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India might soon have the most Caesarean births

Number of caesareans was 17.2% for India during the period from Jan 2015 to Dec 2016

A new study based on the data from the National Family and Health Survey has shown that there is a significant increase in the rate of caesarean births in India.

While the WHO recommends the rate of caesarean delivery to be 10-15%, the number was 17.2% for India during the period from Jan 2015 to Dec 2016. This is higher than the rate seen in rich countries such as the Netherlands and Finland. The report says that if this trend continues, India could soon have the largest number of C-section births in the world.

But is C-section bad? A 2018 report in The Lancet pointed out that the prevalence of maternal mortality and morbidity is higher after caesarean than after vaginal birth. Also, it is noted to be associated with an “increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth.” Many studies have pointed out that babies born via C-section have less bacterial exposure, which in turn alters their immunity and gut microbiome diversity. Children tend to have increased chances of allergy, asthma, and childhood obesity.

The study noted the rates varied widely across States, with just 5.8% in Nagaland to 57.7% in Telangana. When taking socioeconomic conditions into account, the researchers found that the rate of C-section was as small as 4.4% among the poorest group to 35.9% among the richest quintile.

“More than a third of the births are delivered by caesarean section among the richest quintile and in several states of South India such Andhra Pradesh, Kerala and Telangana – with rates above 50% reported in some districts”, underlines Alexandre Dumont, demographer at the Population and Development Center, The French Research Institute for Development, Paris in a release. He is one of the authors of the study published in JAMA Network Open.

Class, a factor

The high rates point out that there is increased C-section deliveries among non-risk pregnancies in the privileged classes. “A C-section is carried out only during medical emergencies. But if the individual insists, that is if it is out of choice, we inform them about all the pros and cons and perform only after full consent,” explains Dr. Gayatri Kartik, senior Obstetrician and Gynaecologist at Manipal Hospital, Bengaluru.

“While we have no direct information on the factor behind the rise of C-sections among the privileged classes from this survey or other sources, we presume that several factors may be at play such as desire for comfort, and fear of pain and health risks from women, and organisational and medical simplicity as well as financial benefits from clinics,” explains Dr. Christophe Z Guilmoto, in an email to The Hindu. He is the corresponding author of the study.

“There is an urgent need to monitor the deliveries in clinics and hospitals. The government should inform practitioners and women of the unnecessary risks of non-medically justified C-sections,” he adds. “India has to face a “double burden” of providing C-sections to populations that still have no access to it (because of poverty, remoteness or lack of facilities, etc.) and at the same time of curbing overuse.”

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