The caesarian deliveries in private hospitals of both Punjab and Chandigarh are more than double as compared to the government facilities, the National Family Health Survey (NFHS)-4 has found.
The survey was conducted between January and June, during which information from 16,449 households, comprising 19,484 women and 3,027 men, was gathered.
Overall, in Punjab, the caesarian deliveries accounted for 24.6 % whereas in NFHS-3 they were 16.5%. In private hospitals, the caesarean deliveries went up to 39.7% from 31.5% in the NFHS-3. The C-section deliveries at public hospitals stood at 17.8 %. The births took place up to 5 years preceding the survey.
In private hospitals of urban Punjab, the figure is 40.4 % and for rural areas it is 38.9%.
In a statement in April 2015, the World Health Organisation (WHO) had said that since 1985, the international healthcare community considered the ideal rate for C-section deliveries to be 10-15%. “Since then, caesarean sections have become increasingly common in both developed and developing countries. When the rate goes above 10%, there is no evidence that mortality rate improves.”
Data for Chandigarh was collected for the first time under the NFHS. In the Union Territory, the total caesarian deliveries have been as high as 22.6% among the births preceding 5 years from the survey.
In city private hospitals, the figure is 44%, which is even higher than Punjab. At public health facilities, it is less than half at 19.5%.
NFHS-4 fieldwork for Chandigarh was conducted from May to June and information was gathered from 751 households, comprising 746 women and 120 men.
“The C-section deliveries are very high in Punjab and Chandigarh. Privatisation of healthcare is responsible as private hospitals want to earn more, whereas in government hospitals it is need-based. Sedentary lifestyle of women is also responsible for the spurt in C-section deliveries,” said Prof Aswini Kumar Nanda, Population Research Centre, Centre for Research in Rural and Industrial Development (CRRID), Chandigarh.
“Profit is definitely one of the motives in private hospitals as there are packages for C-section deliveries and number of days of hospitalisation also increases. At times women also prefer C-section over normal deliveries. They are working and in delayed pregnancies, it is recommended. C-section deliveries are easier for gynaecologists, otherwise they have to wait,” said Dr Shalini Gainder, associate professor in genecology department of Post Graduate Institute of Medical Education and Research. She said in PGIMER, if a woman had already undergone C-section, she was offered a choice. “I agree that caesarian deliveries are high in Chandigarh and NFHS-4 figure corresponds with our data also. But we can hardly do anything as per present laws. We cannot force private hospitals to reduce C-section deliveries,” said Dr Rakesh Kashyap, director, health services, Chandigarh.
In Haryana, for which NFHS 4 data was gathered in 2015, the caesarian deliveries have risen to 11.7% from 5.3% in NFHS-3 for the births preceding five years before the survey. In private hospitals it has risen to 25.3% from 15.2% and in public health facilities it has decreased to 8.6% from 14.3 %.
So far, data for 23 states has been released but a number of states, including Himachal Pradesh and Jammu and Kashmir, are still left.
The C-section deliveries in private hospitals of Telangana (74.9%) Tripura (73.7%), West Bengal (70.9%), Andhra Pradesh (57%), Odisha (53.7%), Assam (53.3%), Tamilnadu (51.9%), Goa (51.3%), Sikkim (49.3%), Puducherry (48.3%), Chattisgarh (46.6%) and Manipur (46.2%) have higher rate than Chandigarh and Punjab.