No government in India has successfully formulated policies to manage the country’s human population growth, which stands at 1.6% a year, down from a high of about 2.3% in the 1970s.

In that decade there were aggressive sterilisation campaigns, mainly targeting men, and these have stigmatised family planning ever since.

India is forecast to become the world’s most populous country in 2030, up from 1.25 billion today to nearly 1.5 billion.

Teaching poorly educated women in remote communities how to use pills or contraceptives is more expensive than the mass sterilisation campaigns, and despite successive years of economic growth, governments have systematically chosen the cheaper option.

India, therefore, has one of the world’s highest rates of female sterilisations, with about 37% of women having the operations, compared with 29% in China, according to the UN. About 4.6 million Indian women were sterilised in 2011 and 2012, according to the government.

Only a tiny fraction of men choose to have vasectomies. Male sterilisation is viewed as culturally unacceptable in India’s conservative society, experts say.

Incentives vary, however in the central Indian state of Chhattisgarh – where 14 women have died recently and more 20 are in intensive care after surgery at two government-run sterilisation camps – women were supposed to get about 1,400 rupees (£14), for having the operation, equivalent to nearly two weeks wages for a manual labourer. That is a substantial sum in the very poor communities where the campaign is often focused.

Some incentives have been more generous. But health advocates worry that paying women is dangerous. “The payment is a form of coercion, especially when you are dealing with marginalised communities,” said Kerry McBroom, director of the Reproductive Rights Initiative, at the Human Rights Law Network, in New Delhi.

However, Pratap Singh, commissioner of Chhattisgarh’s department of health and family welfare, insisted the state’s sterilisation programme was voluntary.

One key question is whether quotas are being set, at national, state or district level. Local officials in Chhattisgarh say they were set a target by central government of 220,000 sterilisations a year, including 15,000 in Bilaspur, the district where the botched surgeries took place.

But health officials in Delhi said no such targets for sterilising women had been set since 1998. Both may be telling the truth. “The government of India denies that there are targets but it’s a matter of semantics. At a local level they simply call them expected levels of achievement,” Sona Sharma, joint director for advocacy at the Population Foundation of India, New Delhi, said this week.

Though large numbers of young people can be an economic advantage, a combination of unfulfilled aspirations, scarce land and water, overcrowding in growing cities, as well as inadequate infrastructure could lead to social tensions and political instability.

One further problem is a gender imbalance, arising from selective abortion of girls or their murder immediately after birth. In some communities there are fewer than eight women for every 10 men, with the ratio skewed even further among younger people.

Experts point out that the population control strategy is linked to a series of other problems relating to discrimination against women and marginalised communities. In Indian states where female literacy is higher the fertility rates are lower.