Changing the Discourse on Caesarean Births in India: Issues emerging from NFHS-5 (2019–2021)

With increasing institutional deliveries, India has witnessed an increasing prevalence of caesarean births since 2005–2006, which by 2019–2021 increased a manifold more than WHO’s estimated acceptable proportion. The paper envisages addressing the critical research question of whether private health facilities and providers are fuelling caesarean births, which could have otherwise been avoided in the overall institutional deliveries in India? Data used are from the two rounds of Indian DHS, known as NFHS. Findings are from NFHS-5 (2019–2021) with the corresponding values from NFHS-4 (2015–2016). Descriptive statistics, bivariate, and multivariate regression analysis have been used to portray caesarean births' significant cofactors across 36 states/UTs at state, 707 districts. Twenty-two percent of live births in India in the five years preceding NFHS-5 (2019–2021) were caesarean births, up from 17 percent in 2015–2016 and 9 percent in 2005–2006. Caesarean deliveries among the births in private health facilities were as high as 47 percent. The predicted probabilities of caesarean births substantially increased over the last five years, especially among young mothers, those having lower order births, well educated, and delivering in private health facilities. Disproportionately higher caesarean births in private health facilities, especially among young mothers having lower order births, exist in different states/districts despite the recent opposition to such a high prevalence of caesarean births. As a substantial proportion of caesarean births are provider-driven avoidable operations, where higher financial gains may be the real motive, it should be minimized.