Interstate differences in institutional delivery and Caesarean section rates in India

Abstract

In the last two decades, India witnessed a steep rise in institutional delivery (ID) rates and some increase in Caesarean section (CS) rates. Analysis of raw data from three major surveys was undertaken with the objective of identifying factors associated with both low and high institutional deliveries and Caesarean rates so that appropriate locale specific corrective interventions can be initiated. The raw data from NFHS4, AHS and DLHS4 were analysed to assess urban-rural and interstate differences in ID and CS rates in government and private institutions and CS rates in relation to sociodemographic and obstetric profile of the woman.At national level 3/4 of women had ID. There were substantial interstate variations (50·4% to 99·8%). ID rates were higher in urban areas and in DLHS4 states. CS rate in ID at the national level was 18·5%; CS rates in ID were higher in urban areas, in DLHS4 states and in private institutions in all states. Interstate differences in CS rate were high (2·4% in government institutions in Bihar to 69·2% in private institutions in West Bengal. CS rates were higher in urban, educated women from higher SLI group delivering in private institutions.National surveys help in identifying the states and institutions with lower ID rates and higher CS rates and enable the initiation of appropriate interventions to strengthen institutions. Awareness generation about adverse consequences of home deliveries and CS without obstetric indications will hasten the progress towards universal institutional delivery and optimal CS rates.