Updated: November 26, 2021 7:24:10 am
ALMOST HALF of the deliveries in private institutions in the country were through Caesarean section. The percentage at private facilities has gone up to 47.4, according to data from the fifth round of the National Family Health Survey (NFHS-5), up from 40.9 per cent in the last survey (2015-16).
Overall, there has been a four-point rise in the number of C-sections in the last five years in the country. As against 17.2 per cent of C-section births (NFHS-4 2015-16), the fifth round of NFHS survey now pegs the figure at 21.5 per cent.
The rise in C-section births is not just limited to private health care facilities, but shows a 3 per cent rise in public health facilities as well. Across public health care facilities, the percentage of C-section births according to NFHS-5 data is 14.3 as against 11.9 per cent in the last survey.
The World Health Organisation (WHO) recommends that caesarean deliveries should not exceed 10-15 per cent of all deliveries in any country. The International Institute for Population Sciences, Mumbai, is the nodal agency of the survey. The fieldwork for NFHS-5 was done in two phases, from June 2019 till January 2020, and the second phase from January 2020 till April this year. Information was gathered from 6.36 lakh households, 7.24 lakh women and 1.01 lakh men.
According to NFHS-5 data, the overall percentage of C-section births in the last five years has shown a rise in Haryana (11.7 to 19.5 per cent), Jharkhand, (9.9 to 12.8per cent) Madhya Pradesh (8.6 to 12.1 per cent) and Odisha (13.8 to 21.6per cent), Punjab (24.6 to 38.5per cent) Tamil Nadu (34.1 to 44.9 per cent), Uttar Pradesh (9.4 to13.7per cent), Uttarakhand (13.1 to 20.4 per cent) Kerala (35.8 to 38.9 per cent), Maharashtra (20.1 to 25.4per cent) Goa (31.4 to 39.5 per cent), Gujarat (18.4 to 21 per cent) and Union territories like Chandigarh (22.6 to 31.3per cent).
Delhi has shown a slight dip from 26.7 to 23.6 per cent in C-section births. Mizoram has shown a reduction from 12.7 per cent in 2015-16 (NFHS-4) to10.8 per cent in the fifth round of the NFHS survey. Nagaland also shows a slight decrease in C-section births at 5.8 per cent (NFHS 2015-16) and 5.2 per cent in the latest round.
Dr K S James, Director of the International Institute of Population Sciences told The Indian Express that the ideal rate for caesarean sections should be between 10 per cent and 15 per cent. According to experts, the situation has become grim and the physician-induced demand can be controlled. “The rise in C-section deliveries in the government sector could also be due to complicated cases being referred to the public health facilities during the last stages,” Dr James said.
Dr Sanjay Gupte, former President of Federation of Obstetric and Gynaecological Societies of India (FOGSI) attributed this rising trend to various reasons, including late pregnancies, increasing use of reproductive techniques, more obesity and lifestyle changes and overall demand by patients to avoid complications.
“A crucial factor is neither the patient nor the doctor wants to take any risk as fear of complications can lead to legalities. According to guidelines in Western countries, for instance, even if there is an unfortunate death of the infant, then the doctor is legally protected. However, in our country there is a need for such authentic guidelines so that the government and judiciary can agree for protection towards the doctor in the event of medico legalities,” Dr Gupte told The Indian Express.
Dr Gupte also challenged set notions that the doctor earns more for performing a C-section vis-a-vis a normal delivery. “The cost varies according to the facility. The doctor does not stand to earn more for a C section, other charges are taken into consideration,” he pointed out. Usually, at a good facility, the cost of a C-section is between Rs 90-95,000, while a normal delivery is in the range of Rs 60-65,000.
A majority of states C-section births have indicated a significant rise in both private and public health care facilities. In states like Arunachal Pradesh C-section births have risen from 8.9 per cent to 14.8 per cent. At private healthcare facilities, 47.3 per cent of Caesarean births took place as against 37.5 per cent in the last survey. In the public healthcare facilities too, there is a five-point rise from 12.5 to 17 per cent.
Chhattisgarh also shows a similar trend with a rise in such births from 9.9 per cent to 15.2 per cent. In the private sector too, there has shown 57 per cent C-section births as against 46.4 per cent in the last survey at private healthcare facilities. In the public facilities, the rise is from 5.7 per cent to 8.9 per cent.
Across private facilities in Jharkhand, the percentage of C-section births was 39.5 per cent in the last survey, which went up to 46.7 per cent. Similarly in Madhya Pradesh, the rise is from 40.8 to 52.3 per cent in the private healthcare facilities, while the percentage of Caesarean births in Odisha has risen from 53.7 per cent to 70.7 per cent. Punjab saw 55.5 per cent C-section births up from 39.7 per cent in the private healthcare facilities while Tamil Nadu saw a rise from 51.3 per cent to 63.8 per cent in the private healthcare facilities.
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