Block Community Mobilizer (BCM) Pratima Kumari, 38, poses for a picture on her way back to the Community health centre in Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. Kumari, a government health worker, offers condoms and birth control pills for free in the Kishanganj district and talks to the couples about birth control and the benefits of having just two children in Kishanganj, which has the highest fertility rate of any district in India, soon to be the world's most populous nation. "The minute I tell couples to use condoms or suggest permanent birth control, they ignore it or just change the topic," Kumari told Reuters. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. TPX IMAGES OF THE DAY 

Block Community Mobilizer (BCM) Pratima Kumari, 38, Masera Khatun, 37, who is pregnant with her sixth child, ASHA (Accredited Social Health Activist) facilitator Shilly Kumari, 34, and Aliyara Khatun, 35, who is also an ASHA worker, talk about family planning and the different contraceptive methods available, outside Masera's house in Duadangi village, Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. Kumari, a government health worker, offers condoms and birth control pills for free in the Kishanganj district and talks to the couples about birth control and the benefits of having just two children in Kishanganj, which has the highest fertility rate of any district in India, soon to be the world's most populous nation. "The minute I tell couples to use condoms or suggest permanent birth control, they ignore it or just change the topic," Kumari told Reuters. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Women wait outside the operation theatre of a community health centre in Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. India's fertility rate fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "The state government's focus is to ensure that policy interventions percolate to the ground, its mechanisms such as free sterilisation, temporary birth control instruments are used actively," said Sanjay Kumar Pansari, director in the Bihar government's Directorate of Economics and Statistics. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Md. Wasim, 40, and his family place his wife Zamerun Nisha, 33, on a hospital bed after undergoing sterilisation surgery at a community health centre in Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. Just minutes after giving birth to her fifth child at a government clinic in Kishanganj, Zamerun, who is married to mason Md. Wasim, 40, said she would try to secure permission from her husband to undergo sterilisation before leaving for home, who later agreed to the procedure. "My body cannot take this pressure of having babies anymore," she told Reuters. "I have been lucky to survive each time." REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Zamerun Nisha, 33, gives birth to her fifth child at the labour ward of a community health centre in Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. Just minutes after giving birth to her fifth child at a government clinic in Kishanganj district, Zamerun, who is married to mason Md. Wasim, 40, said she would try to secure permission from her husband to undergo sterilisation before leaving for home, who later agreed to the procedure. "My body cannot take this pressure of having babies anymore," she told Reuters. "I have been lucky to survive each time." REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. TPX IMAGES OF THE DAY 

A nurse takes care of a newborn baby after the birth at a hospital in Kishanganj district, Bihar, India, March 20, 2023. India's fertility rate, fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "I talk to women while they are experiencing labour pain and nudge them to undergo sterilisation immediately after delivery," said Parvati Rajak, a medical officer in one of Kishanganj's seven government health centres. "But the final choice is always made by the family." REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

A nurse holds the feet of a newborn baby after it was delivered at the labour ward of a community health centre in Bahadurganj subdivision of Kishanganj district in the state of Bihar, India, March 21, 2023. India's fertility rate, fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "I talk to women while they are experiencing labour pain and nudge them to undergo sterilisation immediately after delivery," said Parvati Rajak, a medical officer in one of Kishanganj's seven government health centres. "But the final choice is always made by the family." REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Chandani Devi, 36, rests as her mother, Ranjana Devi, holds her newborn daughter at a hospital in the Kishanganj district, Bihar, India, March 20, 2023. India's fertility rate fell to 2.0 in 2019-21, just below the replacement rate of 2.1, but Bihar, one of India's least developed states, had the highest fertility rate of 2.98, estimating Kishanganj's fertility rate at 4.8 or 4.9 with some families expecting women to have at least five children, preferably sons. "For the fourth time I have had a girl...now I will wait for a few years before I try to have a boy," said Chandani Devi, 36, as she tried to fight back tears in a hospital ward after her delivery. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Sabina Begum, 22, sits in a wheelchair after she gave birth in the maternity ward of a community health centre in Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. India's fertility rate, fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "I talk to women while they are experiencing labour pain and nudge them to undergo sterilisation immediately after delivery," said Parvati Rajak, a medical officer in one of Kishanganj's seven government health centres. "But the final choice is always made by the family." REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. TPX IMAGES OF THE DAY 

Sabina Begum, 22, sits before giving birth to her child, at the labour ward of a community health centre in Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. India's fertility rate, fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "I talk to women while they are experiencing labour pain and nudge them to undergo sterilisation immediately after delivery," said Parvati Rajak, a medical officer in one of Kishanganj?s seven government health centres. "But the final choice is always made by the family". REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Zamerun Nisha, 33, lies down as a doctor checks the heartbeat of her child with an ultrasound machine, at the labour ward of a community health centre in Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. Just minutes after giving birth to her fifth child at a government clinic in Kishanganj, Zamerun, who is married to mason Md. Wasim, 40, said she would try to secure permission from her husband to undergo sterilisation before leaving for home, who later agreed to the procedure. "My body cannot take this pressure of having babies anymore," she told Reuters. "I have been lucky to survive each time." REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

A baby is seen at the neonatal intensive care unit of a hospital in the Kishanganj district, Bihar, India, March 20, 2023. India's fertility rate, fell to 2.0 in 2019-21, but State health officials estimate Kishangan''s fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "I talk to women while they are experiencing labour pain and nudge them to undergo sterilisation immediately after delivery," said Parvati Rajak, a medical officer in one of Kishanganj's seven government health centres. "But the final choice is always made by the family." REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

A woman gives water to a pregnant woman having contractions inside the maternity ward of a community health centre in Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. India's fertility rate, fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "I talk to women while they are experiencing labour pain and nudge them to undergo sterilisation immediately after delivery," said Parvati Rajak, a medical officer in one of Kishanganj's seven government health centres. "But the final choice is always made by the family." REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

A wooden board used to explain menstruation and the female anatomy is seen inside the counseling office of a community health centre in Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. India’s fertility rate, fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "The state government's focus is to ensure that policy interventions percolate to the ground, its mechanisms such as free sterilisation, temporary birth control instruments are used actively," said Sanjay Kumar Pansari, director in the Bihar government's Directorate of Economics and Statistics. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Zamerun Nisha, 33, holds her newborn baby as her sister Sanerum, 38, and her sister-in-law Zabinad, 15, keep her company at the maternity ward of a community health centre in Bahadurganj subdivision of Kishanganj district, in the state of Bihar, India, March 21, 2023. Just minutes after giving birth to her fifth child at a government clinic in Kishanganj, Zamerun, who is married to mason Md. Wasim, 40, said she would try to secure permission from her husband to undergo sterilisation before leaving for home, who later agreed to the procedure. "My body cannot take this pressure of having babies anymore," she told Reuters. "I have been lucky to survive each time." REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Patients wait outside a primary health care centre in Belwa village, Kishanganj district, Bihar, India, March 20, 2023. India's fertility rate, fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "The state government's focus is to ensure that policy interventions percolate to the ground, its mechanisms such as free sterilisation, temporary birth control instruments are used actively," said Sanjay Kumar Pansari, director in the Bihar government's Directorate of Economics and Statistics. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Women speak to health workers at a sterilisation camp set-up in a primary health care centre in Belwa village, Kishanganj district, Bihar, India, March 20, 2023. India's fertility rate, fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "The state government's focus is to ensure that policy interventions percolate to the ground, its mechanisms such as free sterilisation, temporary birth control instruments are used actively," said Sanjay Kumar Pansari, director in the Bihar government's Directorate of Economics and Statistics. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

A man walks past a free condom dispenser at a community health centre in Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. India's fertility rate, fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "I talk to women while they are experiencing labour pain and nudge them to undergo sterilisation immediately after delivery," said Parvati Rajak, a medical officer in one of Kishanganj's seven government health centres. "But the final choice is always made by the family." REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Pills and injections used as female contraceptive methods are seen on a table at the community health centre in Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. India's fertility rate, fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "The state government's focus is to ensure that policy interventions percolate to the ground, its mechanisms such as free sterilisation, temporary birth control instruments are used actively," said Sanjay Kumar Pansari, director in the Bihar government's Directorate of Economics and Statistics. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Block Community Mobilizer (BCM) Pratima Kumari, 38, looks at her phone while she eats before leaving for work, at home near Halim Chowk in Kishanganj district, Bihar state, India, March 22, 2023. Kumari, a government health worker, offers condoms and birth control pills for free in the Kishanganj district and talks to the couples about birth control and the benefits of having just two children in Kishanganj, which has the highest fertility rate of any district in India, soon to be the world's most populous nation. "The minute I tell couples to use condoms or suggest permanent birth control, they ignore it or just change the topic," Kumari told Reuters. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Block Community Mobilizer (BCM) Pratima Kumari, 38, walks across her terrace before leaving for work, at home near Halim Chowk in Kishanganj district, Bihar, India, March 22, 2023. Kumari, a government health worker, offers condoms and birth control pills for free in the Kishanganj district and talks to the couples about birth control and the benefits of having just two children in Kishanganj, which has the highest fertility rate of any district in India, soon to be the world's most populous nation. "The minute I tell couples to use condoms or suggest permanent birth control, they ignore it or just change the topic," Kumari told Reuters. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Block Community Mobilizer (BCM) Pratima Kumari, 38, and ASHA (Accredited Social Health Activist) facilitator Shilly Kumari, 34, wait for Aliyara Khatun, 35, who is also an ASHA worker, to get off a vehicle in Duadangi village, Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. Kumari, a government health worker, offers condoms and birth control pills for free in the Kishanganj district and talks to the couples about birth control and the benefits of having just two children in Kishanganj, which has the highest fertility rate of any district in India, soon to be the world's most populous nation. "The minute I tell couples to use condoms or suggest permanent birth control, they ignore it or just change the topic," Kumari told Reuters. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Masera Khatun, 37, who is pregnant with her sixth child, sits outside her house at Duadangi village in the Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. India's fertility rate fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "The state government's focus is to ensure that policy interventions percolate to the ground, its mechanisms such as free sterilisation, temporary birth control instruments are used actively," said Sanjay Kumar Pansari, director in the Bihar government's Directorate of Economics and Statistics. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

A nurse helps Zamerun Nisha, 33, breastfeed her baby at the labour ward of a community health centre in Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. Just minutes after giving birth to her fifth child at a government clinic in Kishanganj district, Zamerun, who is married to mason Md. Wasim, 40, said she would try to secure permission from her husband to undergo sterilisation before leaving for home, who later agreed to the procedure. "My body cannot take this pressure of having babies anymore," she told Reuters. "I have been lucky to survive each time." REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Mati Hasda, 40, who has seven kids, cooks food as she talks with one of her sons, at their house in Duadangi village, Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. India's fertility rate, fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "The state government's focus is to ensure that policy interventions percolate to the ground, its mechanisms such as free sterilisation, temporary birth control instruments are used actively," said Sanjay Kumar Pansari, director in the Bihar government's Directorate of Economics and Statistics. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

A goat grazes outside a community health centre in Bahadurganj subdivision of Kishanganj district, Bihar, India, March 21, 2023. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. 

Men sit next to a board displaying information about the different family planning methods available, during a sterilisation camp set up at a primary health care centre in Belwa village, Kishanganj district, Bihar state, India, March 20, 2023. India's fertility rate, fell to 2.0 in 2019-21, but State health officials estimate Kishanganj's fertility rate at 4.8 or 4.9, creating a population growth problem that the state is trying to curb with the distribution of condoms and birth control pills, as well as the paying 3,000 Indian rupees ($36.50) to women who get sterilised, 4,000 rupees to men, and 500 rupees per surgery to the health workers who perform them. "The state government's focus is to ensure that policy interventions percolate to the ground, its mechanisms such as free sterilisation, temporary birth control instruments are used actively," said Sanjay Kumar Pansari, director in the Bihar government's Directorate of Economics and Statistics. REUTERS/Anushree Fadnavis SEARCH "FADNAVIS POPULATION" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.