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Unnecessary c-sections: Why they’re misused throughout India

Image ID: 41701519 (L) C-section surgery
Doctors perform a caesarean section. Statistics suggest that a relatively high number of unnecessary c-sections are performed in India.

Caesarean sections (c-sections) can be the difference between life and death for some mothers. However, a concerning trend in unnecessary c-sections is being witnessed throughout India – and a recent report from Madhya Pradesh about such practices is raising alarm bells in the state. 

The Central Bureau of Health Intelligence (CBHI) under the Union Ministry of Health and Family Welfare reports that, in Madhya Pradesh, private hospitals are conducting ostensibly unnecessary c-sections at an alarming rate. One in every two pregnant women underwent delivery by c-sections in private institutions, compared to one in twenty in government-run facilities. 

“There is more than one reason for this,” said hospital-in-charge Dr Madhav Hasnani of PC Sethi Hospital in Indore. “The trend of planned delivery has grown in the city as well as the state, which is a reason for increase in caesarean ones…but, we can’t specifically say that it is the reason behind the increase until we have exact figures regarding it.” 

World Health Organization (WHO) guidelines indicate that c-sections ought not to exceed ten to fifteen percent of all deliveries. Cognisance of high delivery rates by the procedure in some quarters of Madhya Pradesh has been raised in the past. Reports of a fifty percent rise in the number of c-sections in the state’s Dewas district prompted state health minister Tulsiram Silawat to commission an investigation. In 2017, it was reported that practitioners in the state could face revocation of their license if c-sections accounted for more than 25 percent of deliveries performed by them, as per a recommendation by the State Women’s Commission. 

Earlier this year, The Hindu reported that India had witnessed an increase in the number of c-sections and could soon see the largest number of births delivered by c-section in the world. At the national level, in the 2015-16 period, c-sections accounted for 17.2 percent of deliveries versus the WHO recommendation of ten to fifteen percent. However, the prevalence of such procedures varied widely from 5.8 percent in Nagaland to 57.7 percent in Telangana. 

The National Family Health Survey (NFHS) pegged the proportion of births by c-section to be 40.9 percent in private hospitals, compared to 11.9 percent in government-run hospitals. In India, childbirth has previously been referred to as “a moneymaking racket, with caesarean sections pushed by unscrupulous medical practitioners in search of profit. Healthy young women who could easily have had normal, natural deliveries are lied to, told that they and their babies are at risk, and advised to have invasive surgery. Worried families feel helpless and afraid to refuse doctors’ orders. Thousands of women in even the smallest towns are put through this ordeal for no medical reason at all.” Indeed, c-sections cost between two and five times as much as vaginal births. 

Other factors include a desire by families to undergo c-sections down to personal preference or lifestyle factors such as their age and weight. As such, it would be misleading to claim that all doctors who perform unnecessary c-sections are motivated by profit. Nonetheless, the ostensible overuse of c-sections is a concerning trend and efforts ought to be undertaken to identify the factors driving it. Madhya Pradesh is far from alone in having a high rate of unnecessary c-sections. It is a pan-Indian problem and requires a considered and effective response in order to be addressed. 

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