Blog Post

September 25, 2019 Vinay Joshi

The Rise of C-sections in India: A report from our India Country Manager

Vinay Joshi, spends a lot of his time with Indian neonatologists and pediatricians. As D-Rev’s India Country Manager and lead facilitator of our Newborn ECHO Tele-training, one of his primary focuses is to work with doctors to identify the barriers that prevent delivering the best healthcare to newborns in rural India. Recently, Vinay brought to the team’s attention a growing health concern in India – the rise of elective C-sections. With India making up about a fifth of the world’s population, this trend will not only impact the nation, but will require a robust response from the global health community as well.

Read Vinay’s full report below.

In 2005-2006 institutional deliveries (child births taking place in a health facility) in India were just 38.7%, rural institutional deliveries were even worse at 28.9%. Thanks to the sustained governmental efforts and awareness programs run by various different non-governmental organizations, the rate of institutional deliveries in 2015 stood at 78.9%. The rural rate also improved significantly to 75.1%. In addition, the availability of private hospitals even at the block level has also improved the rate of institutional deliveries (1).

However, as the institutional deliveries in India grew so did the rate of C-section deliveries. According to the medical journal, The Lancet, C-section deliveries in India during the same time period grew from 9% in 2000 to 18.5% in 2015. According to The Lancet, 10-15% of total deliveries may require a C-section procedure (2) (3).

While the number of reported C-section deliveries were a little higher than the average recommendation, private hospitals are opting for unnecessary C-section deliveries in India. The National Family Health Survey (NFHS) done in 2015 reveals that while 40.9% of total deliveries in private hospitals were C-section, this number stood at only 11.9% in public facilities.

This difference is even bigger if just a few northern and southern states are compared. According to NFHS 2015, Uttar Pradesh, Bihar, and Madhya Pradesh had C-section delivery rates at 9.4%, 6.2%, and 8.6% respectively. On the other hand, Kerela, Tamil Nadu, and Telangana reported C-section delivery rates of 35.8%, 34.1%, and 57.7% respectively (4). This is mostly attributed to the mushrooming of private hospitals in southern states, which are believed to be pushing for more expensive and sometimes unnecessary C-section deliveries.

The study conducted by Indian Institute of Management (IIM) Ahmedabad mentions that the biggest reason for more C-section deliveries at private hospitals is financial incentives- hospital charges almost double when parents opt for a C-section delivery (5). Normally C-section delivery is opted when there is a risk of maternal and perinatal mortality. However, it is becoming more popular in India to push for a C-section for personal reasons: the convenience of scheduling your delivery, avoidance of the unpleasantries associated with vaginal birth, and sometimes even to align the birth date according to auspicious dates.

However, C-sections pose a significant health burden on the mother and newborn if it is carried out unnecessarily. The newborn will often have delayed breastfeeding and higher chances of lower birth weight, respiratory illnesses, increased rate of hospitalization, and lower Apgar scores. In addition, mothers have a risk of infection, bleeding of lining of the womb and might develop problems in future pregnancies like low-lying placenta.

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