Published May 29, 2026 | 8:11 PM ⚊ Updated May 29, 2026 | 8:11 PM
Across India, 54.1% of births in private hospitals were delivered through C-section compared to the 16.9% in public hospitals.
Synopsis: NFHS-6 reveals that South India continues to dominate India’s C-section delivery landscape, with Telangana recording the country’s highest rate at 62.2% and Andhra Pradesh crossing the 50% mark. Karnataka saw the sharpest increase nationwide, while Tamil Nadu remained among the top states, highlighting the growing medicalisation of childbirth across the region.
South India continues to dominate India’s caesarean section delivery landscape, with Telangana retaining its position as the country’s C-section capital, according to the National Family Health Survey-6 (NFHS-6) released on Friday, 29 May.
Andhra Pradesh crossed the 50% mark, as Tamil Nadu remained among the top five states. Karnataka registered the sharpest increase in surgical births nationwide, the survey said.
The latest survey painted a striking picture of childbirth patterns in India. While the national C-section rate increased from 21.5% in NFHS-5 (2019-21) to 27.2% in NFHS-6 (2023-24), several southern states reported rates that were nearly double or even triple the national average.
Telangana recorded the highest C-section rate among major states at 62.2%, followed by Andhra Pradesh at 52.2%. Tamil Nadu stood at 46.9%, while Karnataka rose dramatically to 45.7%. Kerala recorded 41.3%.
Together, the figures reinforced a trend that has persisted across multiple rounds of NFHS: South India remains the epicentre of surgical childbirth in the country.
For the second consecutive survey, Telangana recorded the highest rate among major states.
NFHS-6 revealed that nearly two out of every three births in the state were delivered through caesarean section.
The state’s overall rate rose from 60.7% in NFHS-5 to 62.2% in NFHS-6.
Also Read: What is ‘Caesarean Muhurat’?
The private sector continued to drive the trend. An astonishing 83.9% of births in Telangana’s private hospitals were delivered through C-section. Even public hospitals reported a rate of 48.1%, meaning nearly half of all births in government facilities were surgical.
Urban Telangana reported a C-section rate of 70.1%, among the highest recorded anywhere in India, while rural Telangana stood at 59.5%.
The figures meant that even women delivering in rural Telangana were undergoing surgical births at rates far higher than the national urban average.
Also Read: Why South Asian mothers choose surgery over natural birth
Andhra Pradesh has now joined Telangana in crossing a significant milestone.
For the first time, more than half of all births in the state were being delivered through C-section.
The state’s rate increased from 42.4% in NFHS-5 to 52.2% in NFHS-6, representing a jump of 9.8 percentage points.
Urban Andhra Pradesh recorded a C-section rate of 57.3%, while rural areas stood at exactly 50%.
Private hospitals reported a rate of 66.2%, compared with 38% in public facilities.
The findings indicated that surgical delivery has become deeply embedded across both rural and urban maternal healthcare systems in the state.
Together, Telangana and Andhra Pradesh represented a unique phenomenon in India, where C-section deliveries have become the dominant mode of childbirth rather than an intervention reserved primarily for complicated pregnancies.
Also Read: When is a C-section really needed?
While Telangana remained at the top and Andhra Pradesh crossed the halfway mark, Karnataka produced the most surprising finding in NFHS-6.
The state recorded the largest increase in C-section deliveries anywhere in India.
Its rate surged from 31.5% in NFHS-5 to 45.7% in NFHS-6, an increase of 14.2 percentage points in just a few years.
No other state recorded a rise of this magnitude.
Urban Karnataka reported a C-section rate of 52.6%, while rural Karnataka stood at 40.2%.
Private hospitals recorded a rate of 63.8%, nearly double the 34% reported in public facilities.
The sharp increase has transformed Karnataka from a state moderately above the national average into one of India’s leading centres for surgical childbirth.
Public health researchers might examine whether the rise reflected changes in maternal age, high-risk pregnancies, healthcare-seeking behaviour, expansion of private healthcare, or broader shifts in obstetrics practice.
Tamil Nadu, often regarded as one of India’s strongest performers in maternal healthcare, continued to record high levels of C-section deliveries.
The state reported a rate of 46.9%, up from 44.9% in NFHS-5.
Unlike some states where the rural-urban divide remained substantial, Tamil Nadu’s figures were remarkably similar across geographies. Urban areas reported 47.8%, while rural areas recorded 46.3%.
Private hospitals reported a C-section rate of 60.3%, while those at public facilities stood at 39.6%.
The relatively narrow gap between urban and rural areas suggested that surgical childbirth has become widespread across the state’s healthcare system rather than being concentrated in specific populations.
Kerala recorded a C-section rate of 41.3%, lower than the other southern states but still significantly above the national average.
One of the most notable aspects of Kerala’s data was the small difference between public and private healthcare facilities.
Private hospitals recorded a rate of 42.5%, while public hospitals reported 39.3%.
This contrasted sharply with states such as Telangana and Andhra Pradesh, where private hospitals reported substantially higher rates than government facilities.
The Kerala pattern may reflect a more uniform healthcare delivery system and relatively consistent access to specialist obstetrics services across sectors.
Taken together, the numbers revealed that the southern states occupied a distinct position in India’s maternal healthcare landscape.
Among major states, southern states claimed four of the top six positions.
Telangana (62.2%), Andhra Pradesh (52.2%), Tamil Nadu (46.9%) and Karnataka (45.7%) all ranked substantially above the national average.
Even Kerala’s 41.3% rate exceeded the national figure by more than 14 percentage points.
The trend suggested that factors beyond medical necessity alone may be influencing childbirth practices across the region.
Experts had pointed to multiple drivers, including higher institutional delivery rates, increased maternal age, smaller family sizes, patient preferences, medico-legal concerns, scheduling convenience, referral patterns, and the growth of private maternity care.
One of the strongest patterns that NFHS-6 revealed was the continued gap between private and public healthcare facilities.
Across India, 54.1% of births in private hospitals were delivered through C-section compared to the 16.9% in public hospitals.
The differences were even more pronounced in some southern states.
In Telangana, the gap stood at nearly 36 percentage points. In Andhra Pradesh, it exceeded 28 percentage points. Karnataka and Tamil Nadu also showed substantial differences.
The data might likely reignite debate over the role of private healthcare in driving India’s rising surgical birth rates.
The World Health Organisation has long maintained that population-level C-section rates substantially above 10-15% were not necessarily associated with better maternal or neonatal outcomes.
While experts acknowledged that modern obstetrics care and changing demographic patterns could justify higher rates, the figures emerging from several southern states remained among the highest reported globally.
NFHS-6 was released amid broader improvements in maternal and child health indicators across the country.
According to the Union Health Ministry, institutional deliveries increased from 88.6% to 90.6%, while antenatal care coverage rose from 92.6% to 95.9%.
Births attended by skilled health personnel increased from 89.4% to 91.3%.
The ministry attributed those improvements to flagship programmes, including Janani Suraksha Yojana, Janani Shishu Suraksha Karyakram, Pradhan Mantri Surakshit Matritva Abhiyan, SUMAN and Pradhan Mantri Matru Vandana Yojana.
The ministry said the survey reflected “significant improvements in maternal and child healthcare services across the country” and highlighted the expansion of institutional care and skilled birth attendance.
The NFHS-6 data also raised important questions about the future of childbirth in India.
As C-section rates continued to climb across much of South India, particularly in Telangana, Andhra Pradesh and Karnataka, policymakers and public health experts were likely to examine whether the rise reflected better access to emergency obstetrics care, changing maternal demographics, or a growing medicalisation of childbirth.
For now, the latest survey has left little doubt about one trend: when it comes to caesarean deliveries, South India is setting the pace for the rest of the country, and the gap appears to be widening rather than narrowing.
(Edited by Majnu Babu).
