Every morning, street vendor Harish Kumar lays out his supplies of socks and underwear on the sidewalk outside the city's largest public hospital. People pour past him from the subway, bandaged or coughing or carrying infants. A legless man begs from his wooden trolley. Families camp under a huge tree, sometimes waiting days to be treated.
Above Kumar's head stands a two-story digital clock, with numbers that click every few seconds. One afternoon last week it read 998,439,901; at one point Friday, it had climbed to 998,499,510. The figures represent the population of India, ticking upward at an estimated rate of 33 a minute, 2,000 an hour, 48,000 a day.
According to some experts, India's population passed 1 billion this week, making it the only nation on the planet besides China to pass that milestone. Others, including government statisticians, calculate that the figure will not be reached until next spring. But as Kumar glances at the numbers ticking above his head, he shakes his head and thinks: This is already enough, this is already too much.
"It is very alarming for my country," said the 32-year-old peddler, who is married but has decided to postpone having children. "We are not rich like America. There are only so many schools, so many jobs. The system cannot support so many people. If India reaches 1 billion, it will make us a weak nation. We will all end up fighting over food."
A hospital security guard named Saqbal Singh joined the conversation. Every day he sees more and more diseased people coming to the hospital, he says, people who live in dirty and overcrowded conditions. But at least in the cities people are having fewer children now, he pointed out.
"In the villages, it is very different," he said. "They don't know about contraceptives, and they don't see that the more children they have, the more they spend. I have two children, but my uncle back in the village has 10. He's an elder, and it is not in our culture to discuss such things. How could I ever talk to him about this?"
Some Indians view reaching 1 billion, known in Hindi as 100 crore, as an opportunity for national celebration, an achievement that symbolizes strength in numbers. Last weekend, when India marked the 52nd anniversary of its independence from Britain, the government ran newspaper ads boasting of India's military might in defeating Pakistan during their recent border conflict in the Kargil region of Kashmir.
"Nothing is impossible when 100 crore Indians work together," the ads crowed. "That is the spirit of Kargil that we salute on this Independence Day." Together, it continued, "we shall overcome everything that stands between today's India and her rightful place among the great nations of the world." Below was the signature of Prime Minister Atal Bihari Vajpayee.
But among social workers, physicians, demographers and others who grapple every day with the effects of rapid population growth on a deeply impoverished nation whose numbers have nearly doubled in the past 30 years, the heady invocation of a "billion-strong" India seems both disingenuous and dangerously misguided.
Ashish Bose, a leading demographer, said he is extremely concerned about the slowly building impact of population growth on a country where 350 million people live in dire poverty, where 400 million are illiterate, where the amount of crop land per person has shrunk by half since 1960.
"Things are not hopeless, but we cannot underestimate the danger we face," he said, painting a bleak picture of water shortages and food riots in the coming years. "My worry is not with the 1 billion figure but with the explosion of urban growth and the basic maladies of a feudal, caste-ridden society. We had better to begin to tackle these problems now, or we will keep on producing these children."
Another who views the numbers with growing alarm is V.P. Reddaiah, who directs the Center for Community Medicine at the All-India Institute of Medicine, the place where the digital clock is ticking. Designed to treat 500 outpatients a day, the hospital is besieged with more than 7,000 a day, many suffering from such preventable diseases as infant diarrhea, tuberculosis and other respiratory infections.
"The population is growing so fast we have to run like Carl Lewis just to stay in place," Reddaiah said. In recent decades, he hastened to add, "there have been tremendous achievements. Malaria and smallpox have been eradicated. The birth rate has fallen from 42 to 27 per 1,000. So I don't despair. We are moving in the right direction, even if not at the right speed."
The question some experts pose, though, is why that speed has not been greater. India, a pioneer in family planning, has had birth control programs since the early 1950s, along with a vast public health and education system available at virtually no cost. Why has it not done a better job of keeping its population to a level it can afford?
The answers, it turns out, have more to do with culture and politics than with technology and infrastructure. In poor rural areas -- such as Bihar state, where women's literacy rates are lowest and family sizes are largest -- girls are often married by the age of 15 and pressured to produce children quickly -- especially sons who will one day provide for their elders and light their father's funeral pyre, a ritual central to Hinduism.
"Many women do not want large families anymore, but this is still a patriarchal society, where men make the decisions on reproduction," said Saroj Pachauri, who heads the local branch of the Population Council, an international nonprofit group. "Ask a woman in Bihar if she wants more children, and she will say no. Ask her if she is using [birth control], and she will also say no."
Government mismanagement and excess zeal have also set back the use of birth control among the rural poor. During the 1970s, the government of Prime Minister Indira Gandhi promoted mass sterilization and set rigid quotas that led to bureaucratic coercion and corruption. The backlash was such that even today, one expert said, politicians are reluctant to bring up the issue.
"Coercion doesn't work in a democracy; you can't just catch people and tie off their [fallopian] tubes," said Pachauri. Now, she said, the government has a more holistic, consensual family planning policy in place, but there are still millions of Indian women who know nothing about it.
Another obstacle is the popular notion, especially in the countryside, that more children mean more hands to work -- rather than mouths to feed -- and that larger clans mean mightier defenses. Reddaiah said many older Indians vividly remember the days when people "died like flies" from plague and smallpox and malaria -- an enormous incentive to repopulate.
Moreover, Indian history is rife with foreign invasions and domination, leaving the nation with a deep-seated insecurity complex. The recent victory in Kargil, in which India's armed forces crushed a Pakistan-based guerrilla force by their sheer size and weight, appears to have revived some of the historic sentiment for strength in numbers.
"After Kargil," said Bose, the demographer, "some people have asked me how I can preach family planning when we need to be militarily strong."
CAPTION: BILLIONS AND BILLIONS BORN (This graphic was not available)