Conclusions
Our findings depict high CS rates in India with a rising trend. However,
the sectoral and subnational geographic differences are noteworthy given
that they might be driven due to supply-side factors such as low service
delivery capacity in rural public facilities and limited antenatal care
and demand-side factors such as higher maternal age, education, and
economic status, greater preference among private sector, etc. Indian
national and subnational estimates match other lower-middle-income
countries in Southeast Asia and South
America.1Our findings build upon earlier work using periodic household
surveys.2We use administrative HMIS data that is routinely collected at a high
geographic resolution that can be better accessed by policymakers and
health planners. There are multiple limitations. There are data
completeness and accuracy challenges inherent to HMIS. However,
previously HMIS CS rates have been known to agree with those from the
National Family Health Survey
data.5The lack of public data prevented investigating disaggregated CS rates
by rural-urban regions, levels of care, and emergency vs. elective
surgeries. Regardless, these findings are important for future research
and policymaking. Excess cesarean sections in India are driven largely
by the private sector in districts clustered in south and central India
while several states in North and Northeast India lack CS delivery
capacity in public facilities. To ensure equitable care, India needs a
targeted (state-level) policy approach regulating the private sector and
simultaneous public system strengthening.
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