By Dr K Madan Gopal & Prof Dr Suneela Garg.
World Health Day reminds us that health is the foundation of a just and prosperous society every year. In 2025, as we reflect on the theme “Healthy Beginnings, Hopeful Futures,” we must confront a troubling reality. In India, the beginning of life is increasingly shaped not by medical needs but by commercial pressures.
Birth should be about life and safety. But somewhere between medical innovation and profit margins, the natural miracle of childbirth is being replaced by surgical convenience.
Across hospitals today, it is not uncommon for a mother’s first moments of joy to be framed by an operating theatre, not a birthing room. In too many hospitals, childbirth has become a business decision.
The changing face of childbirth in India
Across the country, C-section rates have soared to levels that far exceed global recommendations. According to the National Family Health Survey-5 (NFHS-5, 2019-21), 21.5% of all births in India now occur through C-section. In private hospitals, this figure leaps to a staggering 47.4%.In several states, the private sector C-section rates cross 60%, far above the World Health Organization’s advised limit of 10–15%.
Behind these statistics lies a story of two Indias – one where birth remains a natural, supported process, and another where it is increasingly managed by scalpel and schedule.
The gap between public and private healthcare is no accident. It reflects deep-rooted financial incentives, social shifts, and structural challenges within India’s health system.
Why C-Sections are surging
Several forces are pushing India’s C-section numbers up. Private hospitals, incentivised by higher billing rates for surgical procedures, often promote C-sections over vaginal deliveries. A C-section can cost two to four times more than a normal birth, creating an obvious profit motive. For many doctors, convenience outweighs caution. Why wait for a 12-hour unpredictable labour when surgery can be scheduled and completed in an hour?
In an increasingly litigious environment, obstetricians may see C-sections as a way to minimise risk and protect themselves from malpractice suits. Insurance policies under schemes like Ayushman Bharat often reimburse surgical deliveries at higher rates, creating a subtle but strong push towards interventions.
Cultural factors add further pressure. Among affluent urban families, there is a growing trend of “choosing” birth dates based on astrology, resulting in elective C-sections without medical indications. Misconceptions about C-section safety have also taken root. Social media, online forums, and hospital marketing paint surgery as a painless, modern alternative to natural birth – ignoring the serious health risks involved.
Health risks that cannot be ignored
The gleaming operating theatres and seamless scheduling hide a harsher truth: C-sections, when misused, can scar bodies, break health, and steal from futures. While C-sections are essential in cases of medical necessity, their indiscriminate use carries serious risks – for both mothers and newborns. For mothers, surgical deliveries mean greater exposure to infections, haemorrhage, blood clots, and longer recovery periods. A systematic review published in PLOS Medicine found that women who underwent C-sections were three times more likely to suffer severe maternal morbidity compared to those who delivered vaginally. The risks do not end with one pregnancy. C-sections increase the likelihood of complications in future pregnancies, including placenta previa, uterine rupture, ectopic pregnancies, and infertility.
For newborns, the impact is equally worrying. Babies born via C-section face a higher risk of respiratory distress syndrome, neonatal intensive care admissions, and feeding difficulties.
Research published in the Proceedings of the National Academy of Sciences (PNAS) confirmed that C-section deliveries alter the establishment of healthy gut bacteria, weakening immune development and increasing risks of allergies, asthma, and even obesity later in life. These are not theoretical concerns. They are real, long-lasting burdens that thousands of families face every year.
Real stories, stark realities
Consider Priya, a first-time mother from Delhi. Her doctors recommended a C-section at 38 weeks, citing a “big baby” diagnosis. Post-surgery, she suffered infections, delayed milk production, and prolonged emotional distress. Her baby’s birth weight, at 3.2 kg, was later found to be well within the normal range for vaginal delivery. In rural Bihar, Seema’s emergency C-section saved her life during obstructed labour. However, the absence of proper post-operative care led to a severe wound infection, leaving her bedridden and unable to care for her newborn for months.
Both stories, though vastly different, reveal the truth: C-sections can be lifesaving, but when overused, they create medical, emotional, and financial wounds that linger long after discharge.
Financial implications for families
The economic burden of unnecessary C-sections is considerable. In private hospitals, a C-section costs an average of ₹43,000 compared to ₹8,600 in public facilities. For many middle- and lower-income families, an unnecessary surgery can mean taking loans, selling assets, or sacrificing future healthcare needs. It is not just a birth event but a long-term economic setback. Moreover, once a woman has undergone a C-section, the probability of subsequent C-sections increases dramatically, locking families into cycles of repeat surgical interventions and rising costs with every pregnancy.
Restoring Balance: What needs to change
India must act decisively to curb the overuse of C-sections. A multi-pronged strategy is needed:
Strengthen public accountability: Hospitals must report their C-section rates transparently, with independent audits of facilities reporting excessive numbers.
Align insurance incentives: Payment structures must reward outcomes that are best for the health of mothers and babies – not hospital revenues.
Empower women with information: Antenatal care should include education about the risks and benefits of both types of delivery, ensuring women make informed, supported choices.
Promote skilled midwifery services: Countries like Sweden, Japan, and the Netherlands maintain low C-section rates through widespread use of trained midwives – a model India must embrace.
Support safe pain management: Wider access to labour pain relief options such as epidurals can reduce elective C-section requests driven by fear of natural birth.
The evidence is clear: where midwifery is strong, litigation is low, and mothers are empowered, C-section rates naturally fall – and maternal and child health outcomes improve dramatically.
Birth should be about health, not profit
Birth is not a transaction. It is a beginning that demands care, courage, and integrity.
Choosing how to give birth should centre on the health and dignity of mothers and babies – not on hospital balance sheets, convenience, or unfounded fears.
As we mark April 7th , The World Health Day 2025, we must reaffirm a fundamental truth: If we want truly “Healthy Beginnings” and truly “Hopeful Futures,” we must restore childbirth to what it was always meant to be – a deeply human, deeply sacred experience of life, not business. Our society’s future- and every newborn’s first breath – depends on it.The first breath of life should be free – not priced
About the author:
- Dr K Madan Gopal is a Health Sector Expert and is currently working as an Advisor with the National Health Systems Resource Center, New Delhi.
- Prof Dr Suneela Garg is a Public Health expert and was Ex- Chair of program advisory committee, NIHFW, New Delhi
Disclaimer: Views expressed are personal and do not reflect the official position or policy of FinancialExpress.com. Reproducing this content without permission is prohibited.
