India's C-section rate is rising fast; are too many births ending in surgery?

India's latest NFHS data show C-section deliveries have risen sharply, with private hospitals reporting far higher rates than public facilities. The figures have renewed questions over how much of the increase is medically necessary and what reforms could curb avoidable surgery.C-section surge reignites birth surgery debate (Photo: Representational )India is experiencing a significant increase in Caesarean section deliveries, with the latest National Family Health Survey igniting a renewed debate about whether too many women are undergoing surgery to give birth.According to the NFHS 2023-2024, nearly 27 per cent of births in India are now delivered via C-section, up from 17.2 per cent in 2015-2016. The disparity between private and public hospitals is even more pronounced, with over half of all births in private hospitals performed through Caesarean section, compared to around 17 per cent in public health facilities.While doctors agree that Caesarean delivery can be a life-saving procedure for many mothers and babies, they recognise that the current statistics cannot be solely attributed to medical reasons. Experts suggest that this rise is influenced by a combination of changing maternal health profiles, advancements in obstetric care, patient expectations, financial structures, medico-legal concerns, and deficiencies within maternity care systems.Dr Hrishikesh Pai, an obstetrician-gynaecologist, fertility specialist, and Medical Director and Co-Founder of Bloom IVF Group, notes that while some increase in C-section rates is expected as pregnancy patterns evolve, the current disparity between private and public hospitals highlights a broader systemic issue. My article (with Payal Sharma) in today’s Telegraph on India’s “Caesarean Problem”. We present data from latest NHFS survey that suggests suspiciously high rates of caesarean section births in Indian private hospitals (over 80% in some states). Does this reflect a wider problem? pic.twitter.com/q106vvDr0J— Sanjeev Sanyal (@sanjeevsanyal) August 3, 2026 WHY SOME RISE IN C-SECTION DELIVERIES IS EXPECTEDAccording to Dr Pai, India has made tremendous progress in moving from home births to institutional deliveries. As more women now deliver in hospitals, doctors can safely manage high-risk pregnancies that previously carried a much higher risk of death for mothers and newborns.He explains that several genuine medical factors have contributed to the increase. Women today are becoming pregnant at older ages, obesity is more common, and conditions such as gestational diabetes and pregnancy-related hypertension have increased. Hospitals are also treating more complicated pregnancies involving twins, breech babies, placenta previa, foetal distress, previous uterine scars, and pregnancies conceived through assisted reproductive technology. "These factors certainly justify an increase in Caesarean deliveries," says Dr. Pai.However, he believes these reasons alone cannot explain the current national figures."A rise from around 17 per cent to the low twenties is understandable. But it does not explain a national rate of 27 per cent or private hospital rates of over 50 per cent. The same woman with the same pregnancy should not need surgery simply because she entered a different hospital."WHY PRIVATE HOSPITALS REPORT MUCH HIGHER RATESThe large difference between private and public hospitals has become one of the biggest concerns raised by public health experts.According to Dr Pai, no single reason is responsible. Instead, multiple factors work together and gradually increase the likelihood of surgery.Financial incentives play a role because scheduled surgeries are easier to plan and generate predictable hospital revenue. Unlike normal labour, which may continue for many hours, a planned Caesarean allows hospitals to manage operating theatres and staffing more efficiently.However, Dr. Pai says it would be unfair to blame doctors alone.He believes fear of legal action has become an equally important factor. Doctors who attempt a normal vaginal delivery but later face complications often find themselves dealing with legal cases, while performing a Caesarean is rarely questioned in court."This creates an environment where defensive medicine becomes common," he explains.Patient preferences have also changed over time. Some families request a specific delivery date, while others wish to avoid labour pain or uncertainty. In many cases, surgery is presented as the safer or more convenient option.Another challenge, according to Dr Pai, is the declining experience of doctors in managing difficult vaginal births.He says many younger obstetricians receive far more training in performing Caesarean sections than in assisted vaginal deliveries or vaginal birth after Caesarean, making surgery the more familiar option.WHY UNNECESSARY SECTIONS CAN ALSO BE HARMFULAlthough Caesarean section saves countless lives when medically indicated, experts warn that unnecessary surgery also carries risks.Compared with vaginal birth, Caesarean delivery is associated with greater blood loss, higher infection risk, longer recovery, and increased complications in future pregnancies.Dr. Pai points out that every unnecessary surgery leaves a scar on the uterus, increasing the chances of conditions such as placenta accreta in later pregnancies, which can become life-threatening for both mother and baby.He says the discussion should not focus on whether Caesarean sections are good or bad, but whether each surgery is truly needed.WHY INDIA NEEDS TRANSPARENCY RATHER THAN STRICT LIMITSAs concerns over rising Caesarean rates grow, some experts have called for stricter regulation of private hospitals.Dr Pai agrees that greater oversight is needed but warns against setting fixed targets or limits for Caesarean deliveries.According to him, imposing a numerical cap could unintentionally delay emergency surgeries for women who genuinely require immediate intervention.Instead, he believes the focus should be on transparency and accountability.WHAT EXPERTS SAY SHOULD CHANGEDr Pai recommends several reforms that could help reduce unnecessary Caesarean deliveries without affecting patient safety.One of the most important is the mandatory use of the World Health Organisation's Robson Classification System for every delivery. This internationally recognised system categorises women into different obstetric groups, allowing hospitals to compare Caesarean rates fairly based on the type of patients they treat.He also recommends that hospitals publicly disclose their Caesarean rates each year."When hospitals know that patients can compare their numbers, transparency itself encourages better practices," he says.Dr Pai also believes payment systems should be redesigned, so hospitals receive the same reimbursement regardless of whether a woman has a vaginal birth or a Caesarean section. This would remove financial incentives that may favour surgery.Other recommendations include mandatory second opinions for planned non-emergency Caesarean deliveries, greater investment in India's midwifery workforce, and legal protection for doctors who make good faith decisions to attempt vaginal delivery.THE GOAL IS THE RIGHT C SECTION, NOT FEWER C SECTIONSExperts stress that Caesarean section remains one of the most important advances in modern obstetric care and continues to save thousands of mothers and babies every year.The challenge is ensuring that every woman receives the delivery method that is safest for her individual pregnancy rather than one influenced by convenience, fear, or financial considerations.As Dr Pai puts it, "The goal is not fewer Caesareans. The goal is the right Caesarean, for the right woman, at the right time, while every other woman is supported through a safe vaginal birth."With India's Caesarean rates continuing to rise, experts believe better data, greater transparency, stronger maternity care systems, and informed decision-making will be essential to ensure that childbirth remains both safe and evidence-based for every mother.- EndsPublished By: Smarica PantPublished On: Aug 4, 2026 15:37 IST