Nine in ten: Why Jammu and Kashmir’s private hospitals have India’s highest C-Section rate

In Jammu and Kashmir’s private hospitals, nine out of every ten babies born arrived by Caesarean section (C-section) — the highest private-sector C-section rate anywhere in India, according to newly analysed data from the National Family Health Survey-6 (NFHS-6). West Bengal follows at 87.7%, and Telangana at 83.9% — all three states running far above the national private-sector average of 54.1%.In India, medical experts attribute the increase in C-sections to a combination of more institutional deliveries, improved detection of high-risk pregnancies, increasing maternal age and medical complications, greater use of assisted reproductive technologies, previous C-sections, and the rapid growth of private-sector obstetric care, where scheduled deliveries, convenience, financial incentives and maternal preference in some cases also contribute to higher C-section rates.“The objective is not to achieve a specific C-section rate but to ensure that every woman who needs a Caesarean receives one, while avoiding unnecessary surgical intervention. There is no single research study that conclusively explains why C-sections are more common in Jammu and Kashmir,” said Sami Jan from the Gynaecology and Obstetrics department and faculty member at the SKIMS Medical College and Hospital Bemina in Srinagar, Jammu and Kashmir.“But some plausible reasons could be that the tertiary referral system receives a large proportion of high-risk pregnancies from district and peripheral hospitals. This naturally increases the number of women requiring a Caesarean section. Delayed referrals, better technology that can detect distress, geographic and weather challenges, increased maternal age, and infertility treatments are all contributing factors,’’ Ms. Jan added.According to the National Family Health Survey-6 (NFHS-6, 2023–24), 27.2% of all births in India are now delivered by Caesarean section, a sharp rise from 21.5% in NFHS-5 (2019–21), indicating a continued increase in surgical childbirth across the country. The rise is driven largely by the private healthcare sector, where 54.1% of births are by C-section, up from 47.4% in NFHS-5.In contrast, the public sector C-section rate increased more modestly from 14.3% in NFHS-5 to 16.9% in NFHS-6. Overall, the data show that while institutional deliveries have increased from 88.6% to 90.6%, the growth in C-sections has outpaced this rise, with the gap between private and public facilities widening further, raising concerns about the potential overuse of medically unnecessary C-sections, particularly in private hospitals.The World Health Organisation (WHO) says C-sections should be performed only when medically necessary; at the population level, C-section rates above around 10% are not associated with further reductions in maternal or newborn mortality, and WHO no longer recommends a specific national target rate.“Fear of labour pain, anxiety about the baby’s safety, past experiences, misinformation, and cultural beliefs can influence Caesarean decisions for women and their families. Some emerging biomedical evidence suggests that C-sections may influence early gut microbial colonisation in infancy; a meta-analysis of observational studies has reported a modest association with neurodevelopmental conditions such as autism, although causality remains unproven,” said Nikhil Gupta, MD, Integrative Psychiatrist Wellness Clinic Jammu.”“Informed consent requires balanced counselling about both vaginal and surgical delivery, and integrating psychological support throughout pregnancy can promote informed decision-making and help ensure that C-sections are performed only when medically necessary,’’ said Mr. Gupta added.So what explains India’s private-sector numbers running five to nine times higher than that benchmark?