New Delhi: Seeing a rise in caesarean deliveries in India — from 8.5 per cent in 2005 to 21.5 per cent in 2021 — which is well above WHO-recommended levels, researchers are calling for policy measures, including more regulation in private healthcare, in an analysis published in The Lancet Regional Health Southeast Asia journal.
Delivering a baby via a caesarean section (C-section) involves making a surgical cut in the mother’s abdomen and uterus.
The researchers, including those from the Institute of Public Health Bengaluru and Christian Medical College in Vellore, Tamil Nadu, said that while a medically indicated C-section is vital to preventing maternal and newborn mortality, rates of caesarean deliveries exceeding 10 per cent in the population are not linked with reduced mortality — as noted by the World Health Organization.
An unjustified caesarean delivery is related to longer hospital stays and higher healthcare costs, with babies born through the procedure known to be at an increased risk of asthma, obesity, type 1 diabetes and allergies, among other health problems.
The team reviewed 75 previously published studies — mostly from India, followed by Bangladesh and Pakistan — and examined factors in the countries’ health systems contributing to caesarean procedures in the population.
The authors said that an avoidable caesarean delivery can be financially stressful for families across South Asia, where a substantial fraction of deliveries occur in the private sector.
For example, out-of-pocket expenditures for a C-section in India will cost around Rs 43,000 in private hospitals, and around Rs 8,500 in public ones, suggesting that avoidable caesarean deliveries unnecessarily burden the healthcare system and families, they said.
Limited regulation and insurance coverage were among other factors associated with increased C-section rates.
Decision-making at the healthcare provider’s level was influenced by financial incentives, medico-legal concerns and scheduling convenience, the researchers said.
Mother’s education, socioeconomic status and age, and family preferences were found to be individual and community-level factors driving an upward trend in caesarean deliveries.
Caesarean deliveries in Bangladesh are estimated to have increased from 18 per cent in 2011 to 45 per cent in 2022, while those in Pakistan rose to 20 per cent in 2018 from about three per cent in 1990. Data from national surveys were analysed for arriving at the figures.
The authors said that caesarean deliveries are being resorted to at nearly double the rates since 2000, with one in every five births involving the surgical procedure.
C-section rates in Asia rose from 4.4 per cent in 1990 to 19.5 per cent in 2014, with south Asia reflecting similar upward trends seen across the continent, they said.
“The review highlights the need for coordinated policy responses across levels, including payment reforms, regulatory oversight, and improved antenatal counselling, to ensure (C-section) use aligns with clinical need rather than socio-economic or institutional pressures,” the authors wrote.
