When sterilizations lower immunizations: The Emergency experience in India (1975–77)

In the 1970s in India, an aggressive family planning program resulted in more than eight million sterilizations in only a few months. Under the assumption that this extremely unpopular sterilization campaign may have shaped demand for health services, we study the effect of this event on children's immunization and hospital births. To account for possible non-randomness in coercion intensity, we use a difference-in-difference empirical strategy, which relies on the unexpected timing of the program and mother and village fixed effects. We show that an increase in district-wise sterilizations, compared to the previous period, led to a substantial decrease in the use of these services, especially vaccination. Further evidence supports a decline in trust rather than a change in health supply or valuation of children.