According to the latest, one in two women going to a private hospital has a Caesarean section (C-section) National Family Health Survey (NFHS) Data,
The increasing trend in private medical facilities, which has seen an increase in such operations from 40.9% to 47.4%, has led to an increase in the all-India numbers – from 17.2% in 2014-2015 to 21.5% in 2019-2020. to NFHS-5. This means that one in five women who go to any medical facility, whether private or public, have a C-section.
When medically appropriate, C-section can effectively prevent maternal and perinatal mortality and morbidity. According to WHO, the ideal rate is between 10% and 15%. When the rate increases to 10% in a population, the number of maternal and neonatal deaths decreases. When the rate exceeds 10%, there is no evidence that the mortality rate improves.
There are many states and union territories where private hospitals perform seven or eight out of 10 deliveries via C-section. These include West Bengal (82.7%), Jammu and Kashmir (82.1%), Tamil Nadu (81.5%), Andaman and Nicobar (79.2%) and Assam (70.6%). While many of these states have had poor records in the past, there are many others that have seen a big boom in such surgeries.
These included Assam (up 17.3 percentage points to 70.6 per cent), Odisha (17 percentage points to 70.7 per cent), Punjab (up 15.8 percentage points to 55.5 per cent), Tamil Nadu (up 12.5 percentage points to 63.8 per cent) and Karnataka (up 12.2 percentage points to 52.5 per cent). Huh. , 26 states and union territories have shown an increase in private hospitals.
Deliveries in public hospitals have also increased, but this may be partly due to an increase in institutional deliveries in such facilities, which increased from 52.1 per cent in 2014-2015 to 61.9% in 2019-2020. The states with the highest jump in public health facilities are Sikkim (up 12.3 percentage points to 30.4%), Punjab (up 12.1 percentage points to 29.9%), Goa (up 11.6 percentage points to 31.5%), Chandigarh (up 10.9 percentage points to 30.4%) and Tamil Nadu (36% by 9.7 percentage points). Rates for public health facilities across the country increased from 11.9% to 14.3%.
At the other end of the spectrum is Bihar, which has only 3.5% of C-sections in public health facilities, reflecting its inability to provide critical care to prevent maternal and infant deaths.
Experts say there are different factors driving the growth in operations.
Younger birth of women, increase in in-vitro fertility and sedentary lifestyle of mothers are some of the reasons.
“There are factors of caregiver and hospital as well. Doctors practicing alone and giving birth to 20-25 babies in a month cannot stay awake at night, so they prefer to schedule the operation. As far as corporate hospitals are concerned, the high numbers are stressed and doctors who spend 20-30 days on 10 deliveries are discouraged,” said Dr Rinku Sengupta Dhar, consultant and head, maternity programme, Sitaram Bhartia Hospital says.
A location with fewer doctors and fewer caregivers has seen an increase in C-sections in public hospitals due to poor doctor-patient ratios and concentration of high-risk pregnancies.
Different interventions are needed for public and private hospitals as well as for different parts of the country, says Subhashree Balakrishnan, member, Common Health – a coalition for maternal health and safe abortion.
“C-section audit in public hospitals needs to be strictly enforced, while in the private sector there is a need to check widespread commercialization by regulating medical practices and costs. But there are also states where there is an unmet need for C-sections where they are needed to prevent maternal death and poor fetal outcomes. For example, in Bihar, only 3.5% have C-sections in public hospitals. Such states need overall improvement in health system such as more number of anesthetists and specialists, blood banks etc.
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