47.4% babies born in private sector via C-section, far above 14.3% in govt facilities, NFHS shows (2021, India)

New Delhi: The latest National Family Health Survey (NFHS) may have brought the long awaited good news of population stabilisation, but it also shows that while there have been fewer births than before, a higher proportion of those being born are being delivered through caesarean section (C-section).

The fifth NFHS — done in two phases between June 2019 and January 2020, and January 2020 and April 2021, and released by the health ministry Wednesday — showed that the national C-section rate is 21.5 per cent, higher than what the World Health Organization terms “ideal”, 10-15 per cent. The number has has also gone up since NFHS 4 (conducted in 2015-16), when the percentage stood at 17.2.

Far more worrying, however, is the growing disparity in the number of C-section births at government and private sector facilities. At the national level, 47.4 per cent babies born in the private sector are being delivered by surgical methods, as compared to just 14.3 per cent in the government sector.

The disparity in the two numbers has deepened since the last family health survey. In the NFHS 4, the proportion of C-sections was 40.9 per cent in the private sector against 11.9 per cent in the government sector. Experts say there could be several reasons for the growing disparity, among them, the increased health insurance coverage in India since the launch of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in September 2018.

The PMJAY provides an annual health coverage of Rs 5 lakh to eligible families. C-sections are what are known in insurance parlance as “moral hazard” procedures — one that’s often done without medical reasons as the payment is assured for an insured person.

[...]

An interesting change between NFHS 4 and NFHS 5 is the large jump in households with health insurance coverage — from 28.7 per cent to 41 per cent. That, government officials say, is a direct fallout of the Modi government’s Ayushman Bharat PMJAY.

“It is not surprising that proportion of C-section delivery has increased. Evidence from around the world shows that the proportion increases as incomes increase,” said former National Health Authority CEO Indu Bhushan, during whose tenure the PMJAY was launched.