Sikkim, nestled in the Himalayas and surrounded on three sides by Nepal, Bhutan and Tibet, stands out in the teeming diversity of India’s states. It has the country’s tallest peak. It is the world’s largest producer of smoky black cardamom. It also has India’s smallest population, not even three-quarters of a million people, and its lowest birthrate.
That last distinction has state leaders worried about the survival of the unique culture produced by Sikkim’s blend of ethnic groups, religions and geography. And they are taking action.
While India as a whole, with 1.4 billion people and growing, will soon become the most populous country in history, the situation in Sikkim has gotten so dire that the local government is essentially paying people to have babies.
The effort points to a demographic reality in India that is often overshadowed by its sheer scale. Its population growth is highly uneven. A couple of states in the underdeveloped north account for much of it. Other parts of India — particularly the south, where incomes are higher and women are better educated — look more like East Asia or Western Europe, with aging populations that are shrinking or will be in the coming years.
In Sikkim, the birthrate has plummeted, officials say, for a different reason: a lack of economic opportunity, which often forces men and women to search for jobs outside the state, leading to marriages later in life.
Traditionally, women in Sikkim have enjoyed greater freedom than those in many other rural parts of India, where they are often limited to domestic labor and child rearing. With a female labor force participation rate of 59 percent, much higher than the national average of around 29 percent, young people are choosing careers over early marriage and are having fewer babies.
Officials in the state want couples to have at least three children. Government statistics show that women there are having 1.1 on average during their reproductive years, well under the national rate of 2, and below the rate of 2.1 needed to maintain a steady population without migration.
State officials say their own surveys put the figure at 0.89, a rate just above that of South Korea, the least fecund nation in the world.
Countries have tried a number of measures to raise birthrates, but have found only modest success at best.
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 is also offering couples with one child a monthly stipend of about $80 if they have more. And civil servants are being offered salary increases, yearlong maternity leaves and even a babysitter if they expand their families.
Much is at stake as birthrates decline precipitously among all of Sikkim’s dominant ethnic groups: the largely Hindu Nepalis, the Lepchas and the Bhutias, both mostly Buddhist.
“They have to either see their culture vanish or lure people to have more children to keep it alive,” said Alok Vajpeyi, an official at the Population Foundation of India.
The social forces that guide people’s decisions on having children are difficult for any government to change. But Sikkim’s is hoping that I.V.F. will help those who already want children.
Sikkim’s government is overseeing a program that pays about $3,600 for the first attempt at I.V.F. treatment and around $1,800 for the second attempt.
In offering I.V.F., the government must contend with a widespread stigma, including rumors that babies born through the therapy are made in “plastic boxes” or that such children are someone else’s genetically.
“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 office of the chief minister of Sikkim.
Since the policy was instituted, more than 100 couples have opted for I.V.F. treatment, and more are applying each day. Officials said they were also spending more money to educate people about I.V.F. through mass media campaigns.
Arpana Chettri, 40, a civil servant, has experienced the stigma firsthand. One recent morning, she was cradling her 6-month-old daughter, singing a lullaby to her in the Nepali language at her house in Gangtok, the capital of Sikkim. She is on a yearlong maternity leave.
She gave birth after her second I.V.F. procedure. “But now,” Ms. Chettri said, “the problem is people are asking, ‘Did you get the child after injection?’” referring to the misconception that I.V.F. babies are made in plastic tubes.
“How do I tell them this is my baby? I got dozens of injections, and it was painful,” she said. “But she was inside me for nine months, not in a refrigerator.”
One couple, Yogesh and Rupa Sharma, jumped at the opportunity for Ms. Sharma to undergo a round of I.V.F. treatment at government expense after five failed attempts.
Mr. Sharma said he wanted to talk openly about his own family’s I.V.F. experience to encourage people to “give it a try.”
“Childlessness can feel very lonely,” he said. “Because our population is shrinking fast, only science can help us.”
Smita Sharma contributed reporting.