The Lancet study explores factors shaping C-section rates, influenced by location, hospital choice, and income. Globally rising, C-sections pose risks when overused or underused. India's disparities exemplify regional variations tied to culture and wealth. Higher-income women opt for C-sections, primarily in private facilities. Education and urban living impact choices. Understanding these dynamics is vital for informed birth decisions and equitable maternal healthcare access.
A recent study published in Lancet Regional Health-Southeast Asia offers valuable insights into the factors influencing cesarean section (C-section) delivery rates in India. Drawing from data in the National Family Health Survey-5 (2019-21), researchers found that a woman's location, the type of medical facility, and her financial circumstances play crucial roles in determining whether she undergoes a C-section.
C-sections, which involve surgical incisions to deliver a baby, can be lifesaving when medically justified. However, unnecessary procedures can lead to health risks and increased costs, placing a burden on public health resources. Currently, about 21% of births globally are via C-section, and this figure is projected to rise to 28% by 2030. Interestingly, the study notes that “at the population level, a rate above 10–19% has not been linked to a decrease in maternal and perinatal mortality rates.”
The study reveals that both low and high rates of C-sections present challenges. “Low rates indicate that women requiring the procedure may not have adequate access, resulting in maternal and newborn mortality and morbidity,” while high rates may signal overuse without medical necessity, leading to complications and resource misallocation.
In India, the rate of C-sections has increased steadily, from 8.5% in 2005-2006 to 21.5% in 2019-2021. However, significant disparities exist between states. For instance, Telangana reports an impressive 60.7% C-section rate, while Nagaland stands at just 5.2%. The southern states, such as Tamil Nadu and Kerala, benefit from robust healthcare infrastructure and cultural acceptance of C-sections, whereas northeastern states like Meghalaya and Bihar face challenges due to limited access to surgical care.
The researchers identified various reasons for these disparities. In Arunachal Pradesh, for example, many women prefer vaginal deliveries due to fears about long-term health risks and costs associated with C-sections. Conversely, in states like Tamil Nadu and Telangana, factors such as high literacy rates, economic stability, and access to healthcare contribute to higher C-section rates. Cultural influences, including the desire for painless deliveries and auspicious timing for childbirth, also play a role.
Financial status significantly impacts C-section rates, with women from wealthier backgrounds more likely to opt for the procedure. The study found that only about 6% of women from the lowest wealth quintile underwent C-sections in public hospitals, while rates increased with wealth: from 11% in poorer categories to 25% in the richest.
Dr. Anita Gadgil, a co-author of the study, emphasized that awareness is a crucial factor in these disparities. “One of the major reasons for lower rates of C-section delivery among the poor, even in public health facilities, could be lack of awareness,” she noted. Many women may not have timely access to necessary medical care or knowledge of available government support.
The study highlights that southern states, such as Kerala and Tamil Nadu, exhibit higher C-section rates, while poorer states like Bihar and Chhattisgarh have lower rates, indicating underutilization. Even within states, stark differences exist between wealth quintiles, with the richest being far more likely to have C-sections than the poorest.
Nationally, private hospitals report a C-section rate of 47.5%, significantly higher than the 14.3% in public hospitals. This trend persists across wealth categories, with wealthier women more frequently accessing private care, which often provides quicker and more convenient services.
The researchers also found that better-educated women in urban areas tend to have more C-sections, suggesting that increased autonomy and access to healthcare contribute to this trend. By addressing these disparities and improving access to information and healthcare resources, we can empower women to make informed decisions about their childbirth experiences.
Comments