Even as institutional deliveries have become the norm across India, caesarean sections (C-sections) are increasingly dominating childbirth in private hospitals, accounting for 54% of all births in private healthcare facilities in 2023-24, according to data from the National Family Health Survey (NFHS-6) released on Friday, according to Rema Nagarajan's Times of India report.
The survey showed particularly high rates of C-section deliveries in private hospitals in eastern and southern India. West Bengal recorded the highest share at 87.7%, followed by Telangana at 84% and Andhra Pradesh at 66%.
Overall, more than 62% of births in Telangana and 52% in Andhra Pradesh were conducted through C-sections, while the figure stood at 44.5% in West Bengal. Among the 27 states and the Union Territories of Delhi and Jammu & Kashmir covered in the survey, 18 states reported that more than half of all deliveries in private facilities were performed through caesarean sections.
India's reliance on C-sections has steadily increased over the past two decades. The proportion of births delivered through C-section rose from 8.5% in 2005-06 to 17.2% in 2015-16, increased further to 21.5% in 2019-21, and has now reached 27.2% in 2023-24, meaning more than one in four births are delivered surgically.
The rise has been comparatively slower in government hospitals, where C-section rates increased from 15.2% in 2005-06 to 16.9% in 2023-24.
Jammu & Kashmir reported some of the highest C-section rates in the country. Nearly 90% of deliveries in private facilities and close to 49% in government hospitals were conducted through C-sections. As government institutions account for around 80% of births in the Union Territory, surgical deliveries now make up more than half of all births there.
Southern states continued to record elevated C-section rates even in public healthcare facilities. In Telangana, 48% of births in government hospitals were through C-sections, followed by more than 39% in Tamil Nadu and Kerala, 38% in Andhra Pradesh and over 34% in Karnataka.
In contrast, states such as Assam and Odisha reported very high C-section rates in private facilities — 81.4% and 76.8%, respectively. However, their overall C-section prevalence remained relatively lower because more than three-fourths of deliveries occurred in government hospitals, where the corresponding rates were around 18% in Assam and 22% in Odisha.
At the other end of the spectrum were Bihar, Jharkhand and Madhya Pradesh, where overall C-section rates remained among the lowest in the country at around 13% in Bihar and 16% in both Jharkhand and Madhya Pradesh. The low figures were largely driven by limited C-section availability in government hospitals, where the rates stood at just 2.7% in Bihar, 6.1% in Jharkhand and slightly above 10% in Madhya Pradesh.
The low incidence of C-sections in these states may point to inadequate access to emergency obstetric procedures in public healthcare facilities, particularly as maternal mortality levels also remain relatively high. A similar trend appears to be visible in Rajasthan.
Globally, the World Health Organization considers a C-section rate of 10-15% to be appropriate. However, many countries exceed this threshold. C-sections account for more than 32% of births in the United States and 45% in the United Kingdom, while the rate exceeds 52% in Brazil and averages above 42% across Latin America. By comparison, countries such as Sweden and Norway, which emphasise midwife-led care and reducing unnecessary surgical interventions, report rates of 19% and 16%, respectively. France records a C-section rate of about 21%.
(With TOI inputs)
