Nine out of ten: Why private hospitals in Jammu and Kashmir have the highest C-section rates in India

In private hospitals in Jammu and Kashmir, nine out of 10 births were by caesarean section – the highest number of caesarean sections in the private sector anywhere in India, according to newly analyzed data from the National Family Health Survey-6 (NFHS-6). It is followed by West Bengal at 87.7% and Telangana at 83.9% – all three states are well above the national private sector average of 54.1%.

In India, medical experts attribute the rise in caesarean sections to a combination of more facility deliveries, better detection of high-risk pregnancies, increasing maternal age and health complications, increased use of assisted reproductive technology, earlier caesarean sections and the rapid growth of maternity care in the private sector, where planned births, convenience, financial incentives and maternal preferences also contribute to higher cesarean rates in some cases.

“The aim is not to achieve a specific number of caesarean sections, but to ensure that every woman who needs a caesarean section gets one, while avoiding unnecessary surgery. There is no single research study that can conclusively explain why caesarean sections are more common in Jammu and Kashmir,” said Dr. Sami Jan, Faculty Gynecology and Obstetrics Department at SKIMS Medical College and Hospital Srina Kmirash Bemina in.

“However, some plausible reasons may be that a large proportion of high-risk pregnancies come to the tertiary referral system from district and peripheral hospitals. This naturally increases the number of women requiring caesarean sections. Delayed referrals, better technology that can detect distress, geographic and weather issues, increased maternal age and fertility treatment are all contributing factors,” added Dr. John.

According to the National Family Health Survey-6 (NFHS-6, 2023–24), 27.2% of all births in India are now by caesarean section (C-section), a sharp increase from 21.5% in NFHS-5 (2019–21), indicating a continued increase in surgical births across the country. The growth is mainly due to the private health care sector, where 54.1% of births are by caesarean section, compared to 47.4% in NFHS-5.

In contrast, the C-section rate in the public sector increased more modestly from 14.3% in NFHS-5 to 16.9% in NFHS-6. Overall, the data shows that while institutional births increased from 88.6% to 90.6%, growth in caesarean sections outstripped 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 caesarean sections 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.

“Fear of labor, anxiety about the baby’s safety, past experiences, misinformation, and cultural beliefs can influence women and their families’ decisions about cesarean sections. Some new biomedical evidence suggests that cesarean sections may affect early colonization of gut microbes in infancy; a meta-analysis of observational studies suggests a modest association with neurodevelopmental conditions such as autism Guprovenh, integration, integration, Nika, Nika Psychiatrist and Mental Health Physician at the Wellness Clinic Jammu.

“Informed consent requires balanced counseling for both vaginal and surgical delivery, and the integration of psychological support during pregnancy can promote informed decision-making and help ensure that caesarean sections are only performed when medically necessary,” added Dr. Gupta.

So what explains private sector figures in India that are five to nine times higher than this benchmark?

Also read | As Nature Intended: Pregnancy and Cesarean Sections

“India’s rising C-section rate reflects both overuse in some settings and underuse in others, highlighting the need for interventions tailored to the realities of the local health system rather than a one-size-fits-all approach,” said Preety Aggarwal, medical director of obstetrics and gynecology at Motherhood Hospital, Gurugram.

Dr. Aggarwal points to the fear of lawsuits that push some obstetricians to surgery to minimize the perceived medico-legal risk, along with the shift in maternal age and health: “Today, women are increasingly giving birth at a later age, which is associated with a higher rate of pregnancy complications requiring surgical delivery. Also, the rise of civilizational diseases, including obesity, diabetes, hypertension, infertility, further complicates the treatment of pregnant women and multiple infertility.

In addition, maternal preference for C-sections shaped by fear of labor pains, convenience, previous birth experience, or choosing an auspicious delivery date has also increased demand in some urban settings.

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

“Obstetric haemorrhage remains the biggest killer of women during childbirth (in rural India); it accounts for nearly 47% of maternal deaths in India, with the burden falling disproportionately on poorer states,” said Astha Dayal, director of obstetrics and gynecology at CK Birla Hospital, Gurugram, adding that C-section is not just a matter of commerce among countless others. maternal survival and preventable death. When labor is obstructed, the placenta ruptures, or postpartum bleeding gets out of control, early surgery saves both mother and newborn.”

Vaginal delivery remains the preferred method of delivery for most uncomplicated pregnancies because it is associated with lower maternal morbidity, reduced blood loss and infection, shorter hospital stays, faster recovery, earlier breastfeeding, fewer complications in future pregnancies, and improved respiratory adaptation of the newborn.

Mamatha KV, obstetrician-gynecologist and director of SDM College of Ayurveda and Hospital, Udupi, points to the physiological case of vaginal birth: “Normal vaginal birth offers significant benefits for both mother and baby. Passage through the birth canal exposes the newborn to beneficial maternal microbes that help create a healthy gut microbiota, trigger metabolic disturbances and reduce the risk of physiological allergies and hormonal changes. Maturation, breastfeeding and mother-child bonding, while mothers they experience faster recovery and fewer surgical complications.” She adds that the traditional framework of Ayurveda—Garbhasamskara and Garbhini Paricharya—emphasizes preconception care, a monthly prenatal diet and lifestyle, and birth support aimed at uncomplicated vaginal delivery.

India currently has no standard national tariff for C-sections in India. Costs vary widely by city, hospital, room category and complexity of the case – from around ₹50,000 to ₹5,000 or more. The bill usually includes obstetrician and anesthesiologist fees, operating room fees, room rent, nursing care, medications, surgical supplies, laboratory tests, pediatric newborn assessment, and other hospital services. Costs can skyrocket if the mother needs intensive monitoring or additional procedures, or if the newborn requires admission to the NICU.