A study by the Indian Institute of Technology Madras found that there was a rise in the number of Caesarean sections (C-section) between 2016 and 2021 in the country. This, despite a drop in medical complications during pregnancy.
The chances of a delivery through C-section were greater if a woman gave birth in a private hospital, the study revealed. Also, overweight and older women (aged 35-49) were more likely to have C-section deliveries.
The institute’s Department of Humanities and Social Sciences conducted the research in Tamil Nadu and Chhattisgarh. The researchers included Varshini Neethi Mohan and P. Shirisha, research scholar Girija Vaidyanathan and a professor in the institute, V. R. Muraleedharan.
The findings were published in the peer-reviewed journal BMC Pregnancy and Childbirth.
A C-section delivery, a surgical procedure, is generally recommended to save the life of the mother and the unborn infant. When not strictly necessary, however, it can cause several adverse health outcomes, lead to unnecessary expenditure, and place a strain on scarce public health resources, earlier researches have proved.
Factors that could contribute to adverse birth outcomes and possibly justify C-sections (such as the mother’s age being less than 18 years or greater than 34 years, the interval between births being less than 24 months or the child being the fourth or more born to the mother) are considered high-risk fertility behaviour.
In an in-depth analysis of Tamil Nadu and Chhattisgarh, the researchers found that though pregnancy complications and high-risk fertility behaviour were more prevalent in Chhattisgarh, C-section was more prevalent in Tamil Nadu.
Prof. V. R. Muraleedharan said, “A key finding was that the place of delivery (whether the delivery was in a public or a private facility) had the greatest impact on whether delivery was by C-section, implying that ‘clinical need’ factors were not necessarily the reason for surgical deliveries.
Across India and Chhattisgarh, the ‘non-poor’ were more likely to opt for C-sections, while in Tamil Nadu, the case was surprisingly different, as the poor were more likely to have C-sections in private hospitals.”
The prevalence of C-sections across India increased from 17.2% to 21.5% in the five years leading up to 2021. In the private sector, these numbers stand at 43.1% (2016) and 49.7% (2021). It meant that nearly one in two deliveries in the private sector is a C-section.
WHO recommendation
The World Health Organisation recommends that only 10% to 25% of deliveries can be through C-section.
The increase could be attributed to several factors, the study noted. Better educated women living in urban areas were more likely to deliver by C-section, suggesting that greater autonomy and better access to healthcare facilities play a role in the increase in prevalence of C-sections.
“The odds of a caesarean delivery among overweight women and those aged 35-49 were twice those for underweight women and those aged 15-24, respectively. The proportion of overweight women giving birth increased from 3% to 18.7%, while that of women aged 35-49 decreased slightly from 11.1% to 10.9%,” the study said.
The proportion of those with pregnancy complications fell from 42.2% to 39.5%, implying that the increased rate of C-section delivery was largely influenced by non-clinical factors. Women’s own preferences, their socio-economic level and education, and risk-averse physicians practising conservative medicine could be some of these non-clinical factors.
During the study period it was noticed that women delivering at private healthcare facilities were four times more likely to have a C-section. In Chhattisgarh, women had 10 times higher chance of delivering by C-section in a private hospital while in Tamil Nadu, they had a three-times higher chance.
Inadequate infrastructure
This could be due to a lack of adequate infrastructure in public healthcare facilities, the researchers highlighted. In Chhattisgarh, there was a 77% vacancy against the sanctioned posts for obstetricians and gynaecologists in 2021.
To arrive at the above conclusions, the researchers collated and analysed data from the National Family Health Survey (NFHS) conducted in 2015–2016 and 2019-21. The NFHS is a national survey which generates data on population and health indicators, especially on maternal and child health, which is conducted across India.
The researchers recommend that “threshold levels for C-sections be applied cautiously, as several inter-category variations exist, and in states at advanced levels of demographic transition, need factors for C-sections may be more prevalent. There is an alarmingly high proportion of poor women undergoing C-sections in the private sector in Tamil Nadu. This requires further analysis and corrective action in case some of these are clinically unnecessary, the researchers concluded.
