Private C-sections in Maharashtra skyrocket to 56%, five times WHO norms

Pune: An alarming surge in C-section deliveries across Maharashtra’s private hospitals has triggered fresh concerns among health activists and policymakers.State health data accessed by TOI reveal that C-section rates in the private sector have more than doubled in five years, jumping from 24% in 2021-22 to a staggering 56% in 2025-26.This rate is five times the World Health Organisation (WHO) benchmark, which pegs the ideal population-level C-section rate at 10% to 15%. In contrast, govt hospitals have remained closer to global norms, with rates rising more modestly from 24% to 33%. While the state’s 14.13 lakh annual deliveries are split almost equally between the public and private sectors, the outcomes are vastly different: 66% of public births are normal, compared to just 43% in private institutes.Dr A.B. Gadikar, assistant director of state health services (maternal care), admitted the state’s powers are limited. “We conduct sample audits and issue guidelines, but we cannot mandate a prevention of the procedure as it is a life-saving intervention,” he said. Dr Gadikar attributed the rise to late pregnancies and doctor discretion, noting that the department lacks the legal framework to penalise hospitals for excessive surgeries.Health activists argue this “discretion” often masks a profit-driven culture. Dr Abhay Shukla labelled the trend “supplier-induced demand,” where the choice of surgery is driven by the provider rather than clinical necessity.This trend is reflected in the experience of Vrushali(29). Despite seeking a doctor known for normal deliveries, she was pushed into surgery when her water broke. “The doctor performed four C-sections in a few hours. When she claimed my baby’s heart rate was dropping, I had no way to verify it or seek a second opinion,” Vrushali recalled. Eight months later, she suffers from chronic back pain and a permanent scar.Similarly, Nimisha (34) was denied a vaginal birth after Cesarean (VBAC) for her second child. “The doctor simply set a surgery date the moment I hit full term, insisting a normal delivery was impossible because of my history,” she said.Dr Arun Gadre, a veteran gynaecologist, noted that even in the US and UK, rates hover around 30%. “The absurdly high rate in India is the result of unregulated private healthcare. We need strict controls similar to those in England,” he said.However, the medical fraternity argued the issue is more nuanced. Dr. Ameya Purandare, president, Association of Maharashtra Obstetrics and Gynaecological Societies, cited factors like delayed childbearing, previous C-sections, and patient anxiety. “We must avoid blaming mothers and doctors,” he said, advocating for “rationalisation” through scientific data. Dr. Sanjay Gupte added that the fear of litigation or violence often pushes doctors toward the “safer” legal bet of a C-section. “Doctors are often unwilling to take any risks during labour due to the fear of conflict or litigation if something goes wrong.” he said.Beyond clinical reasons, “convenience” and “auspicious timings” often dictate private surgical schedules. With C-section costs in “five-star” hospitals running into lakhs, Dr Shukla suggested that the govt should mandate all private hospitals to publicly display their percentage of C-section versus normal deliveries.“This can only be controlled once the Clinical Establishment Act is enforced,” he said. Medical experts emphasised that vaginal birth remains the healthier biological option, providing newborns with a critical “microbiome jumpstart” for their immune systems—a natural advantage bypassed every time a scalpel is used without absolute necessity.GRAPHICThe World Health Organisation (WHO) advises that at the population level, ideal C-section rates should generally range between 10% and 15%. Research indicates that pushing rates above 10% does not yield further reductions in maternal or newborn mortality.As per the Trends and projections of caesarean section rates published in BMJ Global Health in 2021, data from 2010–2018, from 154 countries covering 94.5% of world live births shows that 21.1% of women gave birth by caesarean worldwide, averages ranging from 5% in sub-Saharan Africa to 42.8% in Latin America and the Caribbean. CS has risen in all regions since 1990.In Maharashtra as per the state health department, below is the percentage of C-section deliveries in private hospitals.2021-22: 31%2022-23: 35%2023-24: 45%2024-25: 50%2025-26: 56%