The findings of the second phase of the fifth round of National Family Health Survey (NFHS-5) were released by the Union Ministry for Health and Family Welfare (MoHFW) in November 2021. With this we get a complete picture of India’s demographic and health situation. One significant improvement seen in NFHS-5 was the rise in percentage of institutional births in the country. NFHS-5 shows that more than 88 percent deliveries in the country now happen in a medical institution under trained health personnel. For a more detailed analysis of the findings of NFHS-5, read this data narrative.

While providing information related to health and demography across Indian states, NFHS-5 data also provides insights into trends in healthcare. One such trend is the rise of caesarean section deliveries across various states in the country. Another trend is the rise in deliveries in public health facilities rather than in private ones.

Figure 1 shows the percentage of institutional births in a public facility, the percentage of births by caesarean section in a state in public or a private facility, as per NFHS-4. If you hover over a state or UT, you will see the state’s data for “Institutional Births in a Public Facility, Percentage of Deliveries by C-Section in Public Facilities, and Percentage of Deliveries by C-Section in Private Facilities.” Figure 2 shows the same information for every state and UT for NFHS-5. States with a higher percentage of C-Section deliveries in private facilities are highlighted in darker shades.

In 2015-16 (NFHS-4), 52.1 percent of all institutional deliveries in the country took place in public facilities. This proportion has risen to 61.9 percent in NFHS-5. Only five states or UTs in the country (Andaman & Nicobar Islands, Goa, Kerala, Sikkim, and Puducherry) bucked this trend and saw the percentage of deliveries in private facilities increase. As per NFHS-5, the lowest percentage of institutional births in public facilities is seen in Kerala at 34.1 percent.

One of the reasons this matters is because private facilities have a much greater proportion of births by caesarian section (C-Section).

C-Section births: Wide gap between private and public facilities

Across India, only 14.3 percent births in public facilities were delivered by C-Section while this percentage for private facilities was 47.4 percent.

In three states, more than 80 percent of births in private hospitals were delivered by C-Section, as per NFHS-5. These are West Bengal (82.7 percent), Jammu & Kashmir (82.1 percent), and Telangana (81.5 percent). In contrast, the same states saw much fewer percentages of deliveries by this procedure in public facilities. In public facilities, West Bengal saw only 22.9 percent deliveries by C-Section while J&K, and Telangana saw 42.7 and 44.5 percent deliveries by this procedure respectively.

Among large Indian states, Rajasthan saw 26.9 percent births take place by C-Section in private facilities, the lowest in the country. It saw only 7.2 percent births in public facilities delivered by this procedure.

For public facilities in large states, the highest percentage of caesarean section deliveries in NFHS-5 are seen in Telangana (44.5 percent), Jammu & Kashmir (42.7 percent), and Kerala (37.2 percent).

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