Over one-fifth of deliveries in India are via caesarean section (C-section), with significant regional and socioeconomic disparities, according to a study published in The Lancet Regional Health-Southeast Asia. While this figure may indicate some level of adequate national access to healthcare, it may not capture disparities between different regions or social groups, which the study points out.
The study published in The Lancet Regional Health-Southeast Asia journal also revealed that caesarean delivery rates were at least twice as high among the wealthiest groups compared to the poorest in nearly 70 per cent of states.
Statewise, C-section rates vary greatly across India, with Telangana having a very high rate of 60.7%, and Nagaland a much lower one at 5.2%. This regional discrepancy suggests differing levels of healthcare access, infrastructure, and perhaps cultural factors that influence birthing choices.
While C-section rates are higher in private healthcare facilities, wealthier individuals are more likely to undergo the procedure, even in private settings. The study also highlights varying rates across states, cultural influences, and the role of access to healthcare, suggesting that economic, social, and regional factors all play a crucial role in shaping delivery choices.
A caesarean delivery is performed by surgically cutting through a pregnant woman's abdomen and uterus.
Researchers, including those from The George Institute for Global Health in New Delhi, analysed live birth data of over 7.2 lakh women aged 15-49 years across 28 states and eight union territories, collected during the fifth round of the National Family Health Survey (2019-2021).
"India's caesarean delivery rate of 21.5 per cent suggests adequate national access but may mask significant disparities," the authors wrote.
Caesarean, or C-section, delivery rates across states were found to substantially vary, "ranging from 5.2 per cent in Nagaland to 60.7 per cent in Telangana".
Facilities performing caesarean deliveries were higher among private health care units, compared to public centres across all wealth groups, the authors found.
However, within private facilities too, wealth disparities were found to exist, with fewer C-section deliveries among the least wealthy and more among the wealthier sections.
"The study concluded that both high-income and low-income individuals in India are more likely to receive caesarean deliveries in private rather than public facilities," the authors noted.
Arunachal Pradesh had a relatively low C-section delivery rate of 14.5 per cent and showed low inequality, while southern states like Tamil Nadu and Telangana exhibited high rates of C-section delivery with lower inequality.
The variation could be attributed to factors such as improved access to healthcare, higher literacy rates, and a stronger Gross Domestic Product (GDP), the authors suggested.
In Bihar, where much of the population belongs to lower wealth groups, there was a higher preference for vaginal deliveries due to their affordability and shorter recovery times, even when medical professionals recommended a C-section.
