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Sikkim, which is located in the Himalayas and is surrounded on three sides by Nepal, Bhutan and Tibet, is visible in the diversity of the Indian state. It has the highest peak in the country. It is the largest producer of smoky black cardamom in the world. It also has the smallest population in India, barely three-quarters of a million people, and the lowest birth rate.
The latter distinction has left state leaders worried about the survival of the unique culture that Sikkim’s mix of ethnic groups, religions and geography has produced. And they took action.
While India as a whole, with 1.4 billion people and counting, will be the most populous country in history, the situation in Sikkim has become so dire that the local government is paying people to have babies.
These efforts reveal a demographic reality in India that is often overshadowed by its sheer scale. Population growth is uneven. Several countries in the north underdeveloped account for many. Other parts of India – especially the south, where incomes are higher and women are better educated – look like East Asia or Western Europe, with aging populations that are shrinking or will be in the coming years.
In Sikkim, the birth rate has declined, officials say, for a different reason: a lack of economic opportunities, which often forces men and women to find work outside the country, leading to early marriages.
Traditionally, women in Sikkim have enjoyed greater freedom than in many other rural areas of India, where they are often restricted to domestic labor and childcare. With a female labor force participation rate of 59 percent, higher than the national average of around 29 percent, young people are choosing careers over early marriage and having fewer babies.
Officials in the country want couples to have at least three children. Government statistics show that women there have an average of 1.1 reproductive years, less than the national rate of 2, and below the level of 2.1 needed to maintain a stable population without migration.
State officials said their own survey put the figure at 0.89, a rate higher than South Korea, the world’s most infertile country.
Countries have tried several measures to raise the birth rate, but with only limited success.
In Sikkim, the government is betting on a three-pronged strategy. Since August, it has been offering cash to childless citizens of reproductive age for in vitro fertilization treatment. It also offers couples with one child a monthly stipend of about $80 if they have more. And civil servants are offered a salary increase, a year’s maternity leave and even a nanny if they expand their family.
Much is at stake as birth rates have fallen sharply among all of Sikkim’s dominant ethnic groups: the predominantly Hindu Nepalis, the Lepchas and the Bhutias, both predominantly Buddhist.
“They have to see their culture disappear or lure people to have children to keep them alive,” said Alok Vajpeyi, an official at the Indian Population Foundation.
The social forces that guide people’s decisions to have children are difficult for governments to change. But Sikkim hopes that IVF will help those who want to have children.
The Sikkim government oversees a program that pays about $3,600 for the first attempt at IVF treatment and about $1,800 for the second attempt.
In offering IVF, the government had to contend with widespread stigma, including rumors that babies born through the therapy were made in “plastic boxes” or that the children were genetically someone else’s.
“We are not only fighting misconceptions and rumors but also trying to save our way of life,” said Shanker Deo Dhakal, a top official in the Sikkim chief minister’s office.
Since the policy was implemented, more than 100 couples have opted for IVF treatment, and more are applying every day. Officials say they are also spending more money to educate people about IVF through mass media campaigns.
Arpana Chettri, 40, a civil servant, has experienced the stigma directly. One morning, she was holding her 6-month-old daughter, singing a lullaby to her in Nepali at her home in Gangtok, the capital of Sikkim. She is on maternity leave for a year.
She gave birth after a second IVF procedure. “But now,” Ms. Chettri said, “the problem is that people ask, ‘Did you get a child after the injection?'” referring to the misconception that IVF babies are made in plastic tubes.
“How can I tell you that this is my baby? I got dozens of injections, and it hurt,” he said. “But they were inside me for nine months, not in the refrigerator.”
One couple, Yogesh and Rupa Sharma, jumped at the chance for Ms. Sharma to undergo a round of IVF treatment at government expense after five failed attempts.
Mr Sharma said he wanted to speak openly about his own family’s IVF experience to encourage people to “give it a try.”
“No child should ever feel so alone,” she said. “As the population is rapidly shrinking, only science can help us.”
Smita Sharma contributed reporting.
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