  Why do vaccination rates remain low even in countries where long-established
immunization programs exist and vaccines are provided for free? We study this
paradox in the context of India, which contributes to the world's largest pool
of under-vaccinated children and about one-third of all vaccine-preventable
deaths globally. Combining historical records with survey datasets, we examine
the Indian government's forced sterilization policy, a short-term aggressive
family planning program implemented between 1976 and 1977. Using multiple
estimation methods, including an instrumental variable (IV) and a geographic
regression discontinuity design (RDD) approach, we document that the current
vaccination completion rate is low in places where forced sterilization was
high. We also explore the heterogeneous effects, mechanisms, and reasons for
the mechanism. Finally, we examine the enduring consequence and present
evidence that places more exposed to forced sterilization have an average 60
percent higher child mortality rate today. Together, these findings suggest
that government policies implemented in the past can have persistent adverse
impacts on demand for health-seeking behavior, even if the burden is
exceedingly high.
