The lesson is not that C-sections are a problem, but that access, equity, and quality of care matter far more than the method of delivery.
Published May 29, 2025 | 7:00 AM ⚊ Updated May 29, 2025 | 7:00 AM
Pregnancy. Representative image.
Synopsis: People often romanticise natural births and downplay caesarean sections as an easier method of giving birth. However, the medical consensus is clear: Caesarean sections can be life-saving and, in some cases, are not just an option but the only viable one.
When Bollywood actor Suniel Shetty recently praised his daughter Athiya for choosing a natural childbirth over a caesarean section (C-section), his words triggered a social media storm.
“In a world where everybody wants the comfort of having a caesarean baby, she chose not to do that and had a natural delivery,” Shetty said in an interview — a comment that some applauded as a nod to maternal strength, while others criticised as tone-deaf in a country where the realities of childbirth are far more complex.
While vaginal births are generally preferred for quicker recovery and fewer long-term complications, the medical consensus is clear: Caesarean sections can be life-saving, and sometimes, they are not just an option but the only option.
“Currently, C-section rates in many parts of India are hovering between 50 and 60 percent,” Dr RV Asokan, former president of the Indian Medical Association (IMA), told South First.
“That has almost become the standard now. There are many reasons for this, from an increase in high-risk pregnancies to the reduced physical capacity of many women today to undergo prolonged labour. Often, families themselves request cesareans.”
However, this has placed obstetricians in a difficult position, caught in what Dr Asokan describes as a “thin red line.” “If a doctor opts for a C-section and the outcome is good, they’re accused of taking the easy route. If they wait for a natural delivery and complications arise, they’re blamed for not acting fast enough,” he said. “People don’t always understand the immense pressure and responsibility involved.”
In 2007–09, the maternal mortality ratio (MMR) in Telangana stood at 134 per 100,000 live births. Over the next decade, as institutional deliveries became near-universal and access to surgical interventions expanded, the MMR dropped sharply, reaching 63 per 100,000 live births by 2016–18.
This drop coincided with a sharp rise in caesarean deliveries. According to NFHS-5 (2019–21), Telangana recorded the highest C-section rate in the country: 60.7 percent of institutional deliveries, up from 57.7 percent in NFHS-4 (2015–16).
Institutional delivery coverage itself was very high, at 97 percent, with both rural and urban areas showing consistently high C-section rates. In 23 of 33 districts, more than half of all births were by caesarean section. For instance, Peddapalli district reported nearly 80 percent C-sections, while even the lowest — Kumaram Bheem Asifabad — was at 27 percent.
By 2020, the Sample Registration System (SRS) reported Telangana’s MMR at just 43 per 100,000 live births — among the lowest in the country, and better than the national average. Health experts pointed to the state’s access to institutional deliveries and timely surgical interventions as key contributors to this success.
However, the NFHS-5 findings raised concerns about potential overuse of C-sections. In response, the Telangana health department launched efforts to curb unnecessary caesarean deliveries. Hospitals were directed to follow stricter clinical protocols, and awareness campaigns were rolled out to promote natural births where feasible. District-level data were scrutinised, and interventions targeted regions with unusually high surgical delivery rates.
However, the results offer a cautionary note. According to the latest SRS data, Telangana’s MMR rose slightly in 2021 to 45 per 100,000 live births, up from 43 the previous year. While still low by national standards, this reversal came at a time when the state began efforts to reduce its C-section rate.
This trajectory suggests a complex reality: High C-section rates, particularly when paired with strong institutional delivery systems, may have played a critical role in improving maternal outcomes.
Amidst such debates, health outcomes tell a more nuanced story. According to the latest Sample Registration System (SRS) reports, India has made notable progress in maternal and infant health. The national MMR stands at 93 per 100,000 live births — down significantly, but still above the UN’s Sustainable Development Goal (SDG) target of 70. The infant mortality rate (IMR), meanwhile, is 27 per 1,000 live births.
Kerala stands out, reporting the country’s lowest MMR (20) and IMR (6), followed by other southern states like Tamil Nadu, Maharashtra, and Telangana. Health experts attribute these numbers to systemic factors: High female literacy, institutional deliveries, antenatal care, and a robust public health system.
Notably, Kerala also sees high rates of caesarean deliveries — a sign that access to surgical interventions, when needed, plays a crucial role in improving outcomes.
“Actually, a caesarean section by itself doesn’t negatively affect infant or maternal mortality,” Dr Alsiha Shafjeer, a senior consultant in high-risk obstetrics at the CRAFT Hospital in Thrissur, told South First. “In fact, timely caesareans have saved countless lives. The problem is, we’ve oversimplified the discussion. Now, everyone’s talking about the microbiome — and while that’s important, blaming cesareans for everything is not scientifically sound.”
Dr Shafjeer points out that while natural births do expose newborns to beneficial maternal bacteria, caesarean babies can still develop a healthy microbiome through diet and reduced antibiotic exposure. “We need to focus on the right things — like curbing indiscriminate antibiotic use and encouraging healthy nutrition, rather than vilifying a medical procedure that, in many cases, is necessary.”
Indeed, the real crisis lies elsewhere: In the alarming regional disparities across India. States like Madhya Pradesh, Uttar Pradesh, and Assam continue to report maternal mortality ratios more than double the national average. Infant mortality in these states also remains high, often linked to poor access to institutional care and emergency interventions — including caesarean surgeries.
Public health experts warn that romanticising natural birth in a vacuum can be dangerous. “The idea that opting for natural birth is somehow more virtuous, or that C-sections are merely a convenience, is misleading,” said the gynaecologist. “In regions with poor infrastructure, the lack of timely access to caesareans is a death sentence for many mothers and newborns.”
As India continues its push toward universal health coverage and improved maternal-child health outcomes, the debate needs to shift from judgement to equity. C-sections are not a moral failing — they are a medical tool. And like any tool, their value lies in how, when, and why they are used.
Suniel Shetty’s comments may have come from a place of pride, but in a country of over 1.5 billion people — where one region sees outcomes matching developed countries while another struggles to provide basic maternal care — the story of childbirth is far from black and white. It is, more often than not, a question of survival.
Moreover, the romanticisation of natural birth, especially by those who have never faced the agony of labour or the terror of complications, is not just tone-deaf — it is dangerous.
(Edited by Muhammed Fazil.)
