Over One-Fifth of Deliveries in India are C-Sections, Private Facilities Dominate: Lancet Study

New Delhi: Over one-fifth of childbirths in India are performed via caesarean sections, with private healthcare facilities performing a much larger proportion of these surgeries compared to public ones, according to a study published in The Lancet Regional Health - Southeast Asia. The study examined caesarean delivery rates across 724,115 women aged 15–49 years who gave birth between 2019 and 2021, covering 28 states and eight union territories.

The findings reveal that 21.5% of deliveries in India are caesarean sections. However, this national figure conceals major disparities across states, economic groups, and healthcare sectors.

Caesarean rates in private healthcare facilities averaged 47.5%, compared to just 14.3% in public hospitals. Geographically, states like Nagaland had the lowest caesarean rate at 5.2%, while Telangana had the highest at 60.7%.

Economic disparities were also stark, with wealthier families significantly more likely to undergo a caesarean section. Caesarean rates for the richest wealth quintile were five times higher than those for the poorest.

Over two-thirds of Indian states reported caesarean rates at least twice as high in the wealthiest quintile compared to the poorest. Assam showed the greatest inequality, with caesarean rates for the richest quintile being nearly 10 times higher than for the poorest.

Dr Nobhojit Roy, co-author from Karolinska Institutet, Sweden, remarked, “Disparities in caesarean delivery rates indicate unequal access to the procedure among different groups, reflecting a dual scenario where some women are deprived of life-saving surgeries, and others are undergoing unnecessary procedures.”

Lead author Rohini Dutta, from Harvard Medical School, stated, “Our findings reveal substantial variations across geography, household income, and type of healthcare facilities. Addressing these disparities is critical for equitable healthcare delivery.”

The study highlights the challenges faced by India’s public healthcare sector, which serves a significant portion of the population but has lower caesarean rates. Wealthier individuals increasingly seek services from private hospitals, where rates are much higher.

This dual system of healthcare leaves economically disadvantaged populations with fewer opportunities for timely caesarean procedures when needed. At the same time, unnecessary caesareans in wealthier groups contribute to higher costs and potential health risks.

The researchers emphasize the need for targeted policies to address these disparities. Government programs such as Janani Suraksha Yojana and Ayushman Bharat, aimed at improving maternal healthcare, must be reassessed to ensure they reach marginalized groups effectively.

Monitoring mechanisms, such as the Robson Classification, could help policymakers evaluate and address the inequalities in caesarean delivery rates.

The study concludes that addressing the inequalities in caesarean delivery rates is crucial to ensuring equitable maternal healthcare in India. These disparities reflect systemic challenges that require coordinated efforts to improve access, quality, and outcomes for women across all sections of society.