Introduction: A mass sterilization campaign took place in India at the height of “The Emergency” in 1976, during which 6.2 million men underwent vasectomies to limit population growth.
Methods: A comprehensive literature search of Pubmed, Google Scholar, and historical documents was done.
Results: The campaign of mass sterilization in India is best understood in the historical context of “The Emergency,” a controversial 21-month period from 1975-1977 during which Prime Minister Indira Gandhi declared a state of emergency, cancelling elections and suspending civil liberties. The perfect storm of recent war with Pakistan, food shortages, inflation, and political unrest laid the foundation for political instability.
Efforts to address economic and food crises caused in part by overpopulation were coordinated on the international stage. The World Bank gave India the largest amount of international aid for sterilization programs at $66 million USD from 1972-1980. International pressure, particularly from Western countries, was intense. US President Lyndon B. Johnson denied food aid to India in 1965, a time of critical food shortage, until it agreed to incentivize sterilization.
The aggressive coercion and politicization of the 1976 campaign has made it a striking part of India’s history. Officials believed that mandatory sterilization would contribute to poverty reduction and was thus critically important to fuel India’s economic growth. Vasectomy quotas were imposed for each state and people were forced to show proof of sterilization to receive their salary or medical treatment. Positive incentives were implemented in some states, paying nearly one month’s salary to be sterilized. Vasectomy camps and traveling clinics became common and efficient. At one point, camps in Uttar Pradesh, India's most populous state, were able to do 5,664 vasectomies a day.
Targeted populations included the poor, illiterate people, prisoners, and homeless men. Men were herded onto buses and taken to hospitals for vasectomies. There was no leniency for unmarried or childless men. There was no follow up care and it is estimated that thousands died of infection. After the Emergency, sterilization plummeted and the backlash of the aggressive campaign contributed to Indira Gandhi's ousting in the subsequent election.
Conclusions: Since 1976, the focus of sterilization in India has shifted to women. 4.5 million women undergo sterilization per year with half of the female population sterilized by age 35. Unfortunately, India’s history of government funded population control is not unique; other countries have their own dark history of compulsory sterilization.