Rising rates of caesarean sections (C-sections) in Himachal Pradesh have been brought to light, emphasising a worrying national trend.
The Times of India has reported that 11,319 C-sections were performed in the state during the 2017-18 period compared to 9,900 such procedures in the 2016-17 period and 9,414 in 2015-16. However, whilst profiteering by private hospitals is often implicated as the cause of rising C-sections, this does not appear to be the case in Himachal Pradesh. The number of C-sections performed in private hospitals in 2017-18 stood at 5,801 – more than the number carried out in 2016-17 (5,501) but less than the number carried out in 2015-16 (5,820).
On the question of unnecessary C-sections potentially being performed in government-run facilities, the state health minister Vipin Parmar told The Times of India “we will look into this matter and take action if required.” Whatever this inquiry throws up, this incidence of potential overperformance of C-sections is far from limited to Himachal Pradesh: it is a national issue.
As reported by Health Issues India earlier this year, “in the last 25 years, the number of caesarean sections being performed in India increased sevenfold. In 1992-93 period, just 2.6 percent of births in India were delivered via c-section. By 2015-16, this figure had jumped to 18.1 percent.” This is compared to the World Health Organization (WHO) benchmark of fifteen percent.
The Indian national average is only a little over three percentage points above this benchmark. In some states, however, the number of C-section births is significantly higher. In Telangana, 58 percent of births between 2011 and 2016 were C-sections, of which a mere 23 percent were medically necessary.
Private sector profiteering is often implicated as the driving force behind this. This is not a wholly baseless assertion. Caesarean deliveries in private hospitals have been likened in the past to “a moneymaking racket”. Indeed, caesarean delivers cost between two and five times more than vaginal births in private hospitals.
Yet profiteering is not the sole reason. Misguided patient preference may be a reason behind unnecessary C-sections, as doctors have claimed. In addition, there is the simple truth that C-sections may be quicker. As was revealed earlier this month, India continues to grapple with a staggering shortage of specialist doctors. Obstetricians and gynaecologists are no exception to this, with Health Issues India reporting in 2018 that there is a 76.7 percent shortfall when it comes to this specialty.
The performance of unnecessary C-sections highlight a range of issues, whether it is unethical practises in the private sector, low awareness among patients, or the shortages of specialist medical professionals. Addressing these issues will be necessary to improve the health of India’s mothers, given that unnecessary C-sections could potentially expose mothers to infections and other complications that could prove lethal. Be it in Himachal Pradesh or Telangana or any state, investigations where instances are flagged are needed to ensure that unnecessary C-sections come down and any unethical practises be dealt with.