Experts warn that unnecessary C-sections increase risks for both mothers and babies, leading to infections, heavy bleeding, longer recovery for mothers, and breathing difficulties and potential long-term health issues for newborns
Published Apr 29, 2025 | 7:00 AM ⚊ Updated Apr 29, 2025 | 7:00 AM
Pregnancy. Representative image.
Synopsis: Telangana has the highest rate of unnecessary Caesarean deliveries among major South Indian states, a new study in PLOS One reveals. About 8.4 percent of all births were preventable C-sections. Despite WHO guidelines recommending 10–15 percent C-sections, Telangana’s overall rate is 63.7 percent. Tamil Nadu, Karnataka, Andhra Pradesh, and Kerala also reported elevated C-section rates far above the ideal range.
Telangana has the highest percentage of unnecessary Caesarean section (C-section) deliveries among major South Indian states, according to a new study that looked at childbirth data from the latest National Family Health Survey (NFHS-5).
The study, published in PLOS One journal, found that 8.4 percent of all deliveries in Telangana were C-sections that could have been avoided. These are called “preventable C-sections” — surgeries that were performed even when there were no clear medical complications requiring them.
For comparison, the rates of preventable C-sections were 7 percent in Tamil Nadu, 6.2 percent in Karnataka, 5.4 percent in Andhra Pradesh, and 3.1 percent in Kerala.
The findings raise serious concerns because, according to the World Health Organization (WHO), C-sections should ideally account for only 10 to 15 percent of total births — and only when medically necessary to save the life of the mother or baby.
But in these South Indian states, the overall C-section rates are already much higher with an average of 44.3 percent. In Telangana, 63.7 percent of all deliveries were conducted through C-sections. In Tamil Nadu, the figure stood at 47.1 percent, while in Andhra Pradesh it was 45.2 percent. Kerala recorded a C-section rate of 39.2 percent, and Karnataka had the lowest among these states at 34.2 percent.
In this study, preventable C-sections were defined carefully. They refer to surgeries done after labor had started, at full term, but without any major medical problems like a breech baby (baby positioned feet first), prolonged labor, or severe bleeding — the usual reasons doctors recommend a C-section.
In other words, these surgeries might not have been necessary if the delivery had been managed properly.
“A C-section delivery that was not planned prior to the onset of labor, conducted at full term, and done without any intrapartum complications such as breech presentation, transverse lie, prolonged labor, and excessive bleeding. This definition provides a conservative estimate of preventable C-sections in India after accounting for most of the medical indications over and above the pregnancies requiring C-sections,” reads the study.
The researchers found several factors that made a woman more likely to have an unnecessary C-section:
Interestingly, women who underwent female sterilization (a permanent birth control surgery) right after giving birth were also more likely to have had a preventable C-section.
“The findings also suggest that there is a possibility of coupling sterilization (through post-partum tubal ligation (PPTL)) and CS deliver‑ ies since those who reported having undergone sterilization had twice the odds of having a preventable CS,” reads the study.
This hints that some women may have opted for a C-section because they planned to end their childbearing with a sterilization surgery, or were advised to combine the two procedures.
Experts have long warned that unnecessary C-sections can harm both mothers and babies. Mothers face greater chances of infection, heavy bleeding, and longer recovery times after a C-section compared to a normal vaginal birth. Babies born via C-section are at higher risk of breathing problems and may have long-term health issues.
Repeated C-sections in future pregnancies can also cause complications like uterine rupture and abnormal placement of the placenta, which can threaten the mother’s life.
There is also a financial burden. Deliveries through C-sections in private hospitals can cost nearly ₹25,000 or more — a heavy expense for many families, sometimes pushing them into debt.
The authors of the study recommend urgent steps to curb the trend of unnecessary C-sections, even in states with strong public health systems like those in South India.
They suggest:
The study also points out that since a C-section in a woman’s first pregnancy often leads to C-sections in later births, special attention should be given to first-time mothers to avoid setting off a chain of surgical deliveries.
As the rates of unnecessary C-sections climb, especially in private healthcare settings, the researchers warn that what should be a life-saving surgery is becoming an avoidable public health burden in India.
A senior health official from Telangana told South First that the government has taken multiple steps to curb unnecessary C-sections, addressing the alarmingly high rate of surgical births in the state, which currently stands at above 60 percent, far above the national average of 22 percent.
“One of the key measures has been a crackdown on private hospitals, with the government increasing its monitoring of deliveries and directing health officials to take stringent action against facilities found performing unnecessary C-sections. To encourage vaginal births in government hospitals, Telangana introduced a strategy known as Team-Based Incentives (TBI). Under this model, hospital staff receive incentives for conducting normal deliveries, making it financially rewarding to avoid unnecessary surgical interventions,” said the official.
He also pointed out that efforts have also been made to upgrade facilities in government hospitals, including improvements in sanitation, availability of medicines, doctor presence, and the quality of food provided to patients — all aimed at supporting safer and more comfortable normal deliveries.
The government has launched an e-birth portal to monitor all births across the state, enabling real-time data collection and helping health authorities track C-section trends more closely.
“Recognizing that cultural factors such as the desire to deliver babies at “auspicious” times (muhurtham) contribute to the scheduling of non-medical C-sections, the government has also engaged district collectors to work with priests and astrologers to discourage such practices,” said the officials.
The health official pointed that the previous Health Minister T Harish Rao has personally toured districts with the highest rates of C-section deliveries, overseeing initiatives and urging gynecologists to avoid recommending surgical births unless absolutely necessary.
(Edited by Ananya Rao)
