State empowerment and reproductive control: develops the focus on gender and reproductive power set out in chapter 1 in the context of state institutions, ideologies and development actors in India. We see how women’s health is caught in a web of institutional governance, politics and workings of the development state but equally within a more international discourse on health system reform and rights-based discourse. We focus on development politics, language (of rights), institutional partnerships and actors (community health workers, CSO health workers, public health workers), their perceptions, practices, desires, moralities, agency to understand how reproductive ‘choice’ is framed and ‘rights’ become practiced within health systems. The chapter is primarily an exploration of why the state in India has been especially interested in reproduction and how it has exercised a bio-politics focused on fertility control. We consider the means by which fertility and health come together in state policy and, along with education and employment form a key site for development and the realisation of modernity. We also see how shifts in reproductive health policies from those focused upon fertility control to rights-based approaches in maternal health are a means to understand the changing nature of the Indian State itself. The role of civil society organisations and actors in shaping state–civil society relationships especially in the arena of health further exemplifies this.