Delivery complications and determinants of caesarean section rates in India - an analysis of national family health surveys, 1992-'93

Abstract

Caesarean section rates have been increasing world-wide raising the question of the appropriateness of the selection of cases for the procedure. This paper examines the levels and correlates of delivery related complications and caesarean section deliveries in eighteen selected states of India in terms of specific maternal and institutional factors, using data from the National Family Health Surveys, 1992-93. Goa (15.3 per cent) and Kerala (13.7 per cent) were the two states with relatively higher caesarean section rates. There is reason to believe that the current caesarean section rates are part of a rising trend. This can not be attributed entirely to the rise in institutional deliveries alone because of the strong association between caesarean sections and private sector institutions. Apart from the fact that the states of Kerala and Goa are having relatively high caesarean section rates, in Andhra Pradesh, Bihar, Gujarat, Karnataka, Punjab and Uttar Pradesh the risk of undergoing caesarean section in the private sector institutions is four or more times that in the public sector. It is possible that this extremely useful surgical procedure is being misused for profit purposes in the private sector in several states. There is therefore a need to examine this phenomenon using disaggregated data by the nature of caesarean sections, i.e. whether it was an elective or an emergency c-section along with the reasons for the choice.