Safe child birth? 41% of all deliveries in private hospitals are caesarian, 28% in urban India; WHO norm: 10-15%

By Rajiv Shah

A new research paper published in a prominent journal has raised the alarm that, while the World Health Organization (WHO), at a 1985 interdisciplinary conference on appropriate technology for birth, unanimously accepted a 10-15% caesarean section (CS) rate "as reasonable" to assist women to deliver safely in the face of complications, in India's urban areas it has reached a whopping 28.3% as against the national average of 17.2%.
Titled "Rising Caesarean Births: A Growing Concern", the paper, authored by a group of scholars led by Prashant Kumar Singh, a Max Planck-India fellow, Max Planck Institute for Demographic Research, Germany, shows that in urban areas the CS rate in Telangana is 63.2%, followed by Jammu & Kashmir (J&K) 53.1%, Andhra Pradesh 48.4%, Kerala 37.1%, West Bengal 36.6%, Tamil Nadu 36.1%, Himachal Pradesh 29.9%, Karnataka 29.6%, Gujarat 27.8%, Maharashtra 26.3%, and so on.

Suggesting that this is mainly due to privatization of the healthcare system, the paper says that in private health facilities, CS rate across India has reached a whopping 40.9% as against 27.7% a decade ago. As against this, in the public health facilities, the CS rate has actually come down from 15.2% to 11.9%. Here also, the figures culled out by the paper show, there is a sharp inter-state divide.
Thus, 75.5% of all deliveries in private facilities in J&K are through CS, followed Telangana 74.9%, West Bengal 70.9%, Andhra Pradesh 57%, Odisha 53.7%, Assam 53.3%, Tamil Nadu 51.3%, Himachal Pradesh 44.4%, Madhya Pradesh 40.8%, Karnataka 40.3%, and so on.
Overall, the paper shows, India has witnessed an increase of 102% in caesarean deliveries during the last one decade, from 8.5% in 2005-06 to 17.2% in 2015-16, which is marginally higher than the WHO standard, underlining, however, that "this could be attributed to the fact that the availability of CS facilities is relatively higher in urban areas than in rural settings."
Pointing towards inter-state imbalance in CS rate, and basing on data from the National Family Health Survey (International Institute for Population Sciences, 2017), the paper says, the CS rate is "highest in Telangana (58%) and lowest in Bihar (6%)", adding, as many as 20 states "recorded CS rates higher than 15%, and the trend during 2005-15 indicates that the CS rate has doubled in 16 states."
Noting that "in a few states the CS rates in public health facilities were higher than the national average —Telangana (41%), Jammu and Kashmir (35%), Kerala (31%), Tamil Nadu and Andhra Pradesh (26%)", the paper says, "An analysis of these trends revealed that during 2005-16, the CS rate in public health facilities had declined, but an increase was observed in the case of private health facilities across many states."

According to the paper, "In India, a very small section of women choose to have CS, being cognisant of the fact that vaginal delivery is an option. This phenomenon is termed as too posh to push' which is prevalent among educated, rich and urban women who want to avoid labour pain during childbirth and are convinced that CS is safer, faster and less likely to affect the quality of sexual life than vaginal birth."
As for the rural women who "uneducated, lack awareness and come from a low socio-economic strata of society, do not have any decision-making power about having a baby", the paper says, "physicians play a crucial role as they have to decide whether it should be a vaginal delivery or CS."
It adds, "This opportunity gives physicians a window to convert vaginal delivery to CS, as a CS procedure will enhance the physicians’ income or time spent in patient care. The fact that referring patients from a government hospital to a private facility for CS can earn commission for government doctors has also been reported."

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