Srinagar- Jammu and Kashmir’s caesarean delivery (CD) rate of 41 percent is significantly higher than the national average, according to the Lancet Journal’s analysis of the National Family Health Survey-5 (NFHS-5) data for 2019–2021. The report highlights significant variations in caesarean delivery rates across India.
According to a survey of the Lancet Journal, the national CD rate stands at 21.5 percent, but this figure masks substantial disparities between states, economic groups, and healthcare sectors.
States like Telangana, Tamil Nadu, and Andhra Pradesh exhibit the highest CD rates, with Telangana leading at 60.7 percent. Conversely, states such as Nagaland, Meghalaya, and Bihar show some of the lowest rates, with Nagaland at just 5.2 percent.
The survey states that Jammu and Kashmir’s CD rate of 41 percent is significantly higher than the national average. This elevated rate reflects patterns of over medicalization, particularly in private healthcare settings.
“Although wealth disparities in the region exist, they are less pronounced compared to states like Assam, which has the highest inequality ratio. Unlike northeastern states with low overall CD rates, Jammu and Kashmir’s figures align more closely with southern states, though its reliance on private facilities contributes substantially to the higher rates,” the report suggests.
These findings also raise concerns about overuse in private settings and potential inequities in public healthcare. Strengthening public health initiatives like the Janani Suraksha Yojana (JSY), which subsidizes institutional deliveries, could improve accessibility for disadvantaged groups. Additionally, better regulation of private healthcare and awareness campaigns promoting safe vaginal deliveries could help balance medical necessity with equitable access.
On the issue of high cesarean rates in the Union Territory of Jammu & Kashmir, speaking to Kashmir Observer, Dr. Masuma Rizvi, HOD, Obstetrics and Gynaecology, LD Hospital, Srinagar said that there are various social and medical reasons for which the trend of cesarean deliveries is higher in J&K.
For medical reasons, she said the age of pregnancies is very high.
“We have many patients who are more than 35 years of age with hypertension, diabetes, and they come to know about these ailments before getting pregnant, so they are not ready to take the risk of a normal delivery. Usually, our hospitals don’t have round-the-clock maternity services. When a patient goes into labor, she does not find herself safe, and labor is a process which takes a minimum time of 24 hours. This is one of the reasons,” Dr. Rizvi said.
She further added that the cesarean delivery rate has increased throughout the world.
“It ranges from around 20 percent in Sub-Saharan Africa due to the lack of facilities to 70 percent in Ireland and the US, where all advanced facilities are available.”
Another reason for higher cesarean rates, Dr. Rizvi said, is the attitudinal changes in the younger generation.
“Patients are not ready to bear the pain during the delivery period, they look for easy ways, i.e., cesarean. Lack of manpower and infrastructure in the private sector is another reason. Those patients who do not want to get their deliveries done in governmental hospitals have very little chance of a normal delivery in a private hospital.”
The Lancet report also reveals that economic inequalities play a significant role in CD rates. Women in the richest wealth quintile experience a CD rate of 39.1 percent, compared to only 7.3 percent in the poorest quintile. The national inequality ratio between the richest and poorest groups is 5.3, highlighting the stark contrast in access to this critical procedure. Furthermore, the private healthcare sector consistently performs more CDs than the public sector across all economic groups, with wealthier populations disproportionately represented in private facilities
According to Dr. Rizvi, the socioeconomic burden on women has increased. “One group of girls is career-oriented, and the other group does not have the right economic position and ends up getting married late, which leads to complicated pregnancies. If there are two girls of the same economic and family background—one getting married at 20 and one at 40—the one getting married at 40 has fewer chances of a normal delivery, as the risk of different diseases increases with age. The one at 20 has fewer chances of abnormalities in delivery,” she explained.
Seconding Dr. Rizvi, Dr. Farhat Jabeen, a senior gynecologist and ex-HOD, Gynaecology, GMC, Srinagar said, “A lot of high-risk pregnancies are being reported in Kashmir. One major reason is late marriages. Patients are not ready to bear the labor pain, and they say, ” want to have painless labor.”
“However, we do not have such facilities available here. They have a right to go for pain-free labor. Infertility is another reason, and they do not want to take a chance. Those patients who cannot tolerate labor pains turn to private nursing homes.”
She further elaborated, “In private nursing homes, there is a lot of pressure from attendants. For a normal delivery to take place, it takes time—from the process of induction to labor—and it can sometimes take two days. This means a lot of money is involved, and patients are not ready to wait for such a long period. It is more a bent of mind wherein people think that through a cesarean, the baby is taken out, and the patient has no trauma, no distress, and no issue in the birth canal. People want shortcuts.”
“We often say a woman delivered normally in retrospect. However, I cannot firmly say, ‘This patient will deliver her baby vaginally,’ because from labor pains to delivery, a mother must overcome many hurdles. If there are no high-risk factors, around eighty percent of patients can deliver without problems. However, about twenty percent may require cesareans or experience traumatic vaginal deliveries, which are well-known facts worldwide. Therefore, we need to educate people.”
Dr. Jabeen said that they, as a medical fraternity, have a bigger role to play. “Ordinary people, elders, social media—everyone has a role to make people aware that cesarean is a traumatic delivery, an abnormal route of delivery, and the surgery has complications associated with it.”
She also voiced concern on cesarean delivery rate in Jammu and Kashmir being above the national average is a matter of concern.
“I always tell my patients that vaginal delivery is the best mode of delivery, and it has many advantages. I try to make them understand that around eighty percent of women can deliver babies without complications, but they want one hundred percent surety, which cannot be given. People here are psychologically stressed and cannot take too much pressure.”
“They want to secure their professions first and then get married, and all these factors have an impact,” she said.
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