Sabamma, 20, lies in a medical clinic in southern India’s boomtown city of Bangalore, waiting to be sterilized.
Five months earlier she travelled from her village to give birth to her second child. Now, Sabamma, who uses just one name, is back in the city for a surgical tubectomy that will provide permanent contraception for her and her husband.
Sterilization is the preferred form of birth control among rural Indian couples and the women don't have much say.
“He asked me to get it done,” she says of her laborer husband. “Husbands do not answer when you ask why they do not want to get it done. It’s the case everywhere."
This kind of sterilization is at odds with Bangalore’s image of a modern and fast-developing city. As India's biggest information technology exporter and third biggest metropolis, Bangalore is a city of the future, named by Forbes magazine as one of the top 10 fastest growing cities of the coming decade.
At the Vani Vilas government hospital in downtown Bangalore, more than 2,800 sterilizations have been performed on women in the last three years and none on men, Madhusudan Das, a medical officer at the hospital, said.
All 2,800 operations were tubal ligations or tubectomies, a surgical procedure in which the fallopian tubes are blocked or tied to prevent fertilization of female eggs.
Nationwide, the gender disparity is glaring: more than 10 million women were sterilized from 2006-10, while just half a million men were given vasectomies, reported India's Rural Health Mission.
India's National Planning Commission reports that female sterilization is the most common method of family planning.
There are no medical reasons that favor female sterilization over vasectomies as a method of birth control. It's more expensive, more complicated, and riskier than condoms or birth control pills.
Shiva, a farm worker from Golahalli village about 15 miles from Bangalore, said it's a matter of custom.
“I prefer that my wife undergoes the operation. I know it is painful but that’s how it has always been in the villages around here,” he said. "Why disturb things the way they are?”
India's 2005-06 National Family Health Survey found a strikingly low use of non-surgical forms of contraception. Of 124,000 rural and urban women aged 15-49 surveyed: 2 percent used intra-uterine devices, 3 percent used the contraceptive pill and 5 percent used condoms. Only 1 percent of the women had husbands who underwent vasectomies, while 37 percent of the women had been sterilized.
From 2006-10, nearly 100 times more women than men were sterilized in Karnataka state, of which Bangalore is the capital, states India's National Rural Health Mission, which collates data from health clinics in villages and cities. While 1.2 million women underwent tubectomies, 14,000 men underwent vasectomies in Karnataka.
The gender disparity exists despite the availability of non-scalpel vasectomies, which take only 36 hours to recover from. Tubectomies require several days' recovery.
The non-scalpel vasectomy procedure isn't widely known.
“If the public is not aware, how will they know about the non-scalpel vasectomy camps?" said Das, referring to vasectomy drives across Karnataka's villages and cities.
Lakshmamma, a domestic worker also from Golahalli, was sterilized four years ago. It took her three months to recover.
“It was painful," she recalled. "It is unfair in some ways. But what to do? What if something had happened to my husband during the surgery? Who would have fed us then?”
Health officials say they encourage non-surgical forms of contraception but must respond to demand for permanent solutions.
The government provides compensation payments for sterilization to poor couples living on less than 60 cents a day. Men get $21 -- 1,000 rupees -- nearly double the $11 awarded women.
"People don’t want to use temporary methods," said C. Anbalagan, senior regional director of Karnataka's Department of Health and Family Welfare. "They may not have a condom but they cannot stop their desire."
Sterilization is a viable, one-off alternative to less reliable forms of contraception, he said.
India boasts one of the earliest national government-sponsored family planning programs in the developing world. Since the early 1950s the national network of state-sponsored health clinics have offered birth planning information.
But gender inequality rooted in cultural norms contributes to a bias against vasectomies in favor of female sterilization. Cultural perceptions of manhood are at play.
“We’re a traditional society. Men tend to believe that if they go for the surgery it may bring down their status,” said Christopher Hoskins, a sociology professor at Bangalore's St. Joseph's College.
The absence of men from family planning seminars is indicative, said the head of the Bangalore branch of India's Family Planning Association, Rekha, who uses only one name.
“Whenever we have a family planning program, men usually don’t participate," Rekha said. "They think bearing the child, rearing the child, everything to do with children is the woman’s responsibility.”