A study published by IIT Madras shows that in Tamil Nadu, access to caesarean section (C-section), an essential medical intervention that can save lives when vaginal deliveries are risky, is more equitable compared to India’s average. However, C-section rates among the women of Tamil Nadu are also alarmingly high, especially in private hospitals, pointing to the need for corrective action, the study points out. The report also compares Tamil Nadu’s figures with those of Chhattisgarh to show how in certain States, C-sections are more prevalent among richer sections of society, while the poor lack access to it.
A C-section delivery refers to a surgical procedure in which an incision is made in the woman’s abdomen to deliver one or more infants. According to the World Health Organization, access to hospitals that are equipped to perform such procedures is crucial to ensure the safety and well-being of both the mother and child in the event of medical necessity. Maternal and neonatal mortality rates decline in countries which have C-section rates of about 10%, the WHO concludes. However, the agency also warns that if C-section rates go beyond 10%, it will not necessarily reduce maternal mortality. In 2021, global C-section rates exceeded 20%. They are projected to rise to 30% by 2030.
Chart 1 | The chart shows the change in the share of births delivered by C-sections in public sector hospitals in India, Tamil Nadu, and Chhattisgarh between 2015-16 and 2019-21.
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In public sector hospitals, nearly 40% of women underwent C-sections in Tamil Nadu in 2019-21. That is, of every 100 deliveries in public sector hospitals, 40 were C-sections. This is much higher than India’s average of around 16% and Chhattisgarh’s 10%.
Chart 2 | The chart shows the change in the share of births delivered by C-sections in private sector hospitals across India, Tamil Nadu, and Chhattisgarh between 2015-16 and 2019-21.
The gap narrowed considerably in private hospitals: close to 64% women underwent C-sections in private sector hospitals in Tamil Nadu in 2019-21 compared to India’s average of around 50% and Chhattisgarh’s 59%. “In Chhattisgarh, a woman is 10 times more likely to undergo a C-section in a private hospital than in a public hospital. This could be due to a lack of adequate or high-quality services in public health institutions,” the study concludes. Assuming that poorer households choose public hospitals for deliveries and richer households prefer private ones, this points to inequitable access at the national level and more equitable access in Tamil Nadu.
The study also shows that the location of childbirth (whether in a public or private institution) had the most considerable influence on the decision to get a C-section delivery. This suggests that ‘clinical necessity’ isn’t always the driving factor for surgical births. Throughout India and Chhattisgarh, individuals who were better off financially tended to choose C-sections more frequently, whereas, in Tamil Nadu, the situation was distinct, with poorer individuals being more prone to undergo C-sections in private hospitals.
Chart 3 | The chart shows the disparity among women from the poor and non-poor categories in their access to C-sections in public hospitals across India, Tamil Nadu and Chhattisgarh in 2015-16 and 2019-21.
Chart 4 | The chart shows the disparity among women from the poor and non-poor categories in their access to C-sections in private hospitals across India, Tamil Nadu and Chhattisgarh in 2015-16 and 2019-21.
It shows that the poor were more likely to have C-sections in private hospitals in Tamil Nadu. “The inversion in income-based inequality in Tamil Nadu in private institutions in 2019-21, with a greater proportion of the poor than the non-poor delivering via C-section, is difficult to explain,” the study says.
Source: Variations in the prevalence of caesarean section deliveries in India between 2016 and 2021 – an analysis of Tamil Nadu and Chhattisgarh
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