India delivers poor results C-sections go up 7 times

In the last 25 years, the number of caesarean deliveries in India went up by seven times with at least 14 states, including Karnataka, recording a number way beyond the benchmark fixed by the World Health Organisation (WHO), according to new research.

The global health body estimates that 10-15% of births medically require a C-section due to complications, suggesting that its average use should lie between these levels. India’s national average is 18%, but there is wide variation among the states.

Telangana tops the list with a whopping 58% C-section births out of all births between 2011 and 2016. Only 23% of them were emergencies requiring caesarean section.

Andhra Pradesh follows with 40% caesarean (15% emergency) delivery, Kerala with 36% (13% emergency) Tamil Nadu with 34% (13% emergency), Goa with 31% (15% emergency) and Karnataka with 24% C-section (only 10% emergency). The other states with high C-section numbers are Maharashtra, Gujarat, Punjab, Manipur and West Bengal.

Worldwide, the number of babies born through C-sections almost doubled between 2000 and 2015 — from 12% to 21% of all births. The analysis was published in a set of three papers in The Lancet on Thursday.

South Asia witnessed the most rapid increase in the use of C-section (6.1% per year) in the last 15 years.

The procedure was underused in 2000 but being overused by 2015 (increasing from 7.2% to 18.1%). The trend is reflected in India.

Way back in 1992-93, only 2.6% of all live births were done through caesarean. The number slowly increased to 7.1% by 1998-99, then to 9% in 2005-06 and jumped to 18% in 2015-16, says the Lancet study that uses data generated by India’s latest national family health survey. There are short and long-term risks associated with C-sections for mothers and children, and there are no benefits of C-section in cases without a medical indication.

“Given the increasing use of C-section, particularly cases that are not medically required, there is a crucial need to understand the health effects on women and children. C-section is a type of major surgery, which carries risks that require careful consideration. Its growing use for non-medical purposes could introduce avoidable complications,” says Jane Sandall, a professor at the King’s College London and one of the authors of the papers.

The unhealthy trend was visible for the first time last February when the country-wide NFHS data was released. The increase in number is mainly because of a rise in unnecessary C-sections in private clinics. Almost 41% deliveries in private clinics and hospitals are through C-section, according to NFHS data. Ten years ago, the number was 27.7% in the private sector. On the contrary, the number of C-section decreased in the public sector in the last 10 years.

While the life-saving surgery is still unavailable for many women and children in low-income countries and regions, the procedure is overused in many middle- and high-income settings.