Lok Sabha Question No. 3308 (UNSTARRED), answered on 2017-08-04
Subject: Caesarean Operations
Ministry: HEALTH AND FAMILY WELFARE
Asked by: ANIRUDHAN SAMPATH

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 3308 TO BE ANSWERED ON 4 TH AUGUST , 2017

## CAESAREAN OPERATIONS

## 3308. DR. A. SAMPATH:

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

- (a) whether the private hospitals are forcing the women patients to undergo Caesarean ope even when these are not necessary, if so, the details thereof;
- (b) the percentage of Caesarean deliveries reported in Government and private hospitals, State -wise;
- (c) whether there is any mechanism with Government to check these unnecessary operations;
- (d) if so, the details thereof?

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

(a): As per National Family Health Survey -IV (2015 - 16), Birth in Health Facility by Caesarean Section (%) in private health facility is 40.9% which is higher than public heal facility where it is 11.9%. However, there are multiple reasons for higher rates of C - section.

Some common and important medical indications for C - section includ e foetal distress, prolonged  labour,  Oblique  presentation  of  the  foetus  and  history  of  previous  C - section.  Now days the family size is small hence, every pregnancy is precious and sometime C - sections are also demanded by some patients. It is observed that du  to good antenatal care, more high risk pregnancies are identified which also leads to higher C - sections.

- (b): State/UT wise details are placed at Annexure .
- (c) & (d): World Health Organisation (WHO) in its statement released in April, 2015 has s id that  at  population  level,  Caesarean  section  rates  higher  than  10%  are  not  associate reductions in maternal and newborn mortality rates.

Government of India (GoI) has already written to all States and UTs sharing the late WHO statement.Inaddition, States have been informed to conduct periodic prescription audi the private health facilities under the Clinical Establishment Act. They have also been that prescription audits can be extended to public health facilities. 10 States a nd 6 UTs have adopted the Clinical Establishment Act. Health being a state subject, it is the responsib states to effectively implement the act.

A communication has also gone to Federation of Obstetrical & Gynecological Societi of India (FOGS I)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 Gyn ecologists registered with them.

All CGHS Empanelled hospitals are directed to display the information regarding ratio of deliveries by Caesarean section vis - à- vis normal deliveries.

## Annexure

| Birth in Health Facility by Caesarean Section (%) Source-NFHS-4   | Birth in Health Facility by Caesarean Section (%) Source-NFHS-4   | Birth in Health Facility by Caesarean Section (%) Source-NFHS-4   | Birth in Health Facility by Caesarean Section (%) Source-NFHS-4   | Birth in Health Facility by Caesarean Section (%) Source-NFHS-4   |
|-------------------------------------------------------------------|-------------------------------------------------------------------|-------------------------------------------------------------------|-------------------------------------------------------------------|-------------------------------------------------------------------|
| S.No.                                                             | States                                                            | Birth delivered by C section                                      | Public Facility                                                   | Private                                                           |
| 1                                                                 | India Andaman & Nicobar                                           | 17.2 19.3                                                         | 11.9 16.9                                                         | 40.9 *                                                            |
| 2                                                                 | Andhra Pradesh                                                    | 40.1                                                              | 25.5                                                              | 57                                                                |
| 3                                                                 | Arunachal Pradesh                                                 | 8.9                                                               | 12.5                                                              | 37.5                                                              |
| 4                                                                 | Assam                                                             | 13.4                                                              | 12.9                                                              | 53.3                                                              |
| 5                                                                 | Bihar                                                             | 6.2                                                               | 2.6                                                               | 31                                                                |
| 6                                                                 | Chandigarh                                                        | 22.6                                                              | 19.5                                                              | 44                                                                |
| 7                                                                 | Chhattisgarh                                                      | 9.9                                                               | 5.7                                                               | 46.6                                                              |
| 8                                                                 | Delhi NCT                                                         | 23.7                                                              | 21                                                                | 42.9                                                              |
| 9                                                                 | Daman & Diu                                                       | 15.8                                                              | 7.3                                                               | 26.8                                                              |
| 10                                                                | Dadar & Nagar                                                     | 16.2                                                              | 12                                                                | 38.4                                                              |
| 11                                                                | Goa                                                               | 31.4                                                              | 19.9                                                              | 51.3                                                              |
| 12                                                                |                                                                   | 18.4                                                              |                                                                   |                                                                   |
| 13                                                                | Gujarat                                                           |                                                                   | 10.8 8.6                                                          | 26.6 25.3                                                         |
|                                                                   | Haryana                                                           | 11.7                                                              |                                                                   |                                                                   |
| 14                                                                | Himachal Pradesh                                                  | 16.7                                                              | 16.4                                                              | 44.4                                                              |
| 15 16                                                             | Jammu & Kashmir Jharkhand                                         | 33.1 9.9                                                          | 35.1 4.6                                                          | 75.5 39.5                                                         |
| 17                                                                | Karnataka                                                         | 23.6                                                              | 16.9                                                              | 40.3                                                              |
| 18                                                                | Kerala                                                            | 35.8                                                              | 31.4                                                              | 38.6                                                              |
| 19                                                                | Lakshadweep                                                       | 37.9                                                              | 25.7                                                              | 59.1                                                              |
| 20                                                                | Madhya Pradesh                                                    | 8.6                                                               | 5.8                                                               | 40.8                                                              |
| 21                                                                | Maharashtra                                                       | 20.1                                                              | 13.1                                                              | 33.1                                                              |
| 22                                                                | Manipur                                                           | 21.1                                                              | 22.6                                                              | 46.2                                                              |
| 23                                                                | Meghalaya                                                         | 7.6                                                               | 9.8                                                               | 31.4                                                              |
| 24                                                                | Mizoram                                                           | 12.7                                                              | 12.3                                                              | 30                                                                |
| 25                                                                | Nagaland                                                          | 5.8                                                               | 13.5                                                              | 31.4                                                              |
| 26                                                                | Puducherry                                                        | 33.6                                                              | 30.4                                                              | 48.3                                                              |
| 27                                                                | Sikkim                                                            | 20.9                                                              | 18.1                                                              | 49.3                                                              |
| 28                                                                | Odisha                                                            | 13.8                                                              | 11.5                                                              | 53.7                                                              |
| 29                                                                | Punjab                                                            | 24.6                                                              | 17.8                                                              | 39.7                                                              |
| 30                                                                | Rajasthan                                                         | 8.6                                                               | 6.1                                                               | 23.2                                                              |
| 31                                                                | Tamilnadu                                                         | 34.1                                                              | 26.3                                                              | 51.3                                                              |
| 32                                                                | Telangana                                                         | 58                                                                | 40.6                                                              | 74.9                                                              |
| 33                                                                | Tripura                                                           |                                                                   | 18.1                                                              |                                                                   |
| 34                                                                |                                                                   | 20.5                                                              |                                                                   | 73.7                                                              |
|                                                                   | UttarPradesh                                                      | 9.4                                                               | 4.7                                                               | 31.3                                                              |
| 35 36                                                             | Uttarakhand West Bengal                                           | 13.1 23.8                                                         | 9.3 18.8                                                          | 36.4 70.9                                                         |