Rising caesarean births highlights the inequity in access to appropriate obstetric healthcare

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Published: April 2, 2019 1:47:53 AM

The rising incidence of caesarean births highlights the inequity in access to appropriate obstetric healthcare.

Effective interventions and policies targeted at women and healthcare professionals to reduce unnecessary caesarean deliveries will be required to avoid growing inequalities in access to safe caesarean delivery procedures and deny unnecessary ones.

A study published in the Journal of the American Medical Association (JAMA) points to the rising number of caesarean births in India. The proportion of births through the procedure was 17.2% from 2010 to 2016, as per the study, as the researchers analysed NFHS-4 data. This is a rate higher than that noticed in the NFHS-3 data (10.6%) and in developed countries such as the Netherlands or Finland. A large proportion—40.9%— of babies in private hospitals are born through C-sec as compared to just 11.9% of those born in government hospitals. There is also considerable disparity across regions in the C-sec birth numbers—87.1% of deliveries in private hospitals of urban Tripura (against 36.4% in government ones) are caesarean while, in urban Haryana, just 25.3% of private hospital births (10.7% in government ones) are through C-Sec.

C-secs save lives but, last year, WHO released a document underscoring its concern about rising C-section rates. They highlighted that the procedure comes with a sizeable chunk of future health risks to the mother and the child. A study conducted by the Indian Institute of Management, Ahmedabad, last year found that these births not only entailed “large out-of-pocket” expenditure but also “delayed breastfeeding, lower birth-weight, respiratory morbidities” amongst other troubles for the newborn. WHO, in 2015, stated that the ideal C-section birth rate of a population is 10-15%, and although India has crossed this mark, there remains a section of women who are are not able to access it despite needing it—caesarean rates of less than 10% were noticed for Rajasthan, Jharkhand and Bihar while Telangana, the state with the highest caesarean births, reported 57.7%.

The study therefore points to significant disparities, with caesarean deliveries less common amongst underprivileged groups vis-a-vis need and almost 2 million excess caesarean births every year amongst the more privileged sections of the population. Effective interventions and policies targeted at women and healthcare professionals to reduce unnecessary caesarean deliveries will be required to avoid growing inequalities in access to safe caesarean delivery procedures and deny unnecessary ones.

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