C-Section Rate in India, have Crossed WHO –Threshold Alarming evidence from NFHS – 5
by – Ajit Kumar Jaiswal, Harshita Chari, and Labhita Das
Due to a high rate of maternity related mortalities in India, there have always been measures undertaken that would promote a safe and secure health of the mother and the born child, which include encouraging deliveries in the presence of trained health professionals under proper hygienic care. Hence with the increase in institutional deliveries, there has been seen an increase in the percentage of caesarean section deliveries over the years. A ‘caesarean section’ or ‘under the knife delivery’ is a surgical procedure in which incisions are made through a woman’s abdomen and uterus to deliver a baby. It can be both voluntary, pre-arranged to ensure best quality of obstetric care, and nursing services; or can be done in an emergency situation where there is a threat to the life of mother and child (Mukherjee S. et. Al. 2006).
Although caesarean delivery is considered as a relatively safe method of delivery (Althabe et.al (2006)), but it still has a higher risk of complications than a vaginal or normal method of birth. There are a number of complications that can occur to the mother and child such as infections, injury during the delivery, heavy blood loss of the mother, immature lungs and breathing problems in the child etc. There is also an added high cost for operation and stay that comes along.
In the previous decade, the rate of caesarean section has increased to almost double in India from around 8% during NFHS 3 (2005-06) to as high as 17% during NFHS 4 (2015-16). The recent 2019-20 National Family Health Survey-5 phase one covered 17 states and 5 Union Territories of India, and the survey work of the remaining 14 States/UTs is under progress and is delayed due to the COVID-19 pandemic. From these recent estimates, a significant increase can be seen in the percentage from the previous round of NFHS. States of Andhra Pradesh and Telangana have the highest percentage among the 22 States/UTs with over 42% and 61% respectively, with Ladakh gaining a huge jump of 21% in this aspect. The increase in the C-section deliveries in the majority of the states in India can be attributed to the motivation to gain profits in the private healthcare sector, the rise in economic status of the population to find this technology affordable. Also due to the rise in age of marriage, the women in their late 20s or early 30s find it safer to give birth by C-section and to also sidestep the long hours of strenuous labour pain.
The North-Eastern and Eastern states like Nagaland, Bihar and Meghalaya are still in the lower quartile with less than 10% of the deliveries happening by caesarean section, and also have gained a minute change from the last NFHS. This could be attributed to the unavailability of medical facilities, weaker economic background, lack of knowledge and also a weak maternity health programme in the states which has not been able to motivate families to go for institutional deliveries. There are also some states/UTs like Lakshadweep and Mizoram which have behaved in an opposite fashion and have had a decrease in the percentage of live birth delivery by caesarean section.
Even though the comparison between the percentage of caesarean section births in India during 2015-16 and 2019-20 is difficult because of the lack of estimates from the remaining states, but looking at the average percentage for 22 states, an increase is seen by 5% from NFHS-4 to NFHS-5. If we go by the trend of the estimates from the NFHS-4, it can be concluded that there will be a dip in the overall estimate of live births delivery by caesarean section in India if and when the estimates for the remaining 17 states/UTs will be included.
There have been improvements in the other parameters related to maternal health such as in antenatal check-ups, consumption of iron and folic acid during pregnancy and receiving post-natal care in many states which signify a positive effectiveness of the schemes and programmes of the government towards awareness of women. The decrease in infant death rates also show that caesarean procedure performs better in saving lives of the children in India.
But to clearly understand the factors working behind the changes in the prevalence, an examination of the socio-economic covariates along with maternal age, education of mother, birth order, the choice of place of delivery is also necessary. As the increase in the caesarean rate creates a huge burden on the health system, and also unwanted caesarean delivery put huge financial stress on the family’s economic status, there is a growing and urgent requirement for the government to develop better health care infrastructure along with more antenatal care related schemes that can help in reducing the risks.