IIT-M study points to more women preferring C-section deliveries
Researchers study delivery patterns in Tamil Nadu and Chhattisgarh, find pregnancy complications and highrisk fertility behaviour being more prevalent in Chhattisgarh, Csection more prevalent in Tamil Nadu. They call for further analysis
Astudy by the Indian Institute of TechnologyMadras found that there was a rise in the number of Caesarean sections (Csection) between 2016 and 2021 in the country. This, despite a drop in medical complications during pregnancy.
The chances of a Csection were greater if a woman opted for delivery in a private hospital, the study revealed. Also, overweight and older women (aged 3549) were more likely to have Csection deliveries.
The institute’s Department of Humanities and Social Sciences conducted the research in Tamil Nadu and Chhattisgarh. The researchers, included Varshini Neethi Mohan and P. Shirisha, research scholar Girija Vaidyanathan and a professor in the institute, V. R. Muraleedharan.
The findings were published in the peerreviewed journal BMC Pregnancy and Childbirth. A Csection delivery, is generally recommended to save the life of the mother and the unborn infant.
When not strictly necessary, however, it can cause several adverse health outcomes, lead to unnecessary expenditure, and place a strain on scarce public health resources, earlier researches have proved.
Factors that could contribute to adverse birth outcomes and possibly justify Csections (such as the mother’s age being less than 18 years or greater than 34 years, the interval between births being less than 24 months) are considered highrisk fertility behaviour.
In an indepth analysis of Tamil Nadu and Chhattisgarh, the researchers found that though pregnancy complications and highrisk fertility behaviour were more prevalent in Chhattisgarh, Csection was more prevalent in Tamil Nadu.
Prof. V. R. Muraleedharan said, “A key finding was that the place of delivery (whether the delivery was in a public or a private facility) had the greatest impact on whether delivery was by Csection, implying that ‘clinical need’ factors were not necessarily the reason for surgical deliveries.
Across India and Chhattisgarh, the ‘nonpoor’ were more likely to opt for Csections, while in Tamil Nadu, the case was surprisingly different, as the poor were more likely to have Csections in private hospitals.”
The prevalence of Csections across India increased from 17.2% to 21.5% in the five years leading up to 2021. In the private sector, these numbers stand at 43.1% (2016) and 49.7% (2021).
WHO recommendation
The World Health Organisation recommends that only 10% to 25% of deliveries can be through Csection. The increase could be attributed to several factors, the study noted. Better educated women living in urban areas were more likely to deliver by Csection, suggesting that greater autonomy and better access to healthcare facilities play a role in the increase.
“The odds of a caesarean delivery among overweight women and those aged 3549 were twice those for underweight women and those aged 1524, respectively. The proportion of overweight women giving birth increased from 3% to 18.7%, while that of women aged 3549 decreased slightly from 11.1% to 10.9%,” the study said.
The proportion of those with pregnancy complications fell from 42.2% to 39.5%, implying that the increased rate of Csection delivery was largely influenced by nonclinical factors.
During the study period it was noticed that women delivering at private healthcare facilities were four times more likely to have a Csection.
Inadequate amenities
This could be due to a lack of adequate infrastructure in public healthcare facilities, the researchers highlighted. In Chhattisgarh, there was a 77% vacancy against the sanctioned posts for obstetricians and gynaecologists in 2021.
To arrive at the above conclusions, the researchers collated and analysed data from the National Family Health Survey (NFHS) conducted in 2015–2016 and 201921.
The researchers recommend that “threshold levels for Csections be applied cautiously, as several intercategory variations exist, and in States at advanced levels of demographic transition, need factors for Csections may be more prevalent. There is an alarmingly high proportion of poor women undergoing Csections in the private sector in Tamil Nadu. This requires further analysis and corrective action, the researchers concluded.