Despite West Bengal and J&K having the highest C-section rates in the private sector, 83% and 82% respectively, the overall share of C-sections in the two states was 32.6% and 41.7% as most deliveries happened in public facilities where the rates were much lower.
The overall C-section rate in Telangana was over 60%, making C-section the new normal for deliveries in the state. Almost half of all institutional births in Telangana happened in the private sector, where the C-section rate was 81.5%. The state also had the highest C-section rate (45%) for public facilities.
Barring a few states, the proportion of C-sections went up sharply in both private and public facilities since the last survey in 2015-16. The highest jump was in private facilities in Assam, where C-sections went from 53% to 71%.
Gujarat has lowest caesarean rate of 31% in private hospitals
However, in both Assam and West Bengal, private facilities accounted for only about a quarter of all births. Gujarat had the lowest caesarean rate of 31% in the private sector.
Public facilities invariably have lower caesarean section rates than private facilities, but the rates have gone up even in the public sector across all states, except in Nagaland, Mizoram and Meghalaya.
C-section rates below 10% are considered to show underuse. By that yardstick, the very low C-section rates in the public sector in Bihar, just 3.6%, a marginal improvement over 2.6% in 2015-16, ought to be a cause for worry. In the three north eastern sates too the C-section rate in public facilities is below 10%.
The international healthcare community has considered the ideal caesarean rate to be 10-15% since 1985, said a World Health Organisation (WHO) statement.
In Nordic countries, known to have the best healthcare, caesarean sections constitute about 17% of all deliveries. Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate, the statement said, adding that C-sections should ideally only be undertaken when medically necessary.
Several studies have shown that C-sections can increase the chance of death and complications. The WHO observed in a 2015 statement that the lack of a reliable and internationally accepted classification system to produce standardised data to enable comparison has made it challenging to define an optimal caesarean section.