While the national average caesarean delivery rate in India is 21.5 per cent, a report published in the peer-reviewed medical journal ‘The Lancet’ shows there are stark disparities based on regions, wealth and sector.
Regionally, Nagaland had the lowest rates of caesarean deliveries, 5.2 per cent while Telangana topped the charts with 60.7 per cent. In fact, not just Telangana, but other southern states, such as Tamil Nadu (44.9 per cent), and Andhra Pradesh (42.4 per cent) also had the highest rates of deliveries by caesarean section. Possible reasons for this include factors such as improved healthcare accessibility, higher literacy, higher GDP, and provision of payments beyond the JSY (the Centre’s Janani Suraksha Yojana) scheme,” they say.
On the other hand, eastern states such as Nagaland, Meghalaya (8.2 per cent), and Bihar (9.7 per cent) had the lowest rates. The journal reported “a preference for vaginal deliveries” in Bihar “due to their affordability and shorter recovery times” as the potential reasons for this.
The report, which uses data from the fifth National Family Health Survey, also shows that the rate of caesarean deliveries is generally higher in private hospitals compared to public ones, across all income groups. On average, about 47.5 per cent of deliveries in private sector facilities were done by caesarean section, compared to only 14.3 per cent in the public sector.
“We demonstrate that CD (caesarean delivery) rates in the private sector are higher than in the public sector across all wealth quintiles in India. This mirrors trends noted in other research reaffirming that wealthier populations are linked to increased CD (caesarean delivery) access,” the report noted.
The disparity between the richest and poorest is also visible, with over two-thirds of states showing at least twice the caesarean delivery rate among the richest wealth quintile compared to the poorest. In three-quarters of the states, the rate of caesarean deliveries was less than 10 per cent among the poorest.
In fact, the “national average rate for the poorest wealth quintile was five times lower than the richest” according to the report, with Assam registering the most stark difference between the rates for its poorest and the richest sections.
The report also found that in the public sector, births decreased from the poorest to the richest quintile, while in the private sector, they increased, highlighting the shift of reliance toward private facilities among high-income populations.
“From our analysis, in the public sector, births decrease from the poorest to the richest quintile (41,825–13,975), while in the private sector, they increase (4,158–15,865), highlighting the shift of reliance toward private facilities among populations with high-income,” the report revealed. “The poorest quintile predominantly relies on public healthcare facilities and is disproportionately impacted by the limited availability and/or subpar quality of care in public establishments.”
The report highlighted the increasing penetration of private healthcare across the country. “Both people with high income and people with low income in India have higher CD rates in private facilities than in public facilities,” the authors observed. “This highlights the dual nature of healthcare in India, where private care is often seen as offering more immediate services, benefiting high-income populations, while low-income populations struggle to access timely and safe CDs.”
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.
