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‘Alarming’ trend of very high C-section births, says survey

The international healthcare community has considered the ideal rate for caesarean sections to be between 10 per cent and 15 per cent. When medically justified, a caesarean section can effectively prevent maternal and perinatal mortality and morbidity.

Written by Udit Misra , Nushaiba Iqbal , Anuradha Mascarenhas | Pune | Updated: December 15, 2020 2:00:31 am
C-sections delivery, Caesarean section, National Family Health Survey, NFH survey, Pune news, Maharashtra news, indian express newsC-sections have increased in the country in a majority of the 22 states according to NFHS -2019-20. (Representational)

There has been an increase in the number of Caesarean section (C-section) deliveries in a majority of states as per recent estimates of the National Family Health Survey 2019-20. States such as Telangana, West Bengal, Himachal Pradesh, and some in the northeast, have shown a jump in C-section deliveries, especially at private healthcare facilities, in the last five years.

The international healthcare community has considered the ideal rate for caesarean sections to be between 10 per cent and 15 per cent. When medically justified, a caesarean section can effectively prevent maternal and perinatal mortality and morbidity. However, an analysis shows that in most states, it is more than 50 per cent in the private healthcare facilities, Dr K S James, director of the International Institute of Population Sciences (IIPS), Mumbai, told The Indian Express.

“C-sections have increased in the country in a majority of the 22 states according to NFHS -2019-20. There has also been a rise in the number of institutional deliveries and a fall-out could be the increase in C-sections,” said Dr James.

Professor Usha Ram, from the department of public health and mortality studies at IIPS, added that motivation for making money, especially in the private healthcare sector, may be one reason for the sharp rise in C-section deliveries in India.

According to Prof Ram, there is another equally important aspect that needs to be understood: women find it convenient to avoid experiencing strenuous long hours of labour pain since the C-section technology is easily available and affordable to most. “It is also important to note that the family size in India has reduced substantially and the couple can afford to spend for C-sections for one or two deliveries, unlike previous times, without fear of any medical complications in the subsequent deliveries,” said Prof Ram.

The Union Ministry of Health and Family Welfare recently released the first set of findings from the fifth and latest round of NFHS conducted in 2019-20 . The first set of findings has been released for only 22 states and union territories and includes the large states of Maharashtra, Bihar and West Bengal. Data from Uttar Pradesh is not included.

NFHS 2019-20 data shows that in Maharashtra, 94.7 per cent of deliveries were institutionalised as against 90.3 per cent in 2015-16. C-section births rose from 20 per cent in 2015-16 to 25.4 per cent in 2019-20.

At private healthcare facilities in Maharashtra, at least 39 per cent of the deliveries were via C-section, according to NFHS data 2019-20, as against 33 per cent in 2015-16.

Telangana saw a jump in the number of births via C-sections from 74.5 percent to 81.5 per cent in 2019-20 in private healthcare facilities. West Bengal, too, noted a similar trend where the percentage of births via C-section at private healthcare facilities rose from 70.9 percent to 82.7 per cent in 2019-2020.

In Himachal Pradesh, at least 88 per cent deliveries were institutionalised, as against 76.4 per cent in 2015-16. Private healthcare facilities saw a rise in C-section births from 44 .4 per cent in 2015-16 to 51.4 per cent births via C-section in 2019-20.

The trend is observed in Jammu and Kashmir too, where institutionalised deliveries have increased from 85.4 per cent in 2015-16 to 92.4 per cent in 2019-20. At least 41.7 per cent deliveries via C-Section were at private healthcare facilities in 2019-20 as against 33.4 per cent in 2015-16.

In Karnataka, 31.5 per cent births were via C-sections in 2019-20 as against 23.6 per cent in 2015-16. At private health facilities, 52.5 per cent births were via C-sections in 2019-20 as against 40.3 per cent in 2015-16.

Kerala has registered 99.8 per cent institutionalised births and here too, there has been a slight jump in the number of deliveries via C-sections. As against 35.8 per cent births in 2015-16 via C-sections, in 2019-20, at least 38.9 percent births were via C-sections. The union territory of Ladakh saw a rise in the number of births via C-sections, from 16.1 per cent in 2015-16 to 37.6 per cent in 2019-20.

In Meghalaya, births via C-section at private healthcare facilities climbed from 31.4 per cent to 40.8 per cent in 2019-20.

In Manipur, too, there was a jump in the number of deliveries via C-sections, from 46.2 per cent to 53.2 per cent in 2019-20. Sikkim also showed a similar trend with births via C-sections, increasing from 49.3 per cent to 55.4 per cent in private healthcare facilities.

Notable exceptions to this trend were Lakshadweep, which saw a decline, from 38.4 per cent in 2015-16 to 31.3 per cent in 2019-20, while Nagaland also showed a decline in the number of births via C-sections at private healthcare facilities, from 31.5 per cent to 23.6 per cent in 2019-20.

According to former vice-president of the Federation of Obstetric and Gynaecological Societies of India, Dr Bharati Dhorepatil, the social pressure at times can be tremendous. “There are late marriages, with women in their late 20s or early 30s. The pelvis can get rigid during the pregnancy and due to safer techniques, there is also pressure from the families to get a C-section,” said Dr Dhorepatil.

Meanwhile, the Covid-19 pandemic has also resulted in an increased rate of C-section , say doctors.

At Jehangir Hospital in Pune, consultant gynaecologist Dr Nina Mansukhani, who has helped several Covid positive women with a normal delivery, said that due to the pandemic, a lot of patients have asked for C-sections.

“The pandemic has resulted in an increased C-section rate due to unnatural fears. There is a perception of a quick in and quick out of hospital, with a C-section,” observed Dr Mansukhani.

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