March 4, 2021
India has had an established universal immunization program since 1985 and immunization services are available for free in healthcare facilities. Despite this, India has one of the lowest vaccination rates globally and contributes to the largest pool of under-vaccinated children in the world. Why is the vaccination rate low in India? This paper explores the importance of historical events in shaping India's current vaccination practices. We examine India's aggressive family planning program implemented during the period of emergency rule in the 1970s, under which millions of individuals were sterilized. We find that greater exposure to the forced sterilization policy has had negative effects on the current vaccination rate. We explore the mechanism and find that institutional delivery and antenatal care are low in states where policy exposure is high. Finally, we examine the consequence of lower vaccination suggesting that child mortality is currently high in states with greater sterilization exposure. Together, the evidence suggests that the forced sterilization policy has had a persistent effect on health-seeking behavior in India.