Alarming C-Section Surge In India: Why Women Must Reclaim Childbirth Rights

India is witnessing a quiet crisis in obstetric care. In Andhra Pradesh alone, recent data show a staggering 56.62 % of deliveries are performed via caesarean section (C-section), more than half of all births in the state. Chief Minister N. Chandrababu Naidu has publicly called out private hospitals and doctors, alleging that surgical deliveries are being scheduled for convenience, fixed auspicious timings, or profit motives, rather than strictly for medical necessity. While not all C-sections are avoidable, the World Health Organization (WHO) maintains that rates above 10-15 % are not associated with additional maternal or neonatal benefit and may indicate overuse. India's national average C-section rate now hovers around 21.5 %, itself more than double that threshold, but state-level disparities are stark.

The shift toward surgical births undermines both physiological benefits of natural labour and a woman's autonomy over her reproductive health. For many women, the journey to motherhood becomes medicalized in ways they neither fully understand nor consent to. Let's take a deeper look at the scale of the C-section escalation in India, the risks it poses, the factors driving it (including institutional profit motives), and the critical need for women to reassert their rights in maternal healthcare.

The Rising Tide Of C-Sections In India: National And State Trends

In the period from National Family Health Survey- 4 (NFHS-4) released in 2016 to NFHS-5 released in 2024, India's caesarean delivery prevalence rose from about 17.2% to 21.5%. In the public vs. private sector, disparity is stark. Earlier data show that delivery in private facilities more than doubled the odds of undergoing a C-section between 2005 and 2016.

States such as Kerala and Andhra Pradesh already revealed high rates (both around 42.4%) in past surveys. A 2025 analysis of state-wise inequalities noted that while India's average is 21.5%, the distribution masks extremes. Some districts and private hospitals report rates close to 50-60%. The Andhra example is particularly dramatic. By many measures, it is an outlier even within India's growing trend of surgical births.

Medical Vs. Non-Medical Drivers Of C-Sections

C-sections are lifesaving in certain obstetric emergencies like placenta previa, foetal distress, obstructed labour. But the alarming rise in India suggests a large share are non-medically indicated (elective), or are influenced by systemic factors:

Institutional profit motive and scheduling convenience

Multiple analyses suggest that private hospitals may favour surgical deliveries, which tend to bring higher revenue, shorter predictability, and scheduling convenience. In Andhra, the current chief minister accused hospitals of setting auspicious "muhurat" times and aligning deliveries accordingly; a claim that, whether fully proven or not, reflects the perception of childbirth being turned into a commodified event.

Defensive medicine and risk aversion

Obstetricians may lean on C-sections to avoid litigation, unforeseen complications, or blame for adverse outcomes in vaginal birth. The predictability of a planned surgery is often safer from a clinician's vantage point. Though not unique to India, this risk-averse mindset heightens the frequency of surgical intervention, especially in private settings.

Patient preference, scheduling, and social norms

Some women or families request C-sections due to fear of labor pain, convenience (selecting delivery dates), or belief in safety. "Precious baby" narratives (e.g. IVF, first pregnancy) often push toward surgical delivery. In communities with strong beliefs about auspicious timing, some deliveries are planned around favourable dates or panchang periods, aligning with doctors' convenience as well.

Prior C-sections and cascading effect

Once a woman undergoes a C-section, future deliveries are more likely to be surgical, a phenomenon dubbed "once a C-section, always a C-section" (though not always medically mandatory). In southern India, the burden of preventable C-sections is especially high among primiparous mothers (first-time mothers).

Institutional practices and resource bias

Some hospitals lack protocols for trial of labour after C-section (TOLAC), or do not sufficiently support natural birth infrastructure like labour rooms, trained midwives, doulas, etc. Where monitoring, staff, or time pressures exist, surgeons may favour the more predictable route.

Why High C-Section Rates Matter For Women's Health

Now, if you are wondering how this surging trend of C-section births impacts women's health, here are some reasons you should know about:

Surgical risk and recovery burden

Every surgical intervention carries risks: bleeding, infection, anaesthesia complications, thrombosis, adhesions, and longer recovery. Vaginal birth, when safe and feasible, typically involves shorter hospital stay, quicker mobility, and fewer complications.

Impact on future pregnancies

Scar tissue in the uterus increases the risk of placenta accreta, uterine rupture, ectopic pregnancy, and complications in subsequent births. The cascade effect of repeat C-sections heightens long-term risks.

Interference with maternal-infant bonding and breastfeeding

Women recovering from surgery may face more pain, mobility limitations and delayed milk production, impacting early bonding and breastfeeding initiation.

Cost burden and resource use

Surgical births are costlier. For families and public health systems, high rates represent a financial burden. From a public policy angle, overuse of C-sections diverts resources.

False assurance of safety

There's a misconception that "surgery is equal to safer." But when used excessively or unnecessarily, C-sections can paradoxically worsen outcomes. Several studies show that beyond an optimal threshold, more C-sections don't reduce maternal or neonatal mortality.

Erosion of natural birth skills and institutional bias

As surgical births dominate, medical training, protocols and institutional culture may devalue vaginal delivery methods, resulting in fewer practitioners skilled or willing to support natural birth.

The Power In Women Taking Charge

High C-section rates underscore an imbalance. The default often shifts away from natural birth, and women may be under-informed or misinformed about their options. Reclaiming reproductive agency is essential. Here's how:

1. Informed consent is not optional

Prior to delivery, women must be given clear, unbiased information about risks and benefits of both C-section and vaginal birth. Hospitals should present a birth plan, alternatives, and permit question time. No surgery should be forced or hidden in jargon.

2. Advocate for trial of labour and VBAC (vaginal birth after caesarean)

If clinically appropriate, women should have access to trial of labour after caesarean (TOLAC). Many are discouraged by default protocols, but with the right monitoring and backup, VBACs are possible and safe in many cases. Women should ask about it, evaluate hospital policies, and choose facilities supportive of VBAC.

3. Choose facilities with birth-friendly practices

Look for hospitals that follow Robson classification to report and audit C-section rates transparently. Seek out centres with active labour rooms, midwife-led care, presence of doulas, non-pharmacological pain management, and low intervention birth culture.

4. Prepare body and mind for natural birth

Prenatal education, childbirth classes, physical conditioning (pelvic floor, yoga), emotional support, and birth plans help women feel confident during labour. Empowered women make informed choices even under pressure.

5. Engage partner, family, and social circle

Often, decisions are influenced by family expectations. Women who involve partners, explain pros and cons, and articulate their preferences reduce external pressure for elective C-sections.

6. Demand policy and oversight change

Civic pressure, activism and women's health organizations should advocate for stricter regulation of obstetric practices. States, like the response in Andhra (which has begun auditing private hospitals and promoting natural delivery), must enforce guidelines on when C-sections are medically indicated, penalize extreme rates, and require audits.

High C-section rates in Andhra Pradesh and India in general are a clarion call. Surgical births, when necessary, save lives. But when they become default, convenience, or profit-driven choices, they risk the health, agency, and dignity of birthing women. The pattern is not just a medical issue. It's a social, institutional and rights-based one.

Indian women deserve more than passive participation in childbirth; they deserve agency, clarity, respectful care and access to natural birth options where safe. Reclaiming reproductive health means asking questions, choosing birth settings that respect normal physiology, demanding informed consent, and organizing for structural change. In India's march toward maternal health, the path forward must focus on women's voices, not the scalpel.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.