Why are C-section deliveries increasing in India?

Jammu and Kashmir's private hospitals have recorded the highest C-section rate in India, with nearly 90 percent of births occurring via Caesarean section, according to data from the National Family Health Survey-6 (NFHS-6). This figure significantly exceeds the national private-sector average of 54.1 percent, placing the region far ahead of other states like West Bengal and Telangana, which have rates of 87.7% and 83.9% respectively. The findings highlight a growing trend in surgical childbirth across the country, though the disparity between private and public sectors raises questions about the appropriateness of these procedures in certain contexts. The increase in C-sections nationwide is attributed to several factors, including a rise in institutional deliveries, better identification of high-risk pregnancies, increasing maternal age, medical complications, and the widespread use of assisted reproductive technologies. Additionally, the expansion of private-sector obstetric care plays a significant role, influenced by factors such as scheduled deliveries, convenience, financial incentives, and patient preferences. In Jammu and Kashmir, the situation appears to be exacerbated by the concentration of high-risk pregnancies in tertiary referral centers, which receive patients from lower-level hospitals. This influx leads to a higher demand for C-sections due to delayed referrals, advanced diagnostic tools capable of detecting fetal distress, geographical and climatic challenges, and the prevalence of older mothers undergoing fertility treatments. Data from NFHS-6 indicates that overall C-section rates in India have risen sharply, from 21.5% in NFHS-5 (2019–21) to 27.2% in NFHS-6 (2023–24). While the public sector saw a more moderate increase, from 14.3% to 16.9%, the private sector experienced a much steeper rise, from 47.4% to 54.1%. This divergence underscores a growing concern regarding the potential overutilization of C-sections in private hospitals, especially when they might not be medically necessary. Institutional deliveries have seen a slight uptick, from 88.6% to 90.6%, yet the surge in C-sections has outpaced this growth, intensifying discussions on the need for balanced medical practices. Experts emphasize that the World Health Organization (WHO) advises against routine C-sections unless medically indicated, noting that rates above 10% do not necessarily lead to further improvements in maternal or neonatal outcomes. The organization does not advocate for a universal target rate, suggesting instead that each case must be evaluated individually based on clinical necessity. However, the influence of fear of labor pain, anxiety about the baby’s well-being, personal experiences, misinformation, and cultural beliefs often drives decisions toward C-sections among expectant mothers and their families. Nikhil Gupta, an integrative psychiatrist at Wellness Clinic Jammu, points out that emerging research links C-sections to early gut microbiome colonization in infants. A meta-analysis of observational studies has suggested a mild correlation with neurodevelopmental conditions such as autism, though causation remains unproven. He stresses the importance of providing balanced information during prenatal counseling, ensuring that both vaginal and surgical delivery options are thoroughly discussed. Psychological support integrated into prenatal care can aid in making informed decisions, helping to ensure that C-sections are used only when clinically required. The phenomenon of India's private-sector C-section rates being five to nine times higher than the WHO-recommended threshold raises complex issues. It reflects not only the overuse of surgical interventions in certain areas but also the underutilization in others, pointing to a broader need for equitable access to appropriate maternity care. As the debate continues, stakeholders are urged to focus on improving awareness, enhancing infrastructure, and promoting evidence-based practices to address the challenges surrounding C-section utilization in the country.