Lok Sabha Question No. 2218 (UNSTARRED), answered on 2020-09-23
Subject: Guidelines for Caesarean Deliveries
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Upendra Singh Rawat, Subhash Ramrao Bhamre, DNV Senthilkumar. S., Amol Ramsing Kolhe, Kuldeep Rai Sharma, Manickam Tagore B, Supriya Sadanand Sule

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

## LOK SABHA UNSTARRED QUE STION NO. 2218 TO BE ANSWERED ON 23 RD SEPTEMBER, 2020

## GUIDELINES FOR CAESA REAN DELIVERIES

## 2218. SHRI UPENDRA SINGH R AWAT:

DR. SUBHASH RAMRAO BHAMR E:

DR. DNV SENTHILKUMAR S.:

DR. AMOL RAMSING KOL HE:

SHRI KULDEEP RAI SHA RMA:

SHRI MANICKAM TAGORE B.:

SHRIMATI SUPRIYA SUL E:

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

- (a)  whether  the  rate  of  caesarean deliveries  across the  country  is  higher  than  the  developed countries, if so, the details thereof indicating the number of such deliveries performed during the last three years and the curr nt year, State/UT - wise including Barabanki, Uttar Pradesh and the r easons therefor;
- (b) the details of the standards declared by WHO for caesarean deliveries;
- (c) whether Government has put in place any guidelines and rules for cesarean deliveries and if so,the present status of compliance thereof by Government and private hospitals and if not, the corrective steps taken in this regard;
- (d) whether the Government and private hospitals and Nursing Homes are forcing the women patients and their family members to undergo caesarean operation even when it is not necessary;
- (e) if so, the details thereof and the action taken against erring Government, private hospitals, nursing homes in this regard; and
- (f) the other steps taken by the Government to bring down C-section deliveries as per the WHO standards?

## ANSWER

## T HE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

- (a) As per NFHS - 4 (2015 - 16),the rate of caesarean deliveries in the country is 17.2% which lower  than  the  developed  countries  viz.  Latin  America  and  the  Car ibbean  countries  (40.5%), North America (32.3%), Oceania (31.1%), Europe (25%), Asia (19.2%) as per the WHO 2018 report.

The details of the C - section deliveries performed during the last three years and curr year, State/UT -wise including Barabanki, Ut tar Pradesh is given in Annexure as per HMIS.

(b)  The  standards  declared  by  WHO  for  Caesarean  deliveries  state  that  at  population caesarean section rates higher than 10% were not associated with reductions in rates of m and newborn mortality. It recommended the adoption of the Robson classification system, which facilitates comparison and analysis of caesarean rates within and between different facilities, and across countries and regions.

(c) & (f) Health is a State subject. However, MoHFW ha s taken the following steps to curb the rise in C - section;

- Conveyed the WHO Statement to all States/UTs urging them to share the same with a Obstetricians and Gynaecologists working in public health facilities in their res States/UTs.
- Collaborated with  Federation  of  Obstetrician  and  Gynaecologists  in  India  (FOGSI)  t share the WHO statement on C - section among all members.
- Under  'LaQshya' - Labour  room  &  maternity  OT  Quality  Improvement  Initiative, Caesarean  section  audit  has  been  implemented  in  all LaQshya  certified  public  health facilities to ensure that Caesarean sections are undertaken judiciously in only tho requiring such surgical interventions
- All CGHS empanelled hospitals are directed to display the information regarding rat deliv eries by caesarean section.

(d) & (e) No such information is available with the Government.

(f)  As above.

226,130

## Annexure

| Sr. No   | States/UTs               | Number of C-section deliveries conducted at public facilities   | Number of C-section deliveries conducted at public facilities   | Number of C-section deliveries conducted at public facilities   | Number of C-section deliveries conducted at public facilities   | Number of C-section deliveries conducted at private facilities   | Number of C-section deliveries conducted at private facilities   | Number of C-section deliveries conducted at private facilities   | Number of C-section deliveries conducted at private facilities   |
|----------|--------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|------------------------------------------------------------------|------------------------------------------------------------------|------------------------------------------------------------------|------------------------------------------------------------------|
|          |                          | 2017-18                                                         | 2018-19                                                         | 2019-20                                                         | Apr20-June20                                                    | 2017-18                                                          | 2018-19                                                          | 2019-20                                                          | Apr20- June20 383437                                             |
|          | AllIndia                 | 1,756,951 922                                                   | 1,897,546 1,030                                                 | 1,860,189 785                                                   | 365161 104                                                      | 1,831,636 0                                                      | 2,051,481 0                                                      | 2,032,486 0                                                      | 0                                                                |
| 1        | A&NIslands               |                                                                 | 94,202                                                          |                                                                 |                                                                 |                                                                  |                                                                  |                                                                  |                                                                  |
| 2        | AndhraPradesh            |                                                                 |                                                                 |                                                                 | 20997                                                           | 148,128                                                          |                                                                  | 141,190 1,062                                                    | 29942                                                            |
| 3        | ArunachalPradesh         | 89,514                                                          |                                                                 | 92,261                                                          |                                                                 |                                                                  | 176,474                                                          | 56,975                                                           | 259                                                              |
| 4        | Assam                    | 2,640                                                           | 2,027                                                           | 2,430 67,707 29,930                                             | 354 11869 4979                                                  | 773 50,094 15,964                                                | 998 52,808 16,531                                                | 17,476                                                           | 11116 1347                                                       |
| 5        | Bihar                    | 62,993 24,710                                                   | 68,092                                                          |                                                                 | 1193                                                            |                                                                  |                                                                  | 0                                                                |                                                                  |
| 6        | Chandigarh               |                                                                 | 29,316                                                          |                                                                 |                                                                 |                                                                  |                                                                  |                                                                  | 0                                                                |
| 7        | Chhattisgarh             | 9,413 19,374 2,141                                              | 9,595 20,179 2,356                                              | 9,218 21,597 2,443                                              | 5899 419                                                        | 0 55,912 446                                                     | 0 55,222 496                                                     | 51,288 583                                                       | 9633                                                             |
| 8        | Dadra&NagarHaveli        | 763                                                             | 1,045                                                           |                                                                 |                                                                 |                                                                  |                                                                  | 179                                                              |                                                                  |
| 9        | Daman&Diu                |                                                                 |                                                                 |                                                                 |                                                                 |                                                                  |                                                                  |                                                                  | 142 51                                                           |
| 10       | Delhi                    | 52,544                                                          | 55,204                                                          | 1,044 53,475                                                    | 260 9491                                                        | 182 23,393                                                       | 144 29,457                                                       | 28,566                                                           |                                                                  |
| 11       | Goa                      |                                                                 |                                                                 |                                                                 |                                                                 |                                                                  |                                                                  |                                                                  | 4300                                                             |
| 12       | Gujarat                  | 3,589                                                           | 3,430                                                           | 3,234 60,973 36,889                                             | 902 10791 7112                                                  | 4,133 132,062 52,023                                             | 4,313 131,979 52,045                                             | 4,618                                                            | 1014                                                             |
| 13       | Haryana                  | 55,252                                                          | 55,694 35,919                                                   |                                                                 |                                                                 |                                                                  |                                                                  | 142,580                                                          | 19647 10877 1789                                                 |
| 14       | HimachalPradesh          | 31,665                                                          |                                                                 |                                                                 |                                                                 |                                                                  |                                                                  | 50,718                                                           |                                                                  |
| 15       | Jammu&Kashmir            | 11,330                                                          | 12,769                                                          | 11,753                                                          | 2848 14895                                                      | 5,801 12,850                                                     | 5,722                                                            | 5,894 14,062                                                     | 3915 3123                                                        |
| 16       | Jharkhand                | 57,863                                                          | 62,388                                                          | 63,889                                                          |                                                                 |                                                                  | 15,014                                                           |                                                                  |                                                                  |
| 17       | Karnataka                | 16,810 123,144 56,563                                           | 19,788 137,244 57,853                                           | 20,759                                                          | 3308 31605 13385                                                | 36,954 133,139 128,429                                           | 36,400                                                           | 32,014                                                           |                                                                  |
| 18       | Kerala                   | 323                                                             | 353                                                             | 143,549 55,033 327                                              | 109                                                             | 0                                                                | 142,641 139,843 0                                                | 144,780 127,853                                                  | 31904 27407 0                                                    |
| 19       | Lakshadweep              |                                                                 |                                                                 |                                                                 |                                                                 |                                                                  |                                                                  | 0                                                                |                                                                  |
| 20       | MadhyaPradesh            |                                                                 |                                                                 |                                                                 |                                                                 |                                                                  |                                                                  |                                                                  |                                                                  |
| 21       | Maharashtra              | 71,622 161,836 4,200                                            | 81,073 175,366 4,626                                            | 78,713 183,711 6,582                                            | 17023 35865 1050                                                | 58,521 188,963 3,012                                             | 53,623 225,528 3,339                                             | 55,731 236,823 3,691                                             | 7854 49458 1001                                                  |
| 22       | Manipur                  | 2,437                                                           |                                                                 |                                                                 |                                                                 |                                                                  |                                                                  |                                                                  |                                                                  |
| 23       | Meghalaya                |                                                                 |                                                                 |                                                                 | 682                                                             | 4,155 1,262                                                      |                                                                  | 5,420                                                            | 1122                                                             |
| 24       | Mizoram                  |                                                                 | 2,465                                                           | 2,744                                                           |                                                                 |                                                                  | 4,767 1,295                                                      |                                                                  | 308                                                              |
| 25       | Nagaland                 | 1,858                                                           | 1,976                                                           | 1,906                                                           | 360                                                             |                                                                  |                                                                  | 462 1,441                                                        |                                                                  |
| 26       | Odisha                   | 1,612 68,306 9,132                                              | 1,412 75,679 8,940                                              | 1,588 71,283 8,367                                              | 94 16058 1591                                                   | 1,242 26,042 4,950                                               | 1,442                                                            | 50,804 1,122                                                     | 385 10577 200                                                    |
| 27       | Puducherry               |                                                                 |                                                                 | 51,278                                                          |                                                                 | 77,192                                                           | 60,104 5,100 84,361                                              | 86,914                                                           |                                                                  |
| 28       | Punjab                   | 51,298 89,504                                                   | 50,712 98,754                                                   | 95,358                                                          | 9604 17518                                                      | 57,990                                                           |                                                                  |                                                                  | 18820 14045                                                      |
| 29       | Rajasthan                |                                                                 |                                                                 |                                                                 |                                                                 |                                                                  |                                                                  |                                                                  |                                                                  |
| 30       | Sikkim                   |                                                                 |                                                                 |                                                                 |                                                                 |                                                                  | 53,941                                                           | 55,994                                                           |                                                                  |
| 31       | TamilNadu                | 1,472                                                           | 1,293                                                           | 1,702                                                           | 453                                                             | 691                                                              | 1,194                                                            | 1,038                                                            | 376                                                              |
| 32       | Telangana                | 201,158 129,273 8,474                                           | 209,781 142,477 8,768                                           | 175,524 126,840 8,500                                           |                                                                 | 211,022 138,508 2,699                                            |                                                                  | 173,399 158,114 4,476                                            |                                                                  |
|          |                          | 97,282                                                          | 98,407                                                          | 112,089                                                         | 42482 30560 1973                                                |                                                                  | 223,019 165,307 2,348                                            |                                                                  | 36500 36101 1069                                                 |
| 33       | Tripura                  |                                                                 |                                                                 |                                                                 | 16181                                                           | 55,733                                                           | 91,358                                                           | 188,779                                                          | 29199                                                            |
| 34 35    | UttarPradesh Uttarakhand | 9,804                                                           | 10,683                                                          | 11,540                                                          |                                                                 |                                                                  | 9,527                                                            | 6,640                                                            | 1641                                                             |
| 36       | WestBengal               |                                                                 |                                                                 |                                                                 | 2068                                                            | 7,138                                                            |                                                                  |                                                                  |                                                                  |

256,650

245,168

31079

192,233

205,141

181,800

18315

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| Sr. No   | State-District   | Number of C-section deliveries conducted at public facilities   | Number of C-section deliveries conducted at public facilities   | Number of C-section deliveries conducted at public facilities   | Number of C-section deliveries conducted at public facilities   | Number of C-section deliveries conducted at private facilities   | Number of C-section deliveries conducted at private facilities   | Number of C-section deliveries conducted at private facilities   | Number of C-section deliveries conducted at private facilities   |
|----------|------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|-----------------------------------------------------------------|------------------------------------------------------------------|------------------------------------------------------------------|------------------------------------------------------------------|------------------------------------------------------------------|
|          |                  | 2017-18                                                         | 2018-19                                                         | 2019-20                                                         | Apr 20 - June 20                                                | 2017-18                                                          | 2018-19                                                          | 2019-20                                                          | Apr 20 - June 20                                                 |
| 1        | UP-Barabanki     | 2887                                                            | 2786                                                            | 3419                                                            | 420                                                             | 1497                                                             | 1980                                                             | 2297                                                             | 32                                                               |

Source: HMIS