Recent studies reveal alarming trends in Caesarean section (C-section) deliveries in southern India. A percentage of these surgeries are deemed preventable. This finding raises concerns about maternal and child health outcomes, healthcare resource utilisation, and economic implications.
About Preventable C-Sections
Preventable C-sections are defined as surgeries not planned before labour onset. They occur at full term without complications like breech presentation or prolonged labour. The study analysed data from 21,499 women aged 15-49 who gave birth in the last five years. It found that 6.2% of deliveries were preventable C-sections.
Regional Variations
Among the southern states, Telangana reported the highest rate of preventable C-sections at 8.4%. Conversely, Kerala had the lowest at 3.1%. Other states showed varied rates – Andhra Pradesh at 5.4%, Karnataka at 6.2%, and Tamil Nadu at 7%. This variation marks the need for targeted healthcare interventions in specific regions.
Institutional Deliveries and C-Sections
Institutional deliveries in these states are remarkably high at 96.5%. However, C-section rates range from 31.5% to 60.7%. Kerala leads with 73.26% of C-sections being planned. A high percentage of planned C-sections can indicate good antenatal care but may also suggest elective surgeries are being favoured.
Common Complications and Risk Factors
The study identified breech presentation as the leading complication in Kerala. In other states, prolonged labour and excessive bleeding were more common. Notably, the risk of post-partum haemorrhage correlates with inadequate antenatal care, particularly in Andhra Pradesh and Telangana, where coverage is lowest.
Demographic
Women aged 25-34 years and those with at least primary education are more likely to undergo preventable C-sections. Uninsured, wealthier, and unemployed women also show higher rates. Primi-mothers, or first-time mothers, are particularly at risk, with 18% opting for C-sections.
Impact of Family Structure and Sterilisation
Women in nuclear families have higher C-section rates. The study suggests a link between C-sections and sterilisation, especially among mothers opting for sterilisation after their last birth. The sterilisation rate among the studied women ranged from 27.1% to 50.1%.
Private vs Public Healthcare Facilities
Deliveries in private healthcare facilities are nearly three times more likely to result in preventable C-sections. Private facilities account for 29.6% of institutional deliveries, with 48% of these being C-sections. The increase in C-section rates in private hospitals from NFHS-4 to NFHS-5 was noted at 17%.
Healthcare Resource Utilisation
Preventable C-sections lead to inefficient use of healthcare resources. They also pose risks of intraoperative complications and affect future health outcomes for mothers and children. Addressing these preventable surgeries is crucial for improving maternal and child health.
Questions for UPSC:
- Estimate the impact of high C-section rates on maternal health in India.
- Critically discuss the relationship between antenatal care and C-section delivery rates.
- Examine the socio-economic factors influencing the choice of delivery method among women.
- Analyse the implications of private healthcare delivery on maternal health outcomes in India.
Answer Hints:
1. Estimate the impact of high C-section rates on maternal health in India.
- High C-section rates can lead to increased maternal morbidity due to surgical risks and complications.
- Post-operative complications, such as infections and hemorrhage, can adversely affect future pregnancies.
- Preventable C-sections contribute to higher healthcare costs, straining economic resources for families and the healthcare system.
- Women with higher C-section rates may have longer recovery times, impacting their physical and mental health.
- Increased C-section rates can lead to a cycle of repeat surgeries, further complicating maternal health outcomes.
2. Critically discuss the relationship between antenatal care and C-section delivery rates.
- Access to quality antenatal care is linked to better birth outcomes, but can also correlate with higher planned C-section rates.
- Inadequate antenatal visits are associated with increased risks of complications, leading to unplanned C-sections.
- Regions with low antenatal care coverage, like Andhra Pradesh and Telangana, show higher rates of preventable C-sections.
- Women receiving full antenatal care are better informed about delivery options, potentially opting for elective C-sections.
- Overall, effective antenatal care can reduce unnecessary C-sections by addressing complications early.
3. Examine the socio-economic factors influencing the choice of delivery method among women.
- Education level influences delivery choices; educated women are more likely to choose C-sections.
- Socio-economic status affects access to healthcare; wealthier women may opt for private facilities, leading to higher C-section rates.
- Uninsured women are at a higher risk for preventable C-sections, often due to lack of access to comprehensive care.
- Women in nuclear families may feel pressured to choose C-sections for convenience or perceived safety.
- Primi-mothers are more likely to undergo C-sections, reflecting both socio-economic factors and healthcare practices.
4. Analyse the implications of private healthcare delivery on maternal health outcomes in India.
- Private healthcare facilities have higher rates of C-sections, often due to profit motives and patient preferences.
- Nearly three times the likelihood of preventable C-sections in private vs. public facilities indicates a disparity in care quality.
- Increased C-section rates in private hospitals can lead to higher maternal morbidity and complications.
- Private healthcare often lacks standardized protocols, contributing to unnecessary surgical interventions.
- The rising trend of C-sections in private settings raises concerns about the overall quality of maternal healthcare in India.
