Lok Sabha Question No. 2717 (UNSTARRED), answered on 2017-03-17
Subject: C-section Surgery
Ministry: HEALTH AND FAMILY WELFARE
Asked by: ANTO  ANTONY, VIJAY KUMAR S.R., ASHOK SHANKARRAO CHAVAN, BIDYUT BARAN MAHATO, BALKA SUMAN, JAYAKUMAR JAYAVARDHAN, JOSE K. MANI, RAVINDRA KUMAR RAY, BANSHILAL MAHTO, GAJANAN CHANDRAKANT KIRTIKAR, SUDHEER GUPTA, BHEEMRAO BASWANTHRAO PATIL, HEENA VIJAYKUMAR GAVIT, RAKSHA NIKHIL KHADSE, RAJEEV SHANKARRAO SATAV, RAMA KISHORE SINGH, SHER SINGH GHUBAYA, SURESH KODIKUNNIL, T. RADHAKRISHNAN, KUNWAR HARIBANSH SINGH, CHINTAMANI MALVIYA, SUNIL BALIRAM GAIKWAD, BHARATENDRA SINGH, B.V. NAYAK, VIJAYSINH MOHITE PATIL

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE

## DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 2717 TO BE ANSWERED ON 1 7 th MARCH, 2017

## C - SECTION SURGERY

2717. SHRI ANTO ANTONY:

SHRI S.R. VIJAYAKUMAR:

SHRI ASHOK SHANKARRAO CHAVAN:

SHRI BIDYUT BARAN MAHATO:

SHRI SUMAN BALKA:

DR. J. JAYAVARDHAN:

SHRI JOSE K. MANI:

DR. RAVINDRA KUMAR RAY:

DR. BANSHILAL MAHATO:

SHRI GAJANAN KIRTIKAR:

SHRI SUDHEER GUPTA:

SHRI BHEEMRAO B. PATIL:

DR. HEENA VIJAYKUMAR GAVIT:

SHRIMATI RAKSHATAI KHADSE:

SHRI SATAV RAJEEV:

SHRI RAMA KISHORE SINGH:

SHRI SHER SINGH GHUBAYA:

SHRI KODIKUNNIL SURESH:

SHRI T. RADHAKRISHNAN:

KUNWAR HARIBANSH SINGH:

PROF. CHINTAMANI MALVIYA:

DR. SUNIL BALIRAM GAIKWAD:

KUNWAR BHARATENDRA:

SHRI B.V. NAIK:

SHRI MOHI TE PATIL VIJAYSINH SHANKARRAO:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether the Government is aware that World Health Organisation has recommended that C -section surgeries should normally constitute 10 - 15% of the total deliveries and if so, the details in this regard;
- (b) whether the Government has expressed deep concern about the increasing trend of hospitals forcing expecting mother to undergo C - section surgery for delivery of their babies and if so, the details there of;
- (c) whether the National Family Health Survey -4 (NFHS- 4) reports indicate that the said percentage is much higher in the country, if so, the details of the report and the reasons therefor, State/UT - wise;

(d) whether the Government is aware of an online petition signed by more than 1.3 lakh people seeking accountability and Government intervention over the alarming rise in caesarean section surgeries in India, mainly in private hospitals, if so, the details thereof;

(e) whether the Government has conducted any study on the impact of mother on C - section surgery and if so, the details thereof; and

(f) whether the Government has also received suggestion to mandate public disclosure of information regarding C - section surgeries as compared to the normal deliveries in all hospitals and nursing homes and if so, the response of the Government thereto?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI FAGGAN SINGH KULASTE)

( a) &( b) : World Health Organisation (WHO) in its statement released in April, 2015 has said that at population level, Caesarean section rates higher than 10% are not associa reductions in maternal and newborn mortality rates.

Government of India (GoI) has already written to all States and UTs sh aring the latest WHO statement.In addition, States have been informed to conduct periodic prescription aud the private health facilities under the Clinical Establishment Act. They have also been that prescription audits can be extended to pu blic health facilities.

A communication has also gone to Federation of Obstetrical & Gynecological Societi of India (FOGSI) which is the largest professional body of Obstetricians and Gynecologists India for sharing the WHO guidance note to all their State chapters and the Obstetrici Gynecologists registered with them.

( c) : As per NFHS-IV, the incidence of C - section in India is 17.2%. State/UT wise details are placed at Annexure.

There are multiple reasons for higher rates of C - secti n. Nowadays the family size is small,  hence,  every  pregnancy  is  precious.  Some  common  and  important  indications  for -section includes foetal distress, prolonged labour, Oblique presentation of the foetus, a w who is pregnant for the first time and previous C - s ction and C - section  on  demand  by  some patients. It is observed that due to good antenatal care, more high risk pregnancies a re identified which also leads to high C - section.

( d) : A petition has been signed by more than 1.3 lakh people on change.org website.

As  per  the  petition,  Caesarean  deliveries  have  become  a  business  and  hospitals doctors  are  making  money  from  unsuspe cting  women  and  pushing  them  towards  surgical deliveries.  Petitioner  also  talks  about  the  higher  rate  of  C - sections  in  private  hospitals  than public hospitals.

- ( e) : Government has not conducted any such study.

## (f): Government has received the suggesti on from the above mentioned petition.

The  Government  of  India  has  enacted  the  Clinical  Establishments  (Registration Regulation) Act, 2010 with the objective of registration and regulation of health care in including  those  in  the  private  sector.  10  States  and  6  UTs  have  adopted  th e  Clinical Establishment Act.

Health being a state subject, it is the responsibility of the state to effectivel the act.

| Birth in Health Facility by Caesarean Section (%)   | Birth in Health Facility by Caesarean Section (%)   | Birth in Health Facility by Caesarean Section (%)   |
|-----------------------------------------------------|-----------------------------------------------------|-----------------------------------------------------|
| S.No.                                               | States                                              | Birth delivered by C                                |
|                                                     | India                                               | 17.2                                                |
| 1                                                   | Andaman & Nicobar                                   | 19.3                                                |
| 2                                                   | Andhra Pradesh                                      | 40.1                                                |
| 3                                                   | Arunachal Pradesh                                   | 8.9                                                 |
| 4                                                   | Assam                                               | 13.4                                                |
| 5                                                   | Bihar                                               | 6.2                                                 |
| 6                                                   | Chandigarh                                          | 22.6                                                |
| 7                                                   | Chhattisgarh                                        | 9.9                                                 |
| 8                                                   | Delhi NCT                                           | 23.7                                                |
| 9                                                   | Daman & Diu                                         | 15.8                                                |
| 10                                                  | Dadar & Nagar                                       | 16.2                                                |
| 11                                                  | Goa                                                 | 31.4                                                |
| 12                                                  | Gujarat                                             | 18.4                                                |
| 13                                                  | Haryana                                             | 11.7                                                |
| 14                                                  | Himachal Pradesh                                    | 16.7                                                |
| 15                                                  | Jammu & Kashmir                                     | 33.1                                                |
| 16                                                  | Jharkhand                                           | 9.9                                                 |
| 17                                                  | Karnataka                                           | 23.6                                                |
| 18                                                  | Kerala                                              | 35.8                                                |
| 19                                                  | Lakshadweep                                         | 37.9                                                |
| 20                                                  | Madhya Pradesh                                      | 8.6                                                 |
| 21                                                  | Maharashtra                                         | 20.1                                                |
| 22                                                  | Manipur                                             | 21.1                                                |
| 23                                                  | Meghalaya                                           | 7.6                                                 |
| 24                                                  | Mizoram                                             | 12.7                                                |
| 25                                                  | Nagaland                                            | 5.8                                                 |
| 26                                                  | Puducherry                                          | 33.6                                                |
| 27                                                  | Sikkim                                              | 20.9                                                |
| 28                                                  | Odisha                                              | 13.8                                                |
| 29                                                  | Punjab                                              | 24.6                                                |
| 30                                                  | Rajasthan                                           | 8.6                                                 |
| 31                                                  | Tamilnadu                                           | 34.1                                                |
| 32                                                  | Telangana                                           | 58                                                  |
| 33                                                  | Tripura                                             | 20.5                                                |
| 34                                                  | UttarPradesh                                        | 9.4                                                 |
| 35                                                  | Uttarakhand                                         | 13.1                                                |
| 36                                                  | West Bengal                                         | 23.8                                                |

Source-NFHS-IV (2015-16)