A recent study published in The Lancet Regional Health – Southeast Asia highlights a significant trend: more women from higher-income groups are opting for caesarean section (C-section) deliveries, even in government hospitals. The study analyzed data from the National Family Health Survey-5 (2019-21) and found that wealthier women are significantly more likely to undergo C-sections than poorer women.
Key Findings
- C-Section by Wealth Quintile:
Only 6% of women from the poorest wealth quintile had C-section deliveries in public hospitals. In comparison, the rates for women from the poorer, middle, richer, and richest quintiles stood at 11%, 18%, 21%, and 25%, respectively. - Regional Differences:
Southern states like Kerala, Tamil Nadu, and Andhra Pradesh reported C-section delivery rates as high as 60%, while states with larger low-income populations, such as Bihar, Assam, and Chhattisgarh, had much lower rates.
Dr. Anita Gadgil, a co-author of the study from the George Institute for Global Health, explained that the low C-section rates among poorer women are likely due to a lack of awareness and accessibility. Despite the procedure being free in public health facilities, many poorer women:
- Lack knowledge about government schemes offering financial support.
- Face difficulties reaching advanced healthcare centers where such procedures are available.
Implications of High and Low Rates
Dr. Gadgil noted the dual challenges associated with C-section rates:
- Low Rates: Indicate limited access to necessary procedures, potentially leading to higher maternal and neonatal mortality and morbidity.
- High Rates: Reflect overuse without medical justification, increasing the risk of adverse health outcomes, unnecessary healthcare expenditure, and resource misallocation.
A separate study by researchers from IIT-Madras revealed that C-section prevalence across India increased from 17% in 2016 to 21.5% in 2021. In the private sector, the rise was more pronounced, growing from 43% to 50% during the same period—meaning nearly half of all private-sector deliveries are now C-sections.
As reported by TOI, the findings suggest that better-educated women living in urban areas are more likely to undergo C-sections. Greater autonomy and improved access to healthcare facilities are believed to contribute to this trend.
While C-section deliveries can be lifesaving when medically required, their overuse or unavailability can lead to severe health and economic consequences, underscoring the need for equitable healthcare access and awareness across all sections of society.