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Alarming Rise of Caesarean Section Deliveries
The phenomenal increase in institutional births in India has been accompanied by a disturbing rise in caesarean section deliveries. The prevalence of, reasons for, and consequences of c-section deliveries in the town of Kulgam in Jammu and Kashmir are studied. The findings not only reveal an alarmingly high prevalence of c-section deliveries in the town, but also that these deliveries are being largely performed without medical indications, adversely affecting the health of women. In order to monitor and control c-section deliveries in the country, immediate policy interventions are required.
The authors want to thank all the respondents who willingly agreed to share their personal experiences. Thanks are also due to all the surgeons, nurses, ANMs and especially the ASHAs and the staff of government and private hospitals who provided valuable information during the fieldwork. The authors express their gratitude to the anonymous referee for their valuable comments and suggestions.
The promotion of institutional delivery by the Government of India is considered an important step to reduce maternal and neonatal mortality. Several government initiatives, including the Janani Suraksha Yojana (JSY), have resulted in phenomenal growth in institutional deliveries. Institutional delivery refers to delivery taking place at a medical institution under the supervision of trained and competent health personnel in order to avert complications or deaths during childbirth. The child can be delivered normally or through a surgical procedure, generally called caesarean section (c-section), wherein the foetus is delivered through an incision in the mother’s abdomen and uterus. There are different kinds of c-sections, namely classical c-section, lower segment c-section (LSCS), caesarean hysterectomy, etc, but the LSCS is the most commonly used procedure today. It is done by making a transverse cut in the peritoneum over the lower segment of the uterus.
Betran et al (2016) analysed the data on c-section rates in 150 countries from 1990 to 2014 and found that 18.6% of all births occur by c-section in these countries. These rates vary from 6% in the least developed countries to 27.2% in the most developed countries. Latin America and the Caribbean region have the highest c-section rates (40.5%), followed by Northern America (32.3%), Oceania (31.1%), Europe (25%), Asia (19.2%), and Africa (7.3%) (Betran et al 2016: 1–12). Although the high or low prevalence of c-section in different countries or regions is caused by different medical and non-medical factors, an important directive from the World Health Organization (WHO) warns against high prevalence of c-section and suggests that “there is no justification for any region to have caesarean section rates higher than 10–15%” (WHO 1985: 436–37). Gibbons et al (2010) have also revealed that the c-section rates above 15% have not shown any additional benefit for the health of mothers and newborns in populations.
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