Fertility targets: linkages between desire for sons and sterilization in India

ABSTRACT

Sterilization is the most widely used form of family planning in India with the burden of sterilization falling almost entirely on women. The existence of a strong son preference and a male-biased sex ratio are also well known in India. In this paper, we investigate the inter-linkages between female sterilization and the desire for sons in the country. Specifically, we examine the causal impact of a woman’s fertility targets for sons being met on her sterilization decision. To measure whether her fertility target is met, we utilize information on her actual versus ideal number of sons. Exploiting exogenous variation in the sex of the firstborn as an instrument in a conditional mixed process estimation, we find that meeting her fertility target for sons increases the probability of a woman’s sterilization by 25.4% points. Moreover, once she has had her ideal number of sons, the probability of getting sterilized within 4 years of getting married increases by 9.4% points whereas delayed sterilization becomes less likely. Our estimates are robust to alternative estimation strategies.

KEYWORDS:

• Sterilization
• fertility targets
• desire for sons
• instrumental variable
• India

JEL CLASSIFICATION:

• C36
• D1
• J13
• J16

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

¹ The Government of India shifted the focus of its family planning program from male to female sterilization in the 1980s and ever since, it has been the most accessed mode of contraception.

² In consonance with this, 92.8% of sterilized women in our sample report that they do not regret sterilization.

³ In the context of India, the cultural role of boys in last rites, important in the Hindu conceptions of freedom from cycle of birth and death encourage son preferences. Conceptions of continuation of “lineage” through sons are also contributors.

⁴ Links reproductive transitions, such as completing fertility and sterilization to women’s status in the household.

⁵ Further details regarding the National Health Mission and the Enhanced Compensation Scheme can be found at www.nhm.gov.in.

⁶ The DHS surveys for all countries are available at https://dhsprogram.com/.

⁷ See IIPS and ICF for more details on the survey methodology.

⁸ Oster (2019) also suggests that if a coefficient is stable after the inclusion of the observed controls, this can be taken as a sign that the omitted variable bias is limited.

⁹ Our measure of wealth is based on the wealth index provided by DHS which is a standardized measure of economic status for households in a given survey. The households are divided into poorest, poor, middle, richer and richest households by the DHS.

¹⁰ In India, bride’s parents are expected to transfer significant amount of assets in cash or as gifts to the groom and his family at the time of marriage. The prevalence of dowry poses significant additional marriage costs for girls’ parents (Rao 1993; Anderson 2003, 2007). Recent estimates suggest payments per marriage amounting to almost 4 to 6 times the annual household income.

¹¹ Sex selective abortion is the practice of terminating a pregnancy based on prenatal sex determination. Selective abortion of female foetuses is most commonly documented, where sons are preferred over daughters.

¹² Using the NFHS − 1 and 2, Bhat and Zavier (2003) documents that Indian parents prefer to have at least 2 kids.

¹³ While we recognize that our sample is too small to reject the hypothesis that sex ratio at birth is biologically normal, to accurately estimate the 95% confidence limits of the sex ratio, we would need a much larger sample. For further details, refer to (Chahnazarian 1988).

¹⁴ To eliminate any potential increases in wealth/assets that may be generated by a son, we only look at parents whose first child was born in 2010 or later. Given that the survey took place in 2015–16, this only restricts us to firstborns aged upto 6 years.

¹⁵ We control for parents’ age, education, religion, sex of household head, caste and state with standard errors clustered at district level.

¹⁶ For expositional purposes, we do not report the results from the various validity checks performed on our instrument. The results are available upon request.

¹⁷ A large number of sterilizations happen at or soon after delivery. Besides, in the camp approach, common around the time of the NFHS surveys when women in our analysis were sterilized, it is frequently seen that women were rounded up (Pant et. al., 2021).