Lok Sabha Question No. 2132 (UNSTARRED), answered on 2017-07-28
Subject: Cesarean Procedure
Ministry: HEALTH AND FAMILY WELFARE
Asked by: SUMEDHANAND SARASWATI, M. I. SHANAVAS, SANTOSH AHLAWAT

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

LOK SABHA UNSTARRED QUESTION NO. 2132 TO BE ANSWERED ON  28 TH JULY, 2017

## CESAREAN PROCEDURE

## 2132. SHRI SUMEDHANAND SARSWATI: SHRI M.I. SHANAVAS: SHRIMATI SANTOSH AHLAWAT:

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

- (a)  whether  a  survey  conducted  by  National  Family  Health  Survey  in  2015 - 16  in  15  States reported the rate of Csection births at 87 per cent and an yearly inc rease at 16.7 per cent above the recommended rate of WHO and one of the highest in the World, if so, the details thereo
- (b)  whether  the  Government  is  planning  to  take  action  against  the  Gynecologists/Nur Homes/private hospitals/Government hospitals , who preferred cesarean procedure to a normal delivery and if so, the details thereof;
- (c)  whether Government has collected  any data  of new born babies by  Cesarean and normal delivery in the country in the last two years and the current year and if so, the deta State/UT - wise and if not, the reasons therefor;
- (d) the steps taken by the Gov ernment to investigate the matter and corrective measures mulled upon; and
- (e) whether the Government is planning to make it mandatory for hospitals to publicly d the number of C - section surgeries and normal deliveries carried out and if so, the de tails thereof?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

(SHRI FAGGAN SINGH KULASTE)

- (a):National Family Health Survey (NFHS 4) 2015 - 16 was conducted in all States and Union Territories (UTs) of the Country. According to NFHS 4, 17.2 percent births (for births years preceding the survey) delivered by Caesarean section in comparison to 8.5 percent reported in NFHS 3 (2005 - 06).  NFHS 4 did not report 87 percent births by Caesarean section for State/UT.  The  World  Health  Organisation  (WHO)  norms  prescribe  that  C - section  deliveries should  ideally  be  around  10 - 15  per  cent  of  the  total  nu mber  of  deliveries  in  the  country,  at population level.

Contd…….

(b): No, as health is a state subject, states needs to work toward implementation of establishment act.

(c): States/UTs are reporting health services data including del ivery conducted by Cesarean section on the web based Health Management Information system (HMIS) established by th Ministry of health and Family welfare.  A statement containing total deliveries and C - section deliveries  reported  by  the  States/UT  during last  2  years  on  the  HMIS  portal  is  given  in Annexure.

(d): Government of India has already written to all States and UTs sharing the latest statement  on  Caesarean  Section  Rates.  In  addition,  States  have  been  informed  to  con periodic prescription audit in the private health facilities under the Clinical Est ablishment Act. They have also been informed that prescription audits can be extended to public health fa 10 States and 6 UTs have adopted the Clinical Establishment Act. Health being a state sub is the responsibility of the states to effe ctively implement the act.

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

(e): Government is aware about the increasing ratio of deliveries through Caesarean sec in Private Hospitals. In this regard, it has been decided that empanelled h ospitals under CGHS shall inform the public about ratio of deliveries by Caesarean Section vis -à- vis normal deliveries in  their  Hospital.  All  CGHS  empanelled  Hospitals  are  therefore  requested  to  display information on voluntary basis prominently near reception of the hospital, to begin with.

………………..

## Annexure

| Sl. No.   | State/ UT                   | Total Institutional Deliveries (including C - sections)   | Total Institutional Deliveries (including C - sections)   | Number of C-section deliveries   | Number of C-section deliveries   |
|-----------|-----------------------------|-----------------------------------------------------------|-----------------------------------------------------------|----------------------------------|----------------------------------|
|           |                             | 2016- 17                                                  | 2015- 16                                                  | 2016- 17                         | 2015- 16                         |
| 1         | A ndaman & N icobar Islands | 3,925                                                     | 4,090                                                     | 1,066                            | 1,177                            |
| 2         | Andhra Pradesh              | 7,23,168                                                  | 7,53,941                                                  | 2,24,761                         | 2,55,397                         |
| 3         | Arunachal Pradesh           | 15,597                                                    | 15,469                                                    | 2,095                            | 1,803                            |
| 4         | Assam                       | 5,59,793                                                  | 5,38,479                                                  | 1,16,003                         | 99,384                           |
| 5         | Bihar                       | 16,13,101                                                 | 16,54,823                                                 | 43,538                           | 47,875                           |
| 6         | Chandigarh                  | 29,107                                                    | 28,233                                                    | 9,556                            | 8,933                            |
| 7         | Chhattisgarh                | 4,32,401                                                  | 4,05,795                                                  | 67,622                           | 55,706                           |
| 8         | Dadra & Nagar Haveli        | 8,704                                                     | 9,057                                                     | 2,264                            | 1,855                            |
| 9         | Daman & Diu                 | 3,497                                                     | 3,600                                                     | 916                              | 971                              |
| 10        | Delhi                       | 2,55,017                                                  | 2,52,833                                                  | 75,525                           | 73,472                           |
| 11        | Goa                         | 17,501                                                    | 19,140                                                    | 6,329                            | 7,288                            |
| 12        | Gujarat                     | 11,62,327                                                 | 12,12,992                                                 | 1,58,503                         | 1,37,884                         |
| 13        | Haryana                     | 4,64,539                                                  | 4,56,607                                                  | 80,821                           | 78,037                           |
| 14        | Himachal Pradesh            | 77,674                                                    | 78,628                                                    | 15,402                           | 15,234                           |
| 15        | Jammu & Kashmir             | 1,85,440                                                  | 1,72,702                                                  | 69,677                           | 63,016                           |
| 16        | Jharkhand                   | 6,62,556                                                  | 5,55,162                                                  | 51,801                           | 45,044                           |
| 17        | Karnataka                   | 9,08,926                                                  | 9,01,006                                                  | 2,47,629                         | 2,22,282                         |
| 18        | Kerala                      | 4,46,123                                                  | 4,71,641                                                  | 1,84,709                         | 1,95,356                         |
| 19        | Lakshadweep                 | 804                                                       | 854                                                       | 296                              | 324                              |
| 20        | Madhya Pradesh              | 12,48,707                                                 | 12,86,462                                                 | 1,30,761                         | 1,27,195                         |
| 21        | Maharashtra                 | 16,34,878                                                 | 16,57,535                                                 | 2,85,407                         | 2,44,039                         |
| 22        | Manipur                     | 33,184                                                    | 31,814                                                    | 8,844                            | 8,437                            |
| 23        | Meghalaya                   | 47,496                                                    | 46,023                                                    | 6,956                            | 6,719                            |
| 24        | Mizoram                     | 17,267                                                    | 18,007                                                    | 2,905                            | 2,980                            |
| 25        | Nagaland                    | 16,430                                                    | 17,885                                                    | 2,761                            | 2,930                            |
| 26        | Odisha                      | 5,73,276                                                  | 6,15,371                                                  | 99,854                           | 92,009                           |
| 27        | Puducherry                  | 40,319                                                    | 41,594                                                    | 13,002                           | 12,465                           |
| 28        | Punjab                      | 3,63,425                                                  | 3,63,910                                                  | 1,22,996                         | 1,17,835                         |
| 29        | Rajasthan                   | 13,61,255                                                 | 13,43,037                                                 | 1,43,939                         | 1,33,138                         |
| 30        | Sikkim                      | 6,994                                                     | 7,651                                                     | 2,051                            | 2,455                            |
| 31        | Tamil Nadu                  | 8,92,508                                                  | 9,21,327                                                  | 4,00,296                         | 3,90,638                         |
| 32        | Telangana                   | 4,17,889                                                  | 5,52,841                                                  | 1,87,421                         | 2,66,842                         |
| 33        | Tripura                     | 44,664                                                    | 45,156                                                    | 10,779                           | 10,000                           |
| 34        | Uttar Pradesh               | 28,26,596                                                 | 30,13,828                                                 | 1,38,521                         | 1,27,018                         |
| 35        | Uttarakhand                 | 1,21,176                                                  | 1,19,618                                                  | 15,729                           | 14,292                           |
| 36        | West Bengal                 | 12,24,799                                                 | 11,97,496                                                 | 4,07,989                         | 3,82,112                         |

Source: Provisional Data as reported by theStates/ UTs on HMIS portal

Status as On: 21 Jul

2017