Procedure 3–10 Times Higher In Pvt Hosp Than In Govt Institutions

An epidemic of caesarean deliveries seems to have overtaken hospitals and government data indicates that private hospitals are largely responsible for this. According to the recently released Annual Health Survey deliveries by caesarean sections (Csection) are 3 to 10 times more prevalent in private institutions compared to government institutions.

In several states, the gap is jaw dropping. In Assam, only 10% of deliveries in government hospitals were by C–section while in private hospitals, the share was 41%. Similarly, in Bihar only 3% of deliveries were done by C–section in government hospitals while this share rose to 22% in private hospitals.

The data was collected in a huge survey carried out by the Census office during July 2010 and March 2011 covering a sample of 1.8 crore people spread over 284 districts in 9 states – Assam, Bihar, Chhattisgarh, Jharkhand, Madya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand. These are states with poor health outcomes in the past and have been targeted by both the government as well as nongovernmental agencies for special attention.

Previous surveys have shown that at the national level, C–section make up about 9% of all deliveries but with huge regional variations, and also, a large rural–urban differential. Clearly, as private facilities have expanded, so has the rate of operated deliveries.

A Caesarean section is the technical name for delivering a baby by operating the mother under anesthesia rather than allowing normal labor and delivery. It is recommended in cases where there is distress due to wrong positioning of the baby in the womb, obstruction, etc. On an average, a caesarean delivery costs anything upward of Rs 25,000.

Why is this happening? Public health experts were aghast at these figures and blamed the irrational practices of the private sector. There is complete lack of regulation of services being provided by the private sector, said pediatrician Vandana Prasad, convenor of National Public Health Resource Network.

"No one knows what private hospitals are doing, why they are doing it, at what cost and how rational it is. The problem is that there is no system for oversight. These figures reflect an obvious problem and are far higher than expected in the private sector," adds Prasad.

While there is no doubt that these are appallingly high figures of C–section in the private sector, there is need to consider the failing public health facilities too, says public health expert Amit Sengupta.

"Poor facilities at the CHC (community health center) level in the rural areas may force people to go to private hospitals," he says.

According to WHO standards, 10–15% C–section rates are acceptable. The AHS data shows that in the public sector, these rates are much lower, while there is compensation in the private sector.