Lucknow. India, like the rest of the developed countries, is now witnessing the rising trend of Caesarean- section (C-section) deliveries and this trend is more pronounced in the private sector health services, but with interstate variations. Caesarean procedures vary from state to state in India with Jammu and Kashmir on the top of the list.
According to the latest round of National Family Health Survey (NFHS, 2015 (http://rchiips.org/NFHS/factsheet_NFHS-4.shtml) of India, 40.9% of deliveries in private facilities were through C-section whereas this was only 11.9% in government facilities. These numbers in NFHS-3 (2005-06) were 27.7% and 15.2% respectively. Thus, the gap in C-section rates between private and public facilities has widened from 12.5 percentage points to 29 percentage points over a decade. The rate of C-section in private sector is above 50% in 9 Indian states with Jammu & Kashmir (75.5%) reporting the highest. In public facilities, Telangana (40.3%) is the state reporting highest C- section deliveries.
Surprisingly, Uttar Pradesh and Bihar, who rank lowly in many human development indicators, are way ahead in regard to performance in C-section deliveries in government hospitals. In Uttar Pradesh, the deliveries which were done through C-section in public and private sectors is 4.7% and 31.3% respectively. Whereas in the case of Bihar these values are 31% for the private sector and 2.6% for the public sector. However, the reason behind such trend could not be conclusively stated.
The benefits accrued to the facility after C-section are longer hospital stays, but the problems associated with it are delayed breastfeeding and higher out-of-pocket expenses for the people. In neonates, it increases chances of respiratory morbidity
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2475575/), lower birth weight, and lower Apgar scores all of which have long-term consequences. The chances of subsequent C-section in other deliveries for the female also increases.
The factors that influence decision of C-section and that can be controlled are factors like rural/urban residence, religion, caste, wealth, state of residence, maternal education and height, birth level variables such as maternal age at birth, birth order (parity), size of the newborn, whether multiple birth situation, prior termination of pregnancy, whether previous birth was through C- section, utilization of antenatal care services and complications faced during pregnancy and delivery. Once these factors have been controlled the gap in C-section between public and private sector comes down to 19% form 29%.
To verify whether C-section was necessary or not NFHS-4 added the question on the time at which decision was taken to carry out C-section. It is believed that if the decision is taken before the onset of labor, it is believed to be required but if performed unscheduled it is generally looked upon as a farce. However, there is no evidence to prove it as in certain cases the complications arise after the
onset of labor.
1. Signore, Caroline (2008), “Neonatal Morbidity and Mortality after Elective Cesarean
2. KEY FINDINGS FROM NFHS-4. http://rchiips.org/NFHS/factsheet_NFHS-4.shtml
3. Ambrish Dongre, IIM Ahmedabad, [email protected]
4. Mitul Surana, IIM Ahmedabad, [email protected]