C-section births surge in private hospitals, drop in public ones: NFHS

In 2015-16, 40.9% of deliveries in private hospitals were through C-section against 27.7% in 2005-06

Private hospitals in the country are increasingly adopting C-section, or caesarean section, to deliver babies, while government hospitals have witnessed a decline in the surgical birth rate, official data suggest.

In 2015-16, 40.9 per cent of the deliveries in private hospitals were done through C-section, a sharp increase from 27.7 per cent in 2005-06, according to the recently released National Family Health Survey (NFHS).

In public hospitals, however, caesarean  births dropped from 15.2 in 2005-06 to 11.9 per cent in 2015-16.

Overall, institutional deliveries increased from 38.7 per cent to 78.9 per cent during the same period, the survey showed, indicating that government institutions were ill-equipped to handle C-section, and private hospitals might have persuaded pregnant women to go under the knife.  

The Centre’s Janani Shishu Suraksha Karyakaram (JSSK) entitles all pregnant women to deliver — normal or C-section — in public health institutions without any cost.

Some experts say C-section births in private hospitals, preferred by urban population, were on the rise because of changing lifestyle and late pregnancy. 

“In our hospitals, 30-40 per cent deliveries are caesarean  section,” said Manisha Singh, head of the gynaecology department at Fortis. 

“It is mainly because of lifestyle diseases and women choosing to get pregnant after the age of 35 years, when normal deliveries become risky and complicated,” she said, defending doctors who recommend C-section to many pregnant women. Singh said such decisions were only taken at the operation table.

Narendra Malhotra, president of the Indian Society for Assisted Reproduction, said lack of exercise and manual labour among expecting mothers in urban areas was the prime reason for such deliveries. 

“When women do not stay physically active during pregnancy, normal delivery becomes difficult. These days an increasing number of women are opting for unconventional methods of pregnancy, such as In Vitro Fertilisation (IVF) where only a caesarean is possible,” he said.

Premier institutes, such as the All India Medical Sciences (AIIMS) in New Delhi, are also witnessing a similar trend. Alka Kriplani, a gynaecologist at AIIMS, said around 40 per cent deliveries at the hospital were C-sections. Super-specialty hospitals undertake C-section when serious cases are referred to them, she said.

Kriplani said most of her patients come with fourth or fifth pregnancy, where it becomes risky to try for a normal delivery. “AIIMS gets all the complicated cases of pregnancies. In such cases, nothing other than a C-section is possible. Else, the mother’s and child’s lives would be in danger,” she said.

“In rural areas, facilities to perform caesarean section are minimal. Hence, the numbers are less in public health facilities,” said Kriplani. 

The NFHS data suggest that only 9.3 per cent caesareans were conducted by public health institutions in rural areas, whereas public hospitals in urban areas conducted 19.9 per cent caesareans.

“There is a lack of infrastructure in rural areas. The government is not spending enough on health care,” rued Bejon Misra, founder of an online consumer forum.

As on March 31, 2015, there were 25,308 functioning public health centres. At the end of 11th five-year plan (2007-2012), 24,049 public health centres were functional.