Private Hospitals More Likely to Prefer C-section, Finds Study

Hyderabad: A recent study conducted by researchers at the Indian Institute of Technology (IIT), Madras, revealed a concerning trend of increased C-section deliveries across India from 2016 to 2021. Despite a decrease in pregnancy complications, the prevalence of C-sections rose sharply, raising questions about the factors driving this surge.

Led by Varshini Neethi Mohan and Dr P. Shirisha, along with Dr Girija Vaidyanathan and Prof. V.R. Muraleedharan, the study scrutinised data from the National Family Health Survey. Published in BMC Pregnancy and Childbirth, the findings show the critical need for a closer examination of birth practices in the country.

Noteworthy is the stark contrast between public and private healthcare facilities. Women delivering in private hospitals were four times more likely to undergo a C-section compared to those in public institutions, a discrepancy that hints at potential non-clinical drivers behind the increase, such as socio-economic status and physician practices.

In an in-depth analysis of Tamil Nadu and Chhattisgarh, the researchers found that despite the fact that both pregnancy complications and high-risk fertility behaviour were more prevalent in Chhattisgarh, Tamil Nadu had the higher prevalence of C-sections.

Elaborating on the importance of these findings and its implications for health policymakers in the country, Prof. V R Muraleedharan, Department of Humanities and Social Sciences, IIT Madras, said,“A key finding was that the place of delivery (whether the delivery was in a public or a private facility) had the greatest impact on whether delivery was by C-section, implying that ‘clinical need’ factors were not necessarily the reason for surgical deliveries. Across India and Chhattisgarh, the non-poor were more likely to opt for C-sections, while in Tamil Nadu, the case was surprisingly different, as the poor were more likely to have C-sections in private hospitals.”

Furthermore, the study revealed a worrying shortage of obstetricians and gynaecologists in public facilities, particularly evident in Chhattisgarh, where a 77 per cent vacancy rate was observed in 2021. Such deficiencies in infrastructure may contribute to the overreliance on C-sections in private settings.

The prevalence of C-sections across India increased from 17.2 to 21.5 per cent in the five years leading up to 2021. In the private sector, these numbers stood at 43.1 per cent (2016) and 49.7 per cent (2021), meaning that nearly one in two deliveries in the private sector is a C-section.

While the prevalence of C-sections soared to 21.5 per cent nationwide, far exceeding the WHO's recommended rate of 10-15 per cent, there was a notable decline in pregnancy complications. This paradoxical trend raises concerns about the appropriateness of surgical interventions and the need for more nuanced guidelines.

The study advocated for a cautious approach to setting threshold levels for C-sections, recognising the complexity of factors influencing birth practices.