Hyderabad: Telangana has earned a dubious distinction by becoming the state with the highest number of cesarean deliveries (CDs). With 60.7% of CDs, Telangana ranks first. Andhra Pradesh ranks third with 42.4%, while Tamil Nadu is positioned second with 44.9%, according to the National Family Health Survey (NFHS)-5.
The NFHS-5 has also revealed that 21.5% of the deliveries across the country are cesarean. It is based on the information collected from 7,24,115 women, aged between 15 and 49 years.
The study published in Lancet Regional Health, Southeast Asia points out the national access to the CD but masks disparities including geographical, wealth, and sector-based inequalities.
The CD is performed to save the mother and neonates, Outcomes uncertain
The surgical procedure, performed to safeguard the lives of mothers and neonates is called cesarean delivery. The Indian average of 21.5% is almost similar to the global CD rate of 21%, which is expected to touch 28% by 2030.
Given the substantial regional variations in cesarean section prevalence across the globe, there is uncertainty over the higher CD rates effectively reducing maternal and perinatal mortality.
Southern states lead in ensuring equitable distribution
The World Health Organisation (WHO), which was insisting on 10-15% ‘optimal’ population-level cesarean rate has now focussed on ensuring fair and universal access to cesarean deliveries for women who medically require the procedure.
The paper published by the Lancet study has also interpreted the equitable distribution of facilities in 28 states and union territories and the level of inequality. Equitable distribution refers to high CD rates and low inequality.
Three south Indian states have topped this list, ensuring equitable distribution with Tamil Nadu topping the table with 1.6%, followed by Kerala (1.6%) and Telangana (2%).
States with low CD and Higher inequality
Contrary to the higher rates of CD in south India, the states in east India have recorded low numbers. Nagaland is placed at the bottom with 5.2% of CDs, while Meghalaya (8.2%) and Bihar with 9.7% complete the list of at least three states where women undergo cesarean deliveries.
The lower number of cesarean deliveries does not necessarily mean that all sections of the population have access to the facilities. The data from eastern and northern India prove this argument.
The highest inequality in providing facilities including provision for cesarean delivery is reported from Himachal Pradesh (13.4%), followed by Nagaland (10.4%), Assam, and Meghalaya with 10.9% each.
Reasons for high CD rates
The researchers have attributed the better healthcare faculties, high literacy, better GDP, and provisions for payment beyond the Janani Suraksha Yojana (JSY) to the higher number of cesarean deliveries in southern states.
Several factors including fear of normal birth, desire to deliver children on auspicious days, and preference for painless deliveries are considered contributing factors to the increase in cesarean deliveries.
