Nine in ten: Why Jammu and Kashmir’s private hospitals have India’s highest C-Section rate

Nine out of every ten babies born in private hospitals of Jammu and Kashmir were born via Caesarean Section (Caesarean Section); It is the highest private sector caesarean section rate in India, according to newly analyzed data from the National Family Health Survey-6 (NFHS-6). This is followed by West Bengal with 87.7 percent and Telangana with 83.9 percent; All three states are well above the national private sector average of 54.1 percent.

In India, medical experts attribute the rise in caesarean births to a combination of more institutional deliveries, better detection of high-risk pregnancies, increasing maternal age and medical complications, greater use of assisted reproductive technologies, previous caesareans and planned births, and the rapid growth of private sector obstetric care, where convenience, financial incentives and, in some cases, maternal preference have also contributed to higher caesarean section rates.

“The aim is not to reach a certain caesarean rate, but to ensure that every woman who needs a caesarean gets one by avoiding unnecessary surgical interventions. There is no single research study that definitively explains why caesareans are more common in Jammu and Kashmir,” said Sami Jan, faculty member and department of Obstetrics and Gynecology at SKIMS Medical College and Hospital Bemina in Srinagar, Jammu and Kashmir.

“However, some plausible reasons may be that the tertiary referral system receives a large proportion of high-risk pregnancies from area and surrounding hospitals. This naturally increases the number of women requiring Caesarean sections. Delayed referrals, better technology that can detect distress, geographical and weather conditions, increasing maternal age and infertility treatments are all contributing factors,” Ms Jan added.

According to the National Family Health Survey-6 (NFHS-6, 2023–24), 27.2% of all births in India are now delivered by caesarean section; There is a sharp increase from 21.5% in NFHS-5 (2019–21); This indicates a continuing increase in surgical births across the country. The increase appears to be largely driven by the private healthcare sector; 54.1% of births occurred by cesarean section; In NFHS-5, this rate was 47.4%.

In contrast, the public sector caesarean section rate increased more modestly, from 14.3% in NFHS-5 to 16.9% in NFHS-6. Overall, the data shows that while institutional deliveries have increased from 88.6% to 90.6%, growth in caesareans has outpaced this increase, with the gap between private and public facilities widening further, raising concerns about the potential overuse of medically unnecessary caesareans, particularly in private hospitals.

The World Health Organization (WHO) says caesareans should only be performed when medically necessary; At the population level, caesarean section rates above approximately 10% are not associated with further reductions in maternal or neonatal mortality, and WHO no longer recommends a specific national target rate.

Integrative Psychiatrist Dr. “Fear of labor pain, concern for the baby’s safety, past experiences, misinformation, and cultural beliefs can influence caesarean section decisions for women and their families. Some emerging biomedical evidence suggests that caesareans may affect early intestinal microbial colonization in infancy; a meta-analysis of observational studies reported a modest association with neurodevelopmental conditions such as autism, although causality has not been proven,” said Nikhil Gupta. Wellness Clinic Jammu.”

“Informed consent requires balanced counseling on both vaginal and surgical birth, and integrating psychological support throughout pregnancy can promote informed decision-making and help ensure caesareans are performed only when medically necessary,” Mr Gupta said.

So what explains India’s private sector figures being five to nine times higher than this benchmark?

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“India’s rising caesarean rate reflects both overuse in some settings and underuse in others, underscoring the need for interventions tailored to local healthcare system realities rather than a uniform approach,” said Preety Aggarwal, medical director of Obstetrics and Gynecology at Gurugram Maternity Hospital.

Aggarwal points out that the lawsuits, along with fears that they will push some obstetricians to perform surgery to minimize perceived medico-legal risk, have also led to a shift in maternal age and health: “Women today are having babies at an increasingly later age, which is associated with higher rates of pregnancy complications requiring surgical delivery. The situation is further complicated by the rise in lifestyle diseases such as obesity, diabetes, hypertension, infertility treatments and multiple pregnancies,” he added.

Additionally, mothers’ preference for caesarean section, shaped by fear of labor pain, comfort, previous birth experience, or choice of an auspicious birth date, has also increased demand in some urban settings.

Meanwhile, in rural India, the picture is turning. According to NFHS-6 (2023–24), 40.5% of births in urban India are by caesarean section, while the rate in rural India is 22.8%.

“Birth hemorrhage remains the biggest killer of women during childbirth [in rural India]; “It accounts for nearly 47% of maternal deaths in India, and the burden falls disproportionately on poorer states,” said Astha Dayal, Director, Obstetrics and Gynecology, CK Birla Hospital, Gurugram, adding that caesarean section is not a matter of convenience or commerce, but rather is the only intervention that stands between maternal survival and a preventable death in countless cases. When labor is obstructed, placenta ruptures or bleeding occurs after birth due to out-of-control coils, timely surgical intervention saves both the mother and the newborn.”

Vaginal birth remains the preferred mode of delivery in most uncomplicated pregnancies because it is associated with lower maternal morbidity, less blood loss and infection, shorter hospital stay, faster recovery, earlier breastfeeding, fewer complications in future pregnancies, and improved neonatal respiratory adaptation.

Mamatha KV, obstetrician-gynecologist and director of SDM Ayurvedic College and Hospital, Udupi, highlights the physiological state of vaginal birth: “Normal vaginal birth provides significant benefits for both the mother and the baby. Passage through the birth canal exposes the newborn to beneficial maternal microbes that help establish a healthy gut microbiome, support immunity and reduce the risk of allergies and metabolic disorders. Birth also triggers hormonal and physiological changes that aid lung maturation, lactation and breastfeeding. Mothers get breastfeeding faster.” “As you heal and experience fewer surgical complications, the mother-baby bond becomes stronger.” He adds that the traditional framework of Ayurveda – Garbhasamskara and Garbhini Paricharya – emphasizes pre-conception care, monthly prenatal diet and lifestyle, and birth support aimed at a complication-free vaginal birth.

There is currently no standard national tariff for caesarean section in India. Costs vary greatly by city, hospital, room category, and complexity of the case; It ranges from roughly 50,000 Indian rupees to 5 lakh rupees or more. The bill generally includes obstetrician and anesthesiologist fees, operating room fees, room rent, nursing care, medications, surgical supplies, laboratory examinations, pediatric evaluation of the newborn, and other hospital services. If the mother requires intensive monitoring or additional procedures, or if the newborn requires NICU admission, costs can add up quickly.