Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Two States: a comparison on access to life-saving C-sections


From UPSC perspective, the following things are important :

Prelims level: NA

Mains level: Health Governance;

Why in the News?

The study released by IIT Madras highlights the concerns related to high rates of C-section deliveries among women in Tamil Nadu, particularly in private hospitals.

  • This indicates the necessity for corrective measures to address the situation.

What is a Caesarean section? 

It is also known as C-section or cesarean delivery, which is the surgical procedure by which one or more babies are delivered through an incision in the mother’s abdomen.

It is often performed because vaginal delivery would put the mother or child at risk.


Changes in the share of births delivered by C-sections in public and private sector hospitals in India, Tamil Nadu, and Chhattisgarh between 2015-16 and 2019-21.

  • High C-section Rate in Public Hospitals: In public sector hospitals in Tamil Nadu, nearly 40% of women underwent C-sections during 2019-21.
  • High C-section Rate in Private Hospitals: Close to 64% of women underwent C-sections in private sector hospitals in Tamil Nadu during 2019-21, which is significantly higher than both the national average of around 50% and Chhattisgarh’s rate of 59%.
  • Higher than the National Average: The rate of C-section deliveries in Tamil Nadu’s public sector hospitals is substantially higher than the national average, which is approximately 16%. Additionally, it surpasses the rate in Chhattisgarh, where it stands at 10%.

Reasons behind the increase in C-section rates despite a decrease in pregnancy complications:

  • Regional Disparities: In Chhattisgarh, the likelihood of a woman undergoing a C-section in a private hospital is ten times higher than in a public hospital. This suggests potential disparities in access to high-quality healthcare services between public and private sectors, with implications for maternal health outcomes.
  • Socioeconomic Factors: The study assumes that poorer households opt for public hospitals while richer households prefer private ones for deliveries. This socioeconomic divide may contribute to inequitable access to healthcare services at the national level.
  • Higher Likelihood in Private Health Facilities: Women delivering in private health facilities are more likely to undergo C-sections compared to those in public facilities, with a notable disparity observed in Chhattisgarh.
  • Maternal Age and Weight Status: Factors such as maternal age (35-49) and overweight status increase the likelihood of C-section delivery.
  • High gap between Poor and Rich: In India, the gap in C-section prevalence between the poor and non-poor narrowed in private facilities, but Tamil Nadu exhibited a concerning trend where a higher percentage of the poor underwent C-sections compared to the non-poor.

Recommendations by the World Health Organization (WHO): Cesarean delivery rates should ideally not exceed 10-15% to achieve the lowest maternal and neonatal mortality rates. When C-section rates go beyond 10%, there is no significant decrease in maternal mortality. In 2021, global C-section rates surpassed 20%, and they are projected to increase to 30% by 2030.

Conclusion: Access to C-sections in Tamil Nadu shows disparities, with high rates in both public and private hospitals. Addressing regional, and socioeconomic factors and adhering to WHO recommendations are crucial for equitable maternal healthcare.

PYQ Mains 

Q Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)

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