What are the reasons behind the increasing number of C-section deliveries?

The Indian Institute of Management, Ahmedabad (IIM-A) had undertaken a study to examine the viability of the private sector as a partner in providing health services. In the report “Too much care? Private health care sector and surgical interventions during childbirth in India,” the IIM-A has outlined the various causes for a higher number of c-sections in India.

Findings of the Study:

The study was conducted based on the data from the National Family Health Survey (NFHS), carried out in 2015-16. The findings of the study include:

• 9 percent of births in private facilities were through C-section as against 11.9 percent in public facilities.
• There were nine lakh “preventable” unplanned cesarean section (C-section) deliveries out of 70 lakh in private hospitals in India in one year.
• C-sections prevent maternal and perinatal mortality and morbidity when medically justified. But if performed unnecessarily they impose a huge burden on the mother and the child that go beyond large out-of-pocket expenses.
• The increased number of C-section deliveries in private hospitals was driven mainly by financial incentives.
• These medically unjustifiable births together with causing economic burden resulted in delayed breastfeeding, lower birth-weight, and respiratory morbidities among other troubles for the newborn.
• Woman opting for the private facility is 13.5-14 percentage points more likely to undergo an unplanned C-section than one opting for the public facility.
• Private players even though are more responsive to patients and exert more effort; they are more likely to provide over-intensive treatments either as a response to demand from patients or due to financial incentives.
• The private players induced c-sections driven by financial incentives, especially when the patient has limited information, is probably an important explanation.

The study notes that to bring down the number of C-sections that are not needed, the government must strengthen public sector facilities, not just in terms of equipment and staffing, but also in terms of facility timings, absenteeism, and attitudes of service providers.