Representative photo: Pixabay/Pexels.
A caesarean section (C-section) delivery is a lifesaving surgical procedure for mothers and babies when certain complications appear during pregnancy or labor. According to a WHO statement published in 2015, the ideal rate for C-sections in a given population should be 10-15%. This rate represents the fact that when they’re performed when they’re necessary, C-sections can effectively prevent maternal and neonatal mortality.
The WHO has also said that when C-section rates rise towards 10%, the number of maternal and neonatal mortality will decrease. However, when the rate goes above 10%, there is no evidence that mortality rates will improve.
A C-section can either be emergency and elective. Emergency C-sections are a boon for mothers and babies – but there is no evidence supporting a similar conclusion for elective C-sections. In fact, the latter could become life-threatening. A systematic review published in 2007 suggested that no study (that it analysed) had reported any evidence for C-section rates above 10% reducing maternal and neonatal mortality or morbidities.
Of course, this doesn’t mean all elective C-sections are bad. There are a few benefits, such as decreased perineal pain and urinary incontinence at three months.
The National Family Health Surveys (NFHS) of 2015 (NFHS-4) and 2019 (NFHS-5) together have sufficient data on the number of people opting for C-sections across India. NFHS-4 found that the C-section rate in India – 17.2% – was higher than the WHO-recommended limit. The Government of India released the NFHS-5 phase 1 data on December 12, and it has worse news.
Telangana has reported the most C-section deliveries in the past half-decade – a stunning 60.7% of all deliveries – followed by Andhra Pradesh (42.4%), Jammu and Kashmir (41.7%), Goa (39.5%) and Ladakh (37.6%).
Nine states and UTs have reported a more moderate increase, of 5-10%. The northeastern states of Manipur (8.2%), Mizoram (10.8%) and Nagaland (5.2%) have the lowest C-section rates and have also reported the smallest increases, of 1-2% since NFHS-4.
In fact, C-section rates have fallen in only three states or UTs between NFHS-4 and NFHS-5: Mizoram, Lakshadweep and Nagaland.
NFHS-5 also reveals an interesting urban-rural difference in C-section deliveries. It may not be surprising that urban areas report more C-sections than rural ones – except in Goa and Lakshadweep, where it’s the other way around.
There are also big differences between states, as their respective rates range from 5.8% to 60.7%. The situation is most alarming in Telangana and Andhra Pradesh.
Studies published in The Lancet (2000) and Birth (2006), among others, have highlighted the risks associated with elective C-sections, including of iatrogenic infections, ectopic pregnancies, even miscarriage. C-sections also pose a 2.84-times higher risk of maternal mortality than after vaginal births. Mothers electing for C-sections also endanger subsequent pregnancies and reduce the chances of vaginal deliveries in future. Risks for babies include being accidentally cut by the surgeon’s knife, increased prevalence of atopy, allergies, childhood obesity, respiratory distress and lower gut-microbiome diversity.
Neha Kumari and Abhishek Anand are MPhil scholars at the International Institute for Population Sciences, Mumbai.