High Caesarean Rates in J&K: Unpacking the Pressing Need for Change in Childbirth Practices

The findings of a recent analysis published in The Lancet shed light on a pressing issue regarding childbirth practices in Jammu and Kashmir (J&K), where the region's Caesarean Section (CS) delivery rates stand alarmingly high. The report highlights that these rates are notably consistent across all socioeconomic backgrounds, revealing only a marginal 2 to 3 percent difference between the wealthiest and poorest households. This contrasts sharply with other Indian states, where economic status largely dictates access to CS deliveries. According to the National Family Health Survey (NFHS-5), a staggering 82.1 percent of deliveries in private hospitals in J&K are performed via CS, while the rate in public facilities stands at 42.7 percent. Both figures significantly exceed the World Health Organization's recommended threshold of 10 to 15 percent for CS deliveries, raising questions about the underlying reasons for this trend in the region. Interviews with gynaecologists and maternal health experts in Kashmir reveal a complex interplay of medical, cultural, and societal factors contributing to the high CS rates. One prominent issue is the increasing trend of women marrying later in life, which has resulted in a higher proportion of pregnancies among women in their 30s and 40s. Medical experts like Prof Farhat Jabeen emphasize that advanced maternal age often correlates with complications that make vaginal deliveries more complex and risky, leading families to opt for CS as a safer alternative. The influence of infertility challenges is also significant, with many pregnancies in J&K resulting from long-term medical treatments that families approach with heightened caution. The resulting emotional and financial investment in these pregnancies leads to a preference for CS to mitigate any delivery risks. Prof Jabeen notes that as families prioritize safety, the practice of "CS on demand" becomes more prevalent. Compounding these issues are widespread health conditions such as polycystic ovary syndrome (PCOS), obesity, and hypertension among women in the region, which further increase the likelihood of complications necessitating surgical intervention. Additionally, both Prof Jabeen and Prof Shahnaz Taing highlight the prevailing misconception that CS guarantees better outcomes for both mother and child, a belief that often overshadows the potential risks associated with unnecessary surgical deliveries. Awareness about the benefits of vaginal delivery is limited, with many women underestimating the complications that can arise from CS procedures. Prof Taing points out that the perception of CS as a painless option needs to be addressed through improved education and outreach within the healthcare system. The role of healthcare providers in shaping delivery practices cannot be overlooked. In J&K, many private hospitals are under-resourced, lacking full-time gynaecologists who can manage the complexities of vaginal births. The prevalent preference for CS among couples, driven by the belief that it leads to improved safety, adds pressure on healthcare systems to accommodate this demand. Over the past decade, institutional deliveries in J&K have surged, now often associated with surgical interventions rather than natural processes. This shift has led to a prevalent expectation among women that hospitalization inherently involves medical intervention, with many believing that giving birth in a healthcare facility mandates a CS. Despite the perceived benefits, the rising rates of unnecessary CS deliveries carry inherent risks for both mothers and infants, including increased chances of infections and longer recovery times. Repeated CS can lead to complications in future pregnancies, and babies born via CS may miss out on critical benefits associated with vaginal births, such as essential microbial exposure. The implications of these high CS rates extend beyond individual health, placing significant financial strain on families and healthcare facilities alike. Prof Taing notes the overwhelming burden on tertiary care facilities, like Lal Ded Hospital, due to the high demand for CS, often resulting in unnecessary patient referrals that further strain resources. As discussions around maternal health and childbirth practices continue, it is imperative for stakeholders in J&K to address the multifaceted factors driving the alarming trend in CS deliveries, striving for a more balanced approach that prioritizes both safety and the health benefits associated with vaginal deliveries. Promoting awareness, education, and resources can pave the way for healthier childbirth practices in the region.