Healthcare

Telangana’s spiralling C-section deliveries

Print edition : June 03, 2022

The Mother and Child Healthcare Center in the district government hospital at Sangareddy in Sangareddy district, Telangana. Photo: MOHD ARIF

Telangana has the second highest percentage of C-section deliveries in district hospitals, according to a recent study by NITI Aayog. A look at some of the reasons behind the alarming trend.

When V.R. Karnan, the Collector of Telangana’s Karimnagar district, recently summoned a meeting of astrologers, pundits, and purohits, it raised more than a few eyebrows. But desperate measures are needed to fix a desperate situation.

Karimnagar, like several other districts in Telangana such as Khammam, Hyderabad and Nizamabad, has witnessed a disquieting trend: a phenomenal increase in the number of women, especially women getting pregnant for the first time, opting for Caesarean section (C-section) deliveries.

Apparently, they opt for a C-section delivery not for medical reasons, but primarily because they want their babies to be born at a predetermined, auspicious muhurtam (auspicious time), when the stars are favourable and the planetary movements appropriately aligned. And these women and their families, in their quest for that unique auspicious muhurtam, have been seeking the services and advice of priests and astrologers.

Talking to Frontline, V.R. Karnan said: “The overwhelming desire for a particular date and time of delivery is driving several families to opt for C-section. People have made it a practice to approach astrologers and pundits to fix the auspicious time and then demand a C-section delivery at that exact time.”

The wide prevalence of the practice is reflected in a recent study conducted across India by NITI Aayog titled ‘Best Practices in the Performance of District Hospitals’, which was conducted together with the Union Ministry of Health and Family Welfare and the World Health Organisation (WHO) in October 2021. It showed that Telangana, with a 53.51 per cent share of Caesarian deliveries in district hospitals, stands second among States for C-section deliveries (Tamil Nadu has the dubious distinction of topping the list with 55.15 per cent of C-section births). Even more glaringly, Telangana’s number of C-section deliveries is well over double the national average (20.80 per cent).

If private hospitals are also taken into account, the percentage of C-section deliveries goes up even further. According to T. Harish Rao, Telangana’s Health Minister, for the month of April, the State had “a 62 per cent rate of C-section births, the most of any State in the country”. Citing an analysis by the State Health Department, the Minister said that C-section deliveries were predominant in North Telangana, where, in some nursing homes and hospitals, almost 99 per cent of all deliveries had been conducted using C-section procedure.

According to the NITI Aayog study, Karimnagar District Hospital with 69.93 per cent of C-section deliveries had the second highest of C-section deliveries in India in the large hospitals (300-plus beds) category (after the District Hospital Machilipatnam, in Andhra Pradesh’s Krishna district, with a 73.34 per cent C-section deliveries). The Khammam District Hospital, with 65.42 per cent, had the third-highest percentage of C-section cases in the mid-sized hospitals category (201-300 beds) in India.

Incidentally, Karnataka’s Vijayapura District Hospital had a 100 per cent record of C-section deliveries.

The NITI Aayog report cites a “lack of awareness regarding the benefits of a normal delivery and fear of labour pains” that is “forcing women in Karimnagar and Khammam hospitals to opt for C-section deliveries”.

In a bid to educate women about the benefits of opting for normal institutional deliveries, district officials such as Karnan are holding weekly meetings with obstetricians, senior gynaecologists, and Child Development Project Officers (CDPOs) of their respective districts.

Said Karnan: “In Karimnagar, we have established a separate portal for deliveries. And in every C-section delivery, the hospital will have to state the reason for it. We are also educating pregnant women on the advantages of normal deliveries.”

According to the Karimagar Collector, the administration is focussing on primigravidas, because they are the easiest section that could be weaned away from C-section deliveries and also since women who have had a C-section delivery in their first pregnancies generally tend to go in for a C-section in their subsequent deliveries as well. Karnan said that the efforts of the district administration were paying off. “We have managed to bring down the prevalence of C-section deliveries from a high of 80 to 85 per cent in district hospitals, government run-primary health centres, and private hospitals to around 60 to 65 per cent.” He reckons that three months ago, private hospitals in Karimnagar had a C-section rate of 90 per cent. It is now down to around 75 per cent, he claims.

The Karimnagar administration also is requesting astrologers and priests not to oblige families who are requesting them to fix auspicious muhurtams for the delivery of babies through C-section.

Said Karnan: “Families who are discouraged by doctors or hospitals just go to another medical facility, so we thought it would be good to speak to astrologers and priests. And they have responded positively. I made an appeal to the astrologers and purohits to discourage such unscientific practice of conducting C-sections to deliver babies. An organisation that represents priests came forward at our recent meeting and announced that they will continue to advise women and families that childbirth was a natural phenomenon and the muhurtam was fixed by god.”

Several temples in the district have begun displaying boards discouraging people from seeking auspicious times from astrologers in order to plan a C-section delivery.

But an obsession with muhurtam is not the only reason why women elect for a C-section delivery. Several obstetricians told Frontline that in many cases it is only on the instance of the mothers, who want to avoid labour pains, that C-sections are performed. Other reasons why women prefer C-section are the newfound economic prosperity and the medical myth over losing sexual pleasure post a vaginal birth. A report commissioned by the United Nations Children’s Fund highlighted the fact that several families in Telangana believed that a C-section delivery was an indication that the family was taking good care of their daughters and daughters-in-law.

Besides the larger medical bills on account of a surgical intervention, hospital managements too are known to encourage C-section deliveries since they avoid complications associated with normal deliveries.

The Telangana government has initiated steps to stem the unbridled growth of unnecessary C-section deliveries. At a recent video conference with District Collectors from across the State, Health Minister Harish Rao asked them to take initiatives to bring down the incidence of C-section deliveries. The Minister asked his officers to keep a tab “on private nursing homes, and take up a campaign among people in a big way on the ill-effects of C-sections and benefits of normal deliveries”.

While an incentive of Rs.3,000 will be offered to government hospital staff to increase normal delivery rates, private nursing homes and hospitals that report high C-section rates could also have their registrations suspended.