The figure is from 2012. In order to keep in check the birth rate, forced tubal ligament is a top "contraceptive" method used in the country. Poor illiterate women are the most affected. In exchange for US$ 10, many accept to undergo the operation without knowing that they will become sterile. Yet, children continue to be born at a rate of about 18 million each year.

New Delhi (AsiaNews/Agencies) - A dozen tables next to each other, sheets stained with blood, doctors and nurses without coats, sometimes without protective masks, and tools only rinsed with hot water are the conditions in which 4.6 million women underwent sterilisation against their will in India last year in accordance with the government's birth control policies.

As part of such policies, vasectomies represent 4 per cent of all sterilisation operations performed. Instead, most forced sterilisations involve women in the poorest states in India. Bihar, which has the lowest annual per-capita income in the country and the highest illiteracy rate, leads the pack.

Often women are tricked into accepting tubal ligation. Recruited for birth control campaigns, actors go from village to village, offering women US$ 10, or about a week's salary for a poor family, in order to undergo this operation. In principle, it is a free choice but in practice the women are not told that they can no longer have children. Many agree only because of the extreme poverty in which they live.

"I did it out of desperation," said Devi, 25, as she lay on the concrete floor recuperating at the clinic in the state of Bihar. "We're so poor, we need the money. Health officials came to our home. They told us it would be best."

In Bihar, the authorities plan to sterilise 650,000 women and 12,000 men annually, according to the state health ministry. This year the state is planning more than 12,000 female sterilisation camps.

Women are the focus of the sterilisation drive because India has a patriarchal, male-dominated culture, said Sona Sharma, co-director of the Population Foundation of India, an advocacy group.

"Men fear they will lose their virility or they will become weak if they undergo the operation," Sharma said. "As the breadwinners they make the decisions."

According to United Nations data, 49 per cent of all couples in India practice birth control. Of that group, about three-quarters do so by having the wife sterilised.

India was the first country in the world to introduce a policy designed to reduce population, beginning in 1952 as hunger mounted in the years following independence.

When it comes to female sterilisations, India leads the world with 37 per cent, more than China (34 per cent).

Paradoxically, large-scale sterilisation campaigns have not had the desired effects. Even though the population grew by 17.6 per cent in the last decade, 4 per cent less than in the previous decade, on average 18 million more children are born each year. One in five babies born in the world starts life in India.

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