Punjab’s C-section rate nears alarming 50%, sparks concern

Punjab’s C-section delivery rate has seen a sharp and concerning rise, with the latest data showing that 47.1% of all births across the state are now cesarean, approaching the 50% mark, according to a response under the Right to Information (RTI) Act.

Punjab’s C-section delivery rate has seen a sharp and concerning rise, with the latest data showing that 47.1% of all births across the state are now cesarean, approaching the 50% mark, according to a response under the Right to Information (RTI) Act. This figure, drawn from hospital information management systems over the past three years, highlights a growing trend in both private and public healthcare sectors.

Health and family welfare minister Balbir Singh stated that today the families are small, typically with one or two children. Even our Total Fertility Rate (TFR) in Punjab is 1.65, which is below the replacement level that indicates that population is declining, not growing. Now the families plan for only one pregnancy, as the mothers are above 30, so the risks become higher. (HT File)

In stark contrast to the World Health Organization (WHO)’s recommended C-section rate of 10% to 15%, Punjab’s current rate is nearly three times higher, sparking concerns over the increasing medical and ethical implications of this trend.

The latest Lancet Regional Health - Southeast Asia report published in December last year, which analysed data from the National Family Health Survey-5 (2019–2021) on C-sections, reveals that C-section rates in India have increased, rising from 8.5% in 2005–2006 to 17.2% in 2015–2016 and 21.5% in 2019–2021.

As per the RTI, the total number of deliveries, including both normal and C-section, is 1,012,526 over the three-year period. In parallel, the total number of C-section deliveries for the same period is 476,026.

The C-section rate was 44.77% in 2022-23. This rate saw a slight increase of 2% in 2023-24 with 46.41%. However, 2024-25 witnessed a doubling of this increase, with the rate jumping by 4% to 50.13%. This represents an overall increase of approximately 5 to 6% over the last three years.

Even more concerning are the figures from the current year. In just three months of 2025 (April, May, and June), the state saw a sharp spike to 53% C-section deliveries. Of the 58,866 total deliveries during this period, 31,429 were performed through a C-section.

According to the data, Pathankot and Gurdaspur have continuously recorded the highest C-section rates. In 2022-23, Pathankot’s rate was 65.38% and Gurdaspur was 63.43%. This upward trend continued into 2023-24, where their rates climbed to 66.21% and 65.42%. In 2024-25, Gurdaspur had the highest rate at 67.95%, followed closely by Pathankot at 66.85%. The data for the three months (April, May, June) of 2025 shows an alarming surge, with Pathankot’s rate soaring to 73.13%.

Other districts, including Jalandhar, Kapurthala, and SBS Nagar, have also featured in the top five, with their rates steadily rising each year. Jalandhar’s rate increased from 51.59% in 2022-23 to 59.46% in 2024-25. Similarly, SBS Nagar’s rate went from 55.22% to 57.35% in the same period. For the first time, Amritsar entered the top five in the three (April May June ) months of 2025, with a rate of 57.54%.

Dr Isha, an obstetrician and gynaecologist from a private hospital of Sangrur, said, “The rising cases of C-section are concerning as it contributes to more complications. Nowadays, everybody wants one or two kids, and they want them to be safe and without risk.”

Explaining the reasons, she added that the pain tolerance of women has also decreased, which can be attributed to less physical activity and an easy lifestyle. Sometimes doctors do opt for these as normal deliveries require monitoring of both the baby and the mother, where C-section becomes an easier option for some doctors.

Talking about the risks involved she said, “As the rate of C-sections is on rise, it has also led to an increase in scar ectopic pregnancies, which were less common in the past but are now on rise. We do counsel people about normal deliveries but they won’t listen. There are situations where we know a normal delivery should be done but patients, their family sometimes argue with us. Then we go with C-section delivery having no option.”

She said that approximately 70% of deliveries are normal cases with only 30% requiring surgery due to risk factors but still people opt to surgeries fearing risks. “To show that the doctors are not interested in C-section deliveries, some hospitals have even made the cost of normal and cesarean deliveries the same,” she said.

A senior official from the health and family welfare department stated that mothers and their families opt for C-sections electively. They go to private hospitals themselves. The official noted that the fertility rate in Punjab is lower than the country’s average, so people go for such treatments, which results in a precious child. “If a woman has a cesarean delivery once, then the next delivery can become a high-risk one, as it sometimes leads to a uterine scar rupture,” she said.

As per the Sample Registration System Statistical Report 2022, the total fertility rate of India is at 2.0. With Punjab’s TFR at 1.5.

Health and family welfare minister Balbir Singh stated that today the families are small, typically with one or two children. Even our Total Fertility Rate (TFR) in Punjab is 1.65, which is below the replacement level that indicates that population is declining, not growing. Now the families plan for only one pregnancy, as the mothers are above 30, so the risks become higher.

He said that we are closely monitoring the situation. “We will make it sure that cesarean sections are performed only when medically necessary for the safety of the mother and child, not for the convenience of the doctor,” he added.

He said that the rate is lower in government hospitals. The private sector, however, operates differently, they have their own reasons and their rates depend on various factors.

“While the overall cesarean section rate in Punjab is not alarmingly high, it is a concern. We’ve established a policy to closely monitor the issue,” he said.

“You see the rate is lower among the lower strata, the cesarean rate is around 10-15%. What is more concerning is that there’s a rise in children being born through IVF and assisted fertilisation. We are currently studying all these factors and have initiated a screening programme to better understand the problem,” he said.

The minister at first said that the C-section rate is not alarmingly high but later he said “47% is on the higher side.”