India population: Is sterilization the answer?

Every day, every minute, on trains and buses, on sidewalks and streets, the country squeezes and shrinks and sucks in its breath to push too many people into too little space.

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In large, economically depressed states like Bihar and Uttar Pradesh, an average woman still bears four children over her lifetime. This means India will surpass China to become the world's most populous country by 2030. The continuing swell threatens the environment and places a tremendous burden on government services.

The main worry? India's National Population Stabilization Fund has brought back controversial, incentive-based sterilization, among other initiatives aimed at reducing the birth rate.

While sterilization in and of itself isn't new to India, for the first time the country is outsourcing the work to private clinics — a move that has raised concerns about poor and illiterate women of rural India being pressured or fooled into going under the knife without fully understanding the risks, consequences and alternatives.

"When you create an incentive system, it privileges one solution over the other and encourages them to cut corners," Das said. "And we've had very bad experiences with that in the past."

That focus on sterilization has its own dangers.

Although activists pushed the Supreme Court to mandate minimum safety and quality standards for sterilization in 2005, there is no real monitoring mechanism to ensure that facilities adhere to the norms. Surgeries are no longer performed in cattle sheds. But Das said that infections and other complications are still common. All too often women die under the knife as tired surgeons rush through operations in hastily erected rural camps.

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