Results
In 2019, the CS rate was 19.56% in total, 14.20% in the public, and
34.47% in the private sector depicting excess CS. The average annual
changes from 2011 to 2019 were 8%, 5.83%, and 5.86% for total,
public, and private sector rates, respectively (Figure 1a) .
While the rates of change for private and public sector CS rates were
similar, private CS rate has been high since 2011. In 2019, 32 states
crossed the excess threshold for total CS rates while 4 states - Uttar
Pradesh, Bihar, Jharkhand, and Meghalaya had inadequate CS rates(Figure 1b) . Excess CS was present in the private sector in 30
states. The public sector in six states had inadequate CS rates. Of the
737 districts, 331 (44.9%) districts had excess CS surgeries while 277
(37.6%) noted inadequacy (Figure 1c) . Zero CS were noted in 24
districts mostly belonging to northeastern states. Most districts with
excess sections were clustered in the southern states of Telangana,
Tamil Nadu, and Kerala. District-level comparison depicted significantly
greater CS rates in the private (n=613, mean=42.43, standard
deviation=25.89) compared to the public sector (n=727, mean=16.56,
SD=15.65) (Figure 1d) . The private sector in 482 districts had
excess CS rates compared to the public sector in 261 districts. The
public sector in 337 districts fell below the 10% threshold compared to
the private sector in 83 districts.