A new study found that more women from high-income quintiles are having caesarean sections (C-sections), even in govt hospitals where the procedure is free.
Only about 6% women belonging to lowest wealth quintile, or the poorest, underwent C-section delivery in public hospitals across India. The rest went for normal delivery, according to the study published in Lancet Regional Health-Southeast Asia, which is based on a cross-sectional analysis of C-section delivery rate data published in National Family Health Survey-5 (2019-21) report.
A wealth quintile is a statistical value, which represents 20% of the population, is a statistical metric that separates a population into five groups of similar size according to wealth.
C-Section Rates in Public Hospitals
The percentage of women undergoing C-section delivery at public hospitals in the poorer, middle, richer and the richest categories stood at 11%, 18%, 21% and 25%, of total births in the respective wealth quintile, it stated.
Understanding C-Section Deliveries
A C-section is a surgical procedure used to deliver one or more babies by making an incision in the abdomen. The procedure can be lifesaving, when medically justified. Unnecessary C-sections can lead to adverse health outcomes, financial strain, and increased pressure on healthcare resources.
Dr. Anita Gadgil from the George Institute for Global Health, one of the study’s authors, identified key reasons for the lower rates of C-sections delivery among the poor women even in public health facilities, where procedure is carried out free of cost, could be lack of knowledge.
“Sometimes, poorer women aren’t referred in time to higher centres where caesarean section delivery is available, or they don’t have money and wherewithal to reach there. These people are often also least aware of govt schemes to provide financial support in such cases,” Dr Gadgil said.
Regional differences in C-Section Rates
The study stated that while southern states like Kerala, Tamil Nadu and Andhra Pradesh have high C-section delivery rates (up to 60%), states with a predominantly poor quintile population like Bihar, Assam and Chhattisgarh have lower C-section rates.
A study by IIT-Madras revealed that the prevalence of C-sections increased nationwide from 17% in 2016 to 21.5% in 2021. In the private hospitals, the rate increased from 43% to 50% over the same period, meaning nearly half of all private-sector deliveries are C-sections. This increase could be attributed to several factors.
The researchers discovered that urban women with higher levels of education were more likely to deliver by C-section, suggesting that greater autonomy and better access to healthcare facilities play an important role in increase in prevalence of C-sections.