The World Health Organization (WHO) historically considered a C-section rate of 10–15% as an approximate threshold. Over the past three decades, however, the global prevalence of Caesarean deliveries has risen sharply, tripling from about 7% in the early 1990s to roughly 20–21% today. A number of countries stand out as clear outliers: Turkey reports rates around 60%, while Brazil and several countries in the Caribbean routinely record rates above 40%.
India’s average is around 20%. But as with most development stats in this country, the inter-state variability is what matters. Telangana has a mindboggling rate of 60% while Kerala, Goa, TN, J&K are in the 40% category. Predictably, the rates for C-sections are also higher in the private sector. The reasons for the rise in C-sections are manifold.
From the supply side, the incentives for the hospitals are to push for C-sections. Vaginal births are unpredictable and can last many hours. This blocks beds and makes it harder for planning occupancy and admissions. Work-life balance for doctors mean getting the babies out during the doctors’ duty hours. And ofcourse, the simple fact that C-sections are more lucrative.
From the demand side, C-sections are often considered to be the ‘safer’ option. Many families decide on dates for the delivery and go with the expert advice that’s dished out by the hospital. In all of this, the agency of the mother to choose, decide or refuse is hardly existent.
Both my daughters were born through C-section. In the first case, the explanation offered was the baby’s position, which might have required a forceps-assisted delivery. In the second, I suspect the familiar clinical logic of “once a C-section, always a C-section” prevailed. For a state that tom-toms its healthcare achievements, this stat is a blot.
Janhavi Nilekani’s podast on the TSATUS was what drove me down this rabbit hole. The whole episode is worth listening to.
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