, “Highly educated
couples in urban areas typically average
1.2 or 1.3,” on par with the lowest rates
seen in Europe and East Asia. “If the coun-
try continues to pursue women and girls’
empowerment policies, this can push the
country to ... 1.4 or below,” he says.
This would have a massive impact on the
country’s future size. The United Nations’s
2019 population projections for India sug-
gested it will rise to 1.64 billion by 2050 be-
fore falling to about 1.45 billion by century’s
end. But some demographers say a steep
drop in fertility could drive a much faster
decline and lead to an imploding economy.
That idea is controversial. Still, as India
dips below replacement fertility, demo-
graphers are now arguing less about how
scarily high its population might get and
more about how scarily low it could go. jFred Pearce is a journalist in London.A mother and her newborn in Chennai, India.
With better health care in the nation, more babies
today grow to adulthood.Steadily shrinking families
Rural women in India tend to have more children than
urban women, but both groups have steadily lowered
fertility rates.1990–
19921996–
19982003–
20052013–
20152019–
202101234Fertility rate (children per woman)Rural Urban