What’s driving the rising number of C-sections in India?

Recently, Andhra Pradesh Chief Minister N Chandrababu Naidu raised an alarm over the steep rise in Caesarean (C-section) deliveries across the State, pointing out that an overwhelming majority, close to 90%, are taking place in private hospitals.

Addressing the Assembly during discussions on the Medical and Health Department, the chief minister condemned the practice of conducting surgeries to suit “auspicious timings” (muhurthams). He stressed that such interventions are neither medically necessary nor ethically justified.

According to news reports, documents submitted to the chief minister showed that 56.62% of deliveries in 2024-25 were by C-section. 

The National Family Health Survey (NFHS-5, 2019-21) pointed out that 21.5% of all births in India were C-sections, up from 17.2% in NFHS-4 (2015-16). 

If one were to break the numbers down state-wise, in Telangana (60.7%), Andhra Pradesh (42–43%), and Kerala (38.9%), C-section deliveries have become the norm rather than the exception. However, Nagaland reported just 5.2%, showing how uneven the experience of childbirth can be across India.

The World Health Organization (WHO) recommends C-section rates at the population level to be between 10 and 15%, a number that India has significantly surpassed.

Why is there a surge in C-section deliveries? The fear of labour pain, preference for “auspicious” birth timings, and a growing acceptance of C-sections as a more convenient option are some factors that explain this trend.

A study released last year by researchers at the Department of Humanities and Social Sciences, IIT Madras, found that better-educated women in urban areas are more likely to undergo C-sections, suggesting that greater autonomy and better access to healthcare facilities play a role in the rising prevalence of surgical deliveries. Between 2016 and 2021, women delivering in private healthcare facilities were four times more likely to have a C-section than those in public hospitals, the study added.

The gap was particularly stark in some states: in Chhattisgarh, women were 10 times more likely to deliver by C-section in private hospitals, while in Tamil Nadu, the likelihood was three times higher. Researchers noted that such trends may also reflect systemic gaps, such as a shortage of specialists in public facilities. In 2021, for instance, Chhattisgarh reported a 77% vacancy rate against sanctioned posts for obstetricians and gynaecologists.

In the private sector, the number of C-sections stood at 49.7% in 2021. WHO research warns that while C-sections can be life-saving, they can put women and babies at unnecessary risk of short and long-term health problems if performed when there is no medical need.

The gap between a woman in a rural area needing timely access to a life-saving surgery and her counterpart in an urban area being subjected to one because she can afford it or due to other reasons needs to be deliberated and acted upon. While awareness and making informed decisions about her body should be a woman’s right, this inequity can be addressed through policy and strict government measures.

States like Andhra Pradesh are auditing private facilities and taking steps to penalise hospitals with excessively high rates, and in July this year, it launched a major midwife training initiative in 86 government hospitals to tackle high C-section rates. 

As India moves towards a robust and comprehensive healthcare system, it should ensure that childbirth remains equitable for all and is not dictated by socio-cultural or profitable reasons.

(Photo by Omar Lopez on Unsplash)