High Caesarean Rates in Jammu and Kashmir: A Culture Shift in Maternal Health Practices

In a startling revelation, an analysis of caesarean section (CS) deliveries in Jammu and Kashmir has unveiled a unique trend: the high rates of CS are consistent across all socioeconomic strata of the region, with only a minimal disparity of 2 to 3 percent between the wealthiest and poorest households. This finding, published in the January 2025 issue of The Lancet, starkly contrasts with many other Indian states where wealth heavily influences access to surgical deliveries. The National Family Health Survey (NFHS-5) indicates that a staggering 82.1 percent of deliveries in private hospitals in Jammu and Kashmir are performed via CS, while in public facilities, the rate stands at 42.7 percent. Both figures are well above the World Health Organization's (WHO) recommendation of 10 to 15 percent, raising concerns about the implications of such high rates on maternal and neonatal health. Medical and cultural experts in the region have identified a blend of factors contributing to the prevalence of CS deliveries. One significant factor is the increasing age at which women are marrying and subsequently becoming pregnant; data suggests a considerable portion of the population remains unmarried until the age of 29. As a result, many women are experiencing pregnancies in their 30s and 40s, which can lead to complications that heighten the necessity for surgical interventions. “Older maternal age brings risks that make vaginal deliveries more challenging,” explains Prof. Farhat Jabeen, a prominent gynaecologist in Kashmir. The rise of conditions like polycystic ovary syndrome (PCOS), obesity, and hypertension further complicates the landscape of maternal health, contributing to a higher likelihood of complications during delivery. Moreover, the perception of caesarean sections as a safer, more controlled alternative is pervasive among families. With the emotional and financial investment in achieving a pregnancy, many expectant mothers and their families opt for CS to mitigate any risks. This mindset fosters a culture of "CS on demand," where families prefer surgical delivery over a natural childbirth experience. “When families invest emotionally and financially in achieving a pregnancy, they prefer to eliminate any uncertainties during delivery," Prof. Jabeen notes. The misconception that CS is entirely painless and devoid of complications exacerbates the situation. Prof. Shahnaz Taing, an infertility specialist in the region, emphasizes the need for increased awareness regarding the potential risks of unnecessary CS procedures. “Most women think that CS is painless, without any complications. This notion needs to change,” she asserts, calling for a concerted effort from healthcare systems at all levels to educate women about the benefits of vaginal deliveries. Financial incentives in private healthcare settings also play a role in the high rates of CS deliveries. Faizan Mir, President of the J&K Private Hospitals and Dialysis Centers Association, highlighted that the absence of full-time gynaecologists in private facilities leads to a reliance on CS, as there is insufficient capacity to monitor and support natural labor. In recent years, the perception of hospital births has transformed, with many women associating delivery in healthcare facilities with surgical intervention. “A large number of women believe that giving birth in a healthcare facility means a doctor must intervene in the natural birth process,” observes Prof. Taing. This expectation further contributes to the normalization of CS deliveries among mothers. However, the implications of such high CS rates are concerning. Prof. Jabeen warns that unnecessary caesarean deliveries can lead to increased risks of infections, blood loss, and prolonged recovery times for mothers. Additionally, repeated CS procedures pose risks for future pregnancies, including complications such as uterine rupture and placenta accreta. Furthermore, babies delivered via CS may face heightened risks of respiratory issues and miss out on the beneficial microbial exposure that comes with vaginal births. The rising prevalence of CS deliveries not only impacts individual families but also places significant financial strain on the healthcare system. Prof. Taing points out that tertiary care facilities, such as Lal Ded Hospital, are often overwhelmed due to the high demand for CS, resulting in unnecessary patient referrals from other hospitals. As Jammu and Kashmir navigates the complexities surrounding childbirth, it is crucial for healthcare providers and policymakers to address the multifaceted reasons behind the high caesarean section rates. By fostering greater awareness about safe delivery practices and providing adequate support for natural childbirth, there is potential to reshape the region's approach to maternal health, ultimately benefiting mothers and their children alike.