The real causes for the alarming rise in C-section births in India
When it comes to giving birth, The World Health Organisation (WHO) has a recommended rate of 10 – 15% for cesarean or C-section births. Till 2010 the number of C-section births in India was 8.5 %, which was well within the recommended level.
According to the National Family Health Survey conducted in 2015-2016 in 15 Indian states and union territories, in some states the rate of C-section births is as high as 87 %. The yearly rate of increase in cesarean births has been 16.7 % which has been one of the highest in the world.
A lot of factors have been responsible for that but the whole issue has been taken up by the Women and Child Development Minister Maneka Gandhi, recently, who has sought surgical data from all private hospitals to know about the actual numbers of C-section deliveries carried out.
This step has been taken in the wake of a petition that has been submitted to her on Change.org by 137,986 people asking her to make it mandatory for all hospitals to declare the number of cesarean deliveries.
Private hospitals and their financial policies and doctors on the lookout for some quick bucks have been blamed for these escalating figures.
An accounts head of a private hospital in Kolkata on conditions of anonymity said: “We charge Rs 150,000 for a cesarean delivery and in the last six months there have been no normal deliveries in our hospital.” The minimum cost of a C-section delivery is Rs 40,000 in an urban hospital in India.
I reached out to around 50 Indian women over social media, based both in India and abroad to find out if they had a normal delivery or a C-Section. Almost all the women based in India, except for one from Bangalore, said they had C-section deliveries.
S. Bhattacharya, a communications specialist from Bangalore, however said her normal delivery was too complicated and way too risky. “Looking back I feel it could have gone grossly wrong but I was lucky.”
Roshni Mukherjee, a journalist, said that her doctor in Kolkata had given her the option and she really wanted to go for normal. “My doctor waited for 12 hours after inducing pain but thought it was too risky to wait longer so she went for C-section.”
Gynecologist Dr Vineeta Kaul, who delivered Roshni’s son, said, “I get very few patients like Roshni who are willing to go for normal delivery. Thirty per cent of my patients tell me from the very beginning of their pregnancy that they wouldn’t want to go through the pain of labour and would opt for C-section. Some even tell me not to inform their parents or in-laws because then they would be pressurized to go for normal delivery.”
Another issue that Indian hospitals face is the lack of infrastructure or trained personnel to monitor a pregnant woman in labour which is very important for everything to go right in case of a normal delivery.
“In first-world countries there are professional midwives who do the delivery and the process is not entirely dependent on the doctor,” said Dr Kaul.
In India, because of its overwhelming population in both urban and rural areas, the doctor-patient ratio is skewed. In such a situation, it is impossible for a doctor to devote so much time to a single patient – be it in a rural hospital or in a super-specialty hospital in the city.
I spoke to a number of Indian women who have given birth abroad in places like Malaysia, Dubai and USA and who have said that they had to go for a C-section because of complications.
It could be the changing lifestyle of the Indian woman that is responsible for the rise in C-section deliveries because in the generation of our grandmothers, the C-section delivery option was sparsely available and so was virtually unheard of.
Dr Kaul said, “In that generation people had a number of children so neo-natal mortality rate and maternal mortality rates were high. Because of the lack of medical facilities available it was accepted at that time, but now if we can use the facilities to reduce the dangers then there is nothing wrong in it.”
Mumbai-based obstetrician Dr Rajiv Punjabi in an interview to Quartz said that most patients in his clinic are in the age group of 32 and women above 35 years are at a greater risk.
Dr Punjabi pointed out: “There has been a rise in the number of patients who are obese and are at risk of developing gestational diabetes.”
But many healthcare specialists and doctors feel that if hospitals charged a flat rate for both delivery procedures, they would then not insist on C-section deliveries which would help bring down their numbers. Also it is important to have counseling centres for couples where they are given the information to make an informed choice and also have exercise centres run by clinics and hospitals for pregnant women so that they prepare their body for normal delivery.
C. Menon, an event manager based in Dubai, said, “I was told by my doctor on all the medications available to handle the pain of labour, from epidural to pethidine. There was a centre in the hospital I was going to where I did gentle exercises under a trained instructor. I was in labour for 14 hours and four people monitored me constantly. There was a lot of effort to ensure a safe normal delivery I feel.”
In countries where normal deliveries are promoted, there is a culture of ensuring that women are informed about healthy diet, exercises and pain handling procedures, something that India lacks at the moment.
Eighty-year-old Basabi Mukherjee, who had both her children through normal delivery said, “I used to wipe the floors with a cloth and water every day in a sitting position during my pregnancy because my doctor said that prepared my body for a normal delivery. I have my doubts how many women today would have the time and inclination to do that.”
While Maneka Gandhi will have to curb the money-making aspect of C-sections, she has a tall task at hand if she is planning to promote normal deliveries. Because it is a fact that C-section birth has also become psychologically and culturally ingrained inside the Indian society.