C-sections on the rise in India: Profiteering to blame?

Caesarean sections are on the rise in India, provoking concerns that doctors are performing the procedure excessively.

The rate of caesarean sections in India has risen sixfold in the past twenty years and doubled in the last decade, reports The Wire. “In some states like Telangana, Tripura, West Bengal, Kerala, Goa, Andhra Pradesh and Tamil Nadu”, the report adds, “the rate is alarmingly high.”

“Over utilisation”

Caesarean deliveries constitute 40.9 percent of births in India’s private hospitals and 11.9 percent of those in public hospitals, according to the National Family Health Survey (NFHS) for 2015-16. Whilst the rate in public hospitals has decreased from 2005-06, the rate in private hospitals has risen sharply. In urban private hospitals, the rate accounts for nearly 45 percent of all births.

The World Health Organization (WHO) says “when caesarean section rates rise towards 10% across a population, the number of maternal and newborn deaths decreases”, citing two Human Reproductive Programme (HRP) studies. “When the rate goes above 10%”, the WHO adds, “there is no evidence that mortality rates improve.”

“A rate higher than 15 percent indicates over utilisation of the procedure for other than life saving reasons”, says an International Union for the Scientific Study of Population (IUSSP) paper by Shewli Shabnam. As Livemint puts it, “anything higher suggests that either women are opting for a controlled birth or that a profiteering healthcare system is pushing women into caesareans.”

Caesareans “a moneymaking racket”

Profiteering is the accusation many doctors are facing, particularly those in private facilities. On International Women’s Day this year, The Guardian published an opinion piece saying

“In India, childbirth has turned into a moneymaking racket, with caesarean sections pushed by unscrupulous medical practitioners in search of profit. Healthy young women who could easily have had normal, natural deliveries are lied to, told that they and their babies are at risk, and advised to have invasive surgery. Worried families feel helpless and afraid to refuse doctors’ orders. Thousands of women in even the smallest towns are put through this ordeal for no medical reason at all.”

Caesarean deliveries cost between two and times five as much as a vaginal birth. The Asian Times reports “the minimum cost of a C-section delivery is 40,000 rupees in an urban hospital in India.”

Doctors deny they are motivated by profit, however. They claim their hand is forced by patients, who are demanding or requiring caesareans. This can be down to personal preference or factors such as their age and weight.

Not all doctors

Maneka Gandhi, the Union Minister for Women and Child Development, interjected in the debate and said it should be mandatory for hospitals to display their rate of caesarean deliveries. Gandhi was responding to a Change.org petition on the issue, which gathered 87,000 signatures.

Doctors responded with fierce criticism of Gandhi. They said her statements would foster mistrust between patients and doctors, and could prevent patients from having caesarean sections when they are needed, thus endangering the lives of both mothers and newborns. They maintain only a minority of doctors are involved in irresponsibly overperforming caesareans for profiteering purposes. Most, they say, attempt to dissuade patients if the procedure is not thought to be necessary.