These photos and related videos also appear in Retro Report: "A Journey through India: The Legacy of Population Fears."
Fertility rates remain high in Bihar, a northern state in India that has also lagged in development. Literacy rates are low, and infant and maternal health is worse than in other regions of the country. The family planning program remains centered on sterilization, and access to different birth control options can be limited in rural areas—access even to sterilization can be limited to sterilization camps, where often dozens of women will undergo the procedure in one day. Doctors point to an underfunded health system that lacks the resources to provide consistent and quality care to women.
In the south, meanwhile, where literacy rates are higher, and maternal and infant health better, fertility is also lower. In Tamil Nadu, a history of social welfare programs has helped address issues like school attendance, nutrition, and maternal health. Infrastructure developments have connected rural areas to urban centers through roads. Electricity projects have brought power—and with that, televisions—to even the most outlying areas. All those factors, experts say, can have an impact on fertility rates.