Study ties C-section deliveries to income

Only 6% of women belonging to the lowest wealth quintile, or the poorest, underwent C-section in public hospitals, the study shows

NEW DELHI: More women from high-income quintiles are undergoing delivery through caesarean section (Csection), even in govt hospitals, according to a new study.
A wealth quintile is a statistical value that divides a population into five equally sized groups based on wealth, with each quintile representing 20% of the population.
Only about 6% women belonging to lowest wealth quintile, or the poorest, underwent C-section delivery in public hospitals across India. The rest went for normal delivery, according to the study published in Lancet Regional Health-Southeast Asia, which is based on a cross-sectional analysis of C-section delivery rate data published in National Family Health Survey-5 (2019-21) report.
The percentage of women undergoing C-section delivery at public hospitals in the poorer, middle, richer and the richest categories stood at 11%, 18%, 21% and 25%, of total births in the respective wealth quintile, it stated. A C-section delivery is a surgical technique that involves making an incision in the belly to deliver one or more infants. When medically justified, the procedure can be lifesaving. However, when not strictly necessary, it can cause adverse health outcomes, lead to unnecessary expenditure, and place a strain on scarce public health resources.
Dr Anita Gadgil, co-corresponding authors of the study, told TOI that one of the major reasons for lower rate of Csection delivery among the poor even in public health facilities, where the procedure is carried out free of cost, could be lack of awareness.
“Also, sometimes the poorer women aren’t able to reach higher centres in time where C-section delivery is available, or they don’t have money and wherewithal to reach there. These people are often also least aware of govt schemes to provide financial support in such cases,” Dr Gadgil said.
The study stated that while southern states like Kerala, Tamil Nadu and Andhra Pradesh have high C-section delivery rates (up to 60%), states with a predominantly poor quintile population like Bihar, Assam and Chhattisgarh have lower C-section rates.
Dr Gadgil, who works at George Institute for Global Health, said low rates indi cate that women requiring the procedure may not have adequate access, resulting in maternal and newborn mortality and morbidity. On the other hand, high rates are suggestive of overuse without medical necessity, which is associated with higher rates of adverse outcomes and misallocation of resources, she added.
A study carried out by researchers from IIT-Madras recently revealed that prevalence of C-sections across India increased from 17% to 21.5% from 2016 to 2021. In the private sector, these numbers stand at 43% (2016) and 50% (2021), meaning that nearly one in two deliveries in the private sector is a C-section.
Researchers found better-educated women living in urban areas were more likely to deliver by C-section, suggesting that greater autonomy and better access to healthcare facilities play a role in increase in prevalence of C-sections.