Data across 15 states and Union territories in the National Family Health Survey released recently show that a disproportionately high number of babies are delivered by Caesarean section in the private sector — mostly double that of the government sector.

The figures range from 87.1 per cent of the deliveries in urban Tripura (against 36.4 per cent in government sector) to 25.3 per cent in urban Haryana (the figure in government sector is 10.7 per cent).
The family health survey otherwise shows up some encouraging statistics on health indicators.

While the data on delieveries over the past five years show a slight difference in figures for urban and rural areas, the trend of an abnormally high C-sec rate in the private sector is constant. WHO norms prescribe that C-sec deliveries should be ideally 10-15 per cent of the total.

In urban Telengana, 74.8 per cent of the private sector deliveries are by C-sec, against 75.1 per cent in rural areas. The figures for the government sector are 42.2 per cent and 39.5 per cent respectively. In urban Andhra Pradesh, the figures are 60.9 per cent and 31 per cent for private and government sector health institutions respectively. In rural areas of the state, they are 55.5 per cent in private and 23.7 per cent in the government sector.

In Haryana, the percentage of C-sec deliveries in the private sector is 25.3 per cent in both urban and rural areas.

In a statement issued on C-secs in April 2015, the WHO said: “Since 1985, the international healthcare community has considered the ideal rate for Caesarean sections to be between 10-15 per cent. Since then, Caesarean sections have become increasingly common in both developed and developing countries.”

While acknowledging that “when medically necessary”, a Caesarean section can prevent maternal and newborn mortality, the report notes, “Two new studies show that when C-sec rates rise towards 10 per cent across a population, the number of maternal and newborn deaths decreases. When the rate goes above 10 per cent, there is no evidence that mortality rates improve.”

In Andhra Pradesh, C-secs make up 40.1 per cent of the total deliveries, in Goa, the figure is 31.4 per cent, in Telengana, 58 per cent, and in Tamil Nadu, 34.1 per cent.

The C-sec figures for urban areas (including government and private) are higher, be it 45.8 per cent in Tripura, 36.6 per cent in West Bengal, 36.1 per cent in Tamil Nadu and 48.4 per cent in Andhra Pradesh.

Dr Jay Satia, professor emeritus at Indian Institute of Public Health, Gandhinagar, said, “As per WHO norms, anything above a total of 10-15 per cent C-secs in a population is abnormally high because this data does not pertain only to risky deliveries, it pertains to all deliveries in a population. So there is an indication that a lot of these C-secs are perhaps unnecessary. Hospitals claim clients went for this option and clients say they were advised to do so. There are many other countries, especially in Latin America, where unnecessary C-secs is a problem.”

Speaking on conditions of anonymity, a senior obstetrician at a private hospital said, “It is usually a medical call whether a Caesarean or a normal delivery is to be performed. However if the client does not want to go through intense labour pain or wants the baby on a particular auspicious date, it is possible that a C-sec is performed. However this is an exception rather than the norm.”