The number of babies born globally through caesarean section (C-section) almost doubled between 2000 and 2015, according to a series of three papers published in The Lancet Thursday, which also shows that India has had a major increase in the number of such deliveries. A Lancet series that tracks trends in C-section use across 169 countries found an increase of 3.7 per cent each year between 2000-2015, rising from 12 per cent of live births (16 million of 131.9 million) in 2000 to 21 per cent of live births (29.7 million of 140.6 million) in 2015.
While it is estimated that 10-15 per cent of births medically require a C-section due to complications, the series’ authors estimate that most countries used C-section above the recommended level. In at least 15 countries, C-section use exceeds 40 %, lead author of the series, Dr Marleen Temmerman, Aga Khan University, Kenya and Ghent University, Belgium said. In India, C-section uses increased from 9 per cent of births in 2005-6 to 18.5 per cent in 2015-16. Within the country, however, there were large differences between the rich and the poor, between the public and private sectors, and between regions. For instance, there were inter-state differences in the C-section rates in India ranging from 7 per cent in Nagaland to 49 per cent in Andhra Pradesh, according to the study.
There were also significant disparities within low- and middle-income countries, where the wealthiest women were six times more likely to have a C-section compared with the poorest women, and where C-section was 1.6 times more common in private facilities than public facilities.
When contacted, Dr Jaideep Malhotra, President of the Federation of the Obstetric and Gynaecological Society of India (FOGSI), told The Indian Express that while C-section rates have gone up all over the world, what is important is that in India, the overall caesarean rate is still about 18%. “There is no prescribed standard caesarean section rate and in the country there are two scenarios. One the caesarean rate is low in many remote areas, because of non-availability and there are few tertiary care hospitals where it is high, because of referral of high-risk cases,” he said.
He also pointed out that in India, trends regarding fertility are changing – women are marrying late, they are more career oriented and with delayed pregnancies, the birth preparedness is poor. He said there is generally a fear of pain and a lack of motivation to deliver normally in certain sections of the upper-middle and high-income group. However, in rural or semi-urban areas, there is a non-availability of doctors, anaesthetists, and paediatricians, and infrastructure is also lacking.