The Centre today received a citizens’ petition to direct hospitals and nursing homes across India to declare how often they perform Caesarean sections.
The appeal came amid suspicions that some doctors were nudging would-be parents towards needless surgery.
Maneka Gandhi, the Union minister for women and child development, accepted the petition from a woman who had undergone a C-section in Calcutta 18 years ago. The petition has drawn 130,000 signatures over the past two months through the social media platform change.org
“The minister said she understands our concerns and would send a letter to the health ministry seeking action,” said Subarna Ghosh, who says she launched her petition after learning over the years that women across the country have shared her experience.
A directive asking hospitals to declare the proportions of C-sections among their deliveries would allow expectant mothers to compare figures for their hospitals with the expected norms and take an informed choice about where to opt for delivery, she said.
Health surveys, medical studies and data obtained through the Right to Information law suggest that India’s rate of C-sections is higher than the 10 per cent to 15 per cent which sections of the medical community say should be the expected average rate of C-sections.
India’s National Family Health Survey for 2015-16 has documented C-section rates from 34 per cent to 58 per cent in some states. The rates are even higher in private hospitals – from 51 per cent among private hospitals sampled in Goa and Tamil Nadu to over 70 per cent in private hospitals in Bengal and Telangana.
OnlineRTI.com, a non-government organisation that files RTI applications for citizens, has obtained figures from the Maharashtra government that show a rise in the proportion of C-section rates in Mumbai over the past five years – from 16 per cent in 2010 to 32 per cent in 2015.
“There seems to be a standard protocol for pushing expectant mothers to accept C-sections – they make us fearful about what might happen if we don’t opt for C-sections,” said Ghosh, who recalls her own doctor raising the spectre of brain damage to the baby and the pain associated with labour.
“It is easy to scare expectant mothers – and many doctors do this very well,” Ghosh said. “But it is also important for us to emphasise that we are not opposing C-sections, which can be life-saving in many cases. We are only opposing C-sections done only for commercial gains.”
A World Health Organisation statement on C-sections has said that at a population level, C-section rates higher than 10 per cent “are not associated with reductions in maternal and newborn mortality rates”.
But sections of doctors say it would be wrong to blame the increase in C-sections on the medical community alone.
“There are many, many reasons that could explain the rise in Caesarean sections,” said Geetendra Sharma, an Ahmedabad-based gynaecologist and chairperson of the ethics and medico-legal committee of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), an association of doctors.
“Some women demand C-sections to avoid the labour pain, some tell their doctors that they do not want any risk to the baby and pressurise them to perform C-sections,” Sharma said.
“New monitoring machinery allows us to detect even minor changes in the foetus and opt for Caesarean sections to save their lives. People do not appreciate this, but the increase in Caesarean sections has contributed to the decrease in neonatal mortality.”
A 2012 research paper by Shewli Shabnam, a scholar at Jawaharlal Nehru University, New Delhi, had suggested that some parents opt to have their baby on an “auspicious” day, such as Janmashtami, through C-section.
“This happens, parents do sometimes ask for Caesarean section deliveries on special days, but this by itself cannot contribute to the observed increase,” said Jaideep Malhotra, president-elect of the FOGSI.
She said the lack of skilled birth attendants, the absence of appropriate foetal monitoring machinery and overcrowded hospitals also at times put pressure on doctors to act before they actually need to.
“It’s not pressure, it is almost terror, a fear that something might go wrong,” Malhotra said. “I am not justifying this, but this is reality.”
Nida Hasan, the director of campaigns with the India unit of change.org, said the size and speed of the citizens’ response generated by Ghosh’s petition was impressive.
“It appeared to resonate with so many people across the country,” Hasan said
Doctors say the rise in C-sections appears to be a global phenomenon. A 2015 study spanning 21 countries had pointed to what medical researchers say is a “large increase” in the C-section rates as countries move from lower to higher human development index categories.