Sterilizations and women health in India

Female sterilization is at the core of family planning programs in many developing countries, including India, where 37% of women older than 25 are sterilized. Emphasized advertisement and financial incentives for operations done in poor sanitary conditions have long raised controversies. We contribute to the decade long debate on the health effects of sterilization by analyzing several large scale surveys providing information on 800,000 Indian women. To address self-selection into sterilization, we control for location fixed effects and rely on an instrumental variable strategy. We exploit the fact that Indian households have different beliefs regarding child mortality risk and have a son preference. Sterilization increases when women have a boy first-born, but less so when they live in a historically malarious area, as they fear losing the boy; this situation provides an instrument. We show that sterilization deteriorates gynecological health and has no effect on nutrition indicators. Women with lower education, from scheduled castes, or having access to low-quality health care are more impacted. We also discuss the channels and interpret the effect as mostly driven by the surgery itself.