By Jisha Krishnan

Published on 17th April 2017

I have had a caesarean section (also known as C-section) delivery. And so have an increasing number of women in India and across the globe. According to the World Health Organization, the ideal rate for C-section deliveries in any society is 10-15 per cent. Anything more (or even less, for that matter) calls for pertinent questions.

There are cases where a C-section becomes a medical necessity. It can be life-saving for the mother and child. Say the fetus weighs more than 4.5 kg, or is in breech position, or perhaps, there are more than one fetus. However, the bone of contention is cases where there is absolutely no medical need for surgical intervention.

Yet doctors (and parents) decide to go in for a C-section.

What the numbers say

As per the latest data released by the National Family Health Survey 2015-16 (NFHS-4), there has been a significant increase in the number of Indian women having C-section deliveries. Interestingly, the numbers are much higher for births in private health facility as compared to corresponding figures in the public health facility.

In Karnataka, the number of C-section births rose from 15.5 per cent in 2005-06 to 23.6 per cent in 2015-16. C-sections in private hospitals increased from 31.9 per cent to 40.3 per cent, while the numbers in government healthcare facilities dropped from 17.2 per cent to 16.9 per cent for the corresponding period.

The pattern is similar for almost all the states where the survey has been completed. While Assam, Gujarat, Bihar, Haryana, Madhya Pradesh, Tamil Nadu, Rajasthan, Punjab,Uttarakhand and Tripura have registered an overall increase in the number of C-Section deliveries, there has been a dip in the numbers corresponding to public health facilities. The biggest dip was registered by public health facilities in Chhattisgarh - from 24.9 per cent in 2005-06 to 5.7 per cent in 2015-16.

However, there are quite a few exceptions. The number of C-section deliveries in Odisha, for instance, has grown phenomenally from 5.1 per cent in 2005-06 to 13.8 per cent in 2015-16. For private health facilities, the percentage rose from 32.4 to 53.7, and in public health facilities from 10 per cent to 11.5 per cent.

Maharashtra’s is a similar story with the number of C-section deliveries almost doubling in a decade from 11.6 per cent to 20.1 per cent. In private hospitals, the numbers rose from 22.3 per cent to 33.1 per cent, while in public health facilities, it rose from 11.6 per cent to 13.1 per cent.

The list of states where the number of C-section deliveries has increased in government facilities includes Manipur (17.6-22.6 per cent), Meghalaya (8.3-9.8 per cent) and Goa (17.9-19.9 per cent). For Daman & Diu, the numbers have been consistent for the last decade at 7.3 per cent.

The bigger picture

The popular perception – with good reason – is that private practitioners promote C-section deliveries because they are more profitable than vaginal births. Also, not many women today seem keen (blame it on lifestyle, emancipation, dread) on enduring the trials and tribulations of labour.

At the same time, we come across new research on the many perils of C-section deliveries almost on a daily basis. From asthma, diabetes and juvenile rheumatoid arthritis to obesity,auto-immune disorders and lymphoblastic leukemia, babies born via cesarean are considered to be at greater risk for innumerable medical conditions.

An interesting study, published recently in the US National Academy of Sciences, claimed that large numbers of women having C-Sections over a long period of time may influence our evolution – by way of babies with larger heads, which will in turn make vaginal births a challenging proposition. Of course, it’s only a theory for now.

 

The question to be asked is: Why are women not paying heed to all these studies? Perhaps, they don’t have access to such information. Or maybe, they have read enough to realise that most of these studies only show a co-relation and not a causal effect. In any case, there’s nothing unethical about an elective caesarean. Unless, of course, the hospitals are raising force alarms and pressuring women for surgical intervention. Unfortunately, there’s no data on that yet.