Maharashtra sees 56 percent c-section rate at private hospitals

Pune: In a shocking trend that has raised concerns among healthcare experts and policymakers, Caesarean-section (C-section) deliveries in Maharashtra’s private hospitals have more than doubled over the last five years, far exceeding global health recommendations.

According to state health department data accessed by TOI, the C-section rate in private hospitals increased from 24 per cent in 2021-22 to a staggering 56 per cent in 2025-26. The figure is nearly five times higher than the World Health Organisation’s (WHO) recommended population-level rate of 10 to 15 per cent.

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In contrast, government hospitals in the state have recorded a comparatively moderate rise in C-section deliveries, increasing from 24% to 33% during the same period. Maharashtra records around 14.13 lakh deliveries annually, divided almost equally between public and private healthcare facilities. However, while nearly 66% of deliveries in government hospitals are normal births, only 43% are normal deliveries in private institutions.

Speaking to TOI, Dr A.B. Gadikar, assistant director of state health services (maternal care), admitted the state’s powers are limited. “We conduct sample audits and issue guidelines, but we cannot mandate the prevention of the procedure as it is a life-saving intervention,” he said. Dr Gadikar attributed the rise to late pregnancies and doctors' discretion, noting that the department lacks the legal framework to penalise hospitals for excessive surgeries.

However, public health activists have alleged that financial motives often influence such decisions. Health activist Dr Abhay Shukla described the trend as “supplier-induced demand,” where surgeries are allegedly encouraged by healthcare providers even when not medically necessary.

The concerns are echoed in the experiences of several women. A 29-year-old mother said she specifically chose a doctor reputed for encouraging normal deliveries, but eventually underwent surgery after her water broke. She recalled that the doctor performed four C-sections in a few hours. When the doctor claimed the baby’s heart rate was dropping, there was no way to verify it or seek a second opinion. Eight months later, chronic back pain and a permanent scar continue to affect her.

Similarly, a 34-year-old woman alleged that she was denied the option of a vaginal birth after Caesarean (VBAC) during her second pregnancy. “The doctor simply set a surgery date the moment I hit full term, insisting a normal delivery was impossible because of my history,” she said.

According to Dr Arun Gadre, a veteran gynaecologist, even in the US and UK, C-section rates hover around 30%. He said the “absurdly high” rate in India is a result of unregulated private healthcare and stressed the need for strict controls similar to those in England.

However, the medical fraternity argued the issue is more nuanced. Dr. Ameya Purandare, president, Association of Maharashtra Obstetrics and Gynaecological Societies, cited factors like delayed childbearing, previous C-sections, and patient anxiety. “We must avoid blaming mothers and doctors,” he said, advocating for “rationalisation” through scientific data. Dr. Sanjay Gupte added that the fear of litigation or violence often pushes doctors toward the “safer” legal bet of a C-section. “Doctors are often unwilling to take any risks during labour due to the fear of conflict or litigation if something goes wrong,” he said, reports TOI.

Experts also pointed out that, beyond medical reasons, factors such as convenience and the preference for “auspicious timings” often influence surgical scheduling in private hospitals. With C-section costs in premium hospitals running into lakhs of rupees, activists have demanded greater transparency.

Dr Shukla suggested that private hospitals should be mandated to publicly display their percentage of C-section and normal deliveries.

“This issue can only be effectively controlled once the Clinical Establishment Act is strictly implemented,” he said.

Medical experts stressed that vaginal birth remains the healthier biological option in most uncomplicated pregnancies, offering newborns important microbial exposure that helps strengthen their immune systems — an advantage often bypassed in unnecessary surgical deliveries.

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