Lok Sabha Question No. 1113 (UNSTARRED), answered on 2016-04-29
Subject: Caesarean Surgery
Ministry: HEALTH AND FAMILY WELFARE
Asked by: RANJANBEN BHATT

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

## LOK SABHA UNSTARRED  QUESTION NO. 1113 TO BE ANSWERED ON 29 TH APRIL, 2016

## CAESAREAN SURGERY

## 1113. SHRIMATI RANJANBEN BHATT:

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

- (a) whether the percentage of Caesarean (C- section) deliveries in the country is constantly on the rise;
- (b) if so, the details thereof and the reasons therefor;
- (c) the details of Caesarean deliveries performedin the Government and private hospitals during each of the last three years and the current year, State/UT - wise; and
- (d)  the  steps  taken/being  taken  by  the Government  to  bring  down  C -section deliveries  and maintain C - section rates within acceptable norms in the country?

## ANSWER

## THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI JAGAT PRAKASH NADDA)

- (a) & (b): As per the World Heath Statistics 2015 report released by WHO, the percentag of births by caesarean section between 2007 - 2014 was 8% for India.

However asper the National Family Health Survey - 3 (2005 - 06) and NFHS - 4 (2015 16)percentage of births by Caesarean section has increased from 11 % (13 states) to 23 %( 17 states) between 2005 - 06 and 2015 - 16. Report isplaced at Annexure.

- (c ): The  details  (survey  data)  of  Caesarean  deliveries  performed  in  the  Government private hospitals during each of the last three years are not available. Therefore NFHS -06)and NFHS 4(2015- 16)data has been compared and is placed at Annexure 1. C - Section in Private sector has increased from 32% to 47% in NFHS - 3 compared to NFHS - 4 and in Public health sector it has increased from 15.6% to 17.8% between NFHS - 3 and NFHS- 4.

(d) : The Medicalofficers staff nurses and ANM are being trained regularl y in empowering their skills for intrapartum care and early detection of complications.

World Health Organisation (WHO) in its new statement released in April, 2015 has said that  e very  effort  should  be  made  to  provide  Caesarean  sections  (CS)  to  women requiring  C section  based  on  clinical  diagnosis,  rather  than  striving  to  achieve  a  specific Government of India (GoI) has already written to all States and UTs sharing the latest WH statement. At population level, Caesarean section rates higher t han 10% are not associated with reductions  in  maternal  and  newborn  mortality  rates. Government  of  India  (GoI) has  already written to all States and UTs sharing the latest WHO statement. In addition, States have been informed to conduct periodic prescriptio n audit in the private health facilities under the Clini Establishment Act. They have also been informed that prescription audits can be extended public health facilities.

A communication has also gone to Federation of Obstetrical & Gyne o ogical Societies of  India  (FOGSI) which  is  the  largest  profession  body  of  Obstetricians  and  Gynecologists India for sharing the WHO guidance note to all their State chapters and the Obstetrici Gynecologists registered under them.

Annexure Percentage of Births delivered by caesarean section (%)

| S. No   | Name of State                            |   Births delivered by caesarean section NFHS-4 (2015-16) | Births delivered by caesarean section NFHS-3 (2005-06)   | Births in a private health facility delivered by caesarean section NFHS-4 (2015-16)   | Births in a private health facility delivered by caesarean section NFHS-3 (2005-06)   |   Births in a public health facility delivered by caesarean section NFHS- 4 (2015-16) | Births in a public health facility delivered by caesarean section NFHS-3 (2005- 06)   |
|---------|------------------------------------------|----------------------------------------------------------|----------------------------------------------------------|---------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------|
| 1       | Andhra Pradesh                           |                                                    40.1  | NA                                                       | 57                                                                                    | NA                                                                                    |                                                                                 25.5  | NA                                                                                    |
| 2       | Andaman & Nicobar                        |                                                    19.3  | NA                                                       | *                                                                                     | NA                                                                                    |                                                                                 16.9  | NA                                                                                    |
| 3       | Bihar                                    |                                                     6.2  | 3.1                                                      | 31                                                                                    | 17.2                                                                                  |                                                                                  2.6  | 7.6                                                                                   |
| 4       | Goa                                      |                                                    31.4  | 25.7                                                     | 51.3                                                                                  | 36.7                                                                                  |                                                                                 19.9  | 17.9                                                                                  |
| 5       | Haryana                                  |                                                    11.7  | 5.3                                                      | 25.3                                                                                  | 15.2                                                                                  |                                                                                  8.6  | 14.3                                                                                  |
| 6       | Karnataka                                |                                                    23.6  | 15.5                                                     | 40.3                                                                                  | 31.9                                                                                  |                                                                                 16.9  | 17.2                                                                                  |
| 7       | Madhya Pradesh                           |                                                     8.6  | 3.5                                                      | 40.8                                                                                  | 28.8                                                                                  |                                                                                  5.8  | 6.8                                                                                   |
| 8       | Maharashtra                              |                                                    20.1  | 11.6                                                     | 33.1                                                                                  | 22.3                                                                                  |                                                                                 13.1  | 11.6                                                                                  |
| 9       | Manipur                                  |                                                    21.1  | 9                                                        | 46.2                                                                                  | 26.7                                                                                  |                                                                                 22.6  | 17.6                                                                                  |
| 10      | Meghalaya                                |                                                     7.6  | 4.1                                                      | 31.4                                                                                  | 26.7                                                                                  |                                                                                  9.8  | 8.3                                                                                   |
| 11      | Puducherry                               |                                                    33.6  | NA                                                       | 48.3                                                                                  | NA                                                                                    |                                                                                 30.4  | NA                                                                                    |
| 12      | Sikkim                                   |                                                    20.9  | 12.3                                                     | 49.3                                                                                  | NA                                                                                    |                                                                                 18.1  | 25                                                                                    |
| 13      | Tamil Nadu                               |                                                    34.1  | 20.3                                                     | 51.3                                                                                  | 33                                                                                    |                                                                                 26.3  | 14.9                                                                                  |
| 14      | Telangana                                |                                                    58    | NA                                                       | 74.9                                                                                  | NA                                                                                    |                                                                                 40.6  | NA                                                                                    |
| 15      | Tripura                                  |                                                    20.5  | 12.9                                                     | 73.7                                                                                  | 69.5                                                                                  |                                                                                 18.1  | 23.7                                                                                  |
| 16      | Uttarakhand                              |                                                    13.1  | 8.1                                                      | 36.4                                                                                  | 27.5                                                                                  |                                                                                  9.3  | 22.2                                                                                  |
| 17      | West Bengal                              |                                                    23.8  | 10.2                                                     | 70.9                                                                                  | 47.6                                                                                  |                                                                                 18.8  | 16.6                                                                                  |
|         | Percentage of all above mentioned states |                                                    23.16 | 10.89                                                    | 47.58                                                                                 | 31.93                                                                                 |                                                                                 17.84 | 15.67                                                                                 |

Source: National Family Health Survey - 3 & 4

*Percentage not shown; based on fewer than 25 unweighted cases