Over one-fifth of deliveries in India are performed via caesarean section, with a higher proportion of these surgeries taking place in private facilities compared to public ones, according to a study published in The Lancet Regional Health-Southeast Asia journal.

A caesarean delivery is performed by surgically cutting through a pregnant woman's abdomen and uterus.

Researchers, including those from The George Institute for Global Health in New Delhi, analysed live birth data of over 7.2 lakh women aged 15-49 years across 28 states and eight union territories, collected during the fifth round of the National Family Health Survey (2019-2021).

"India’s caesarean delivery rate of 21.5 per cent suggests adequate national access but may mask significant disparities," the authors wrote.

Caesarean, or C-section, delivery rates across states were found to substantially vary, "ranging from 5.2 per cent in Nagaland to 60.7 per cent in Telangana".

Facilities performing caesarean deliveries were higher among private health care units, compared to public centres across all wealth groups, the authors found.

However, within private facilities too, wealth disparities were found to exist, with fewer C-section deliveries among the least wealthy and more among the wealthier sections.

"The study concluded that both high-income and low-income individuals in India are more likely to receive caesarean deliveries in private rather than public facilities," the authors noted.

Caesarean delivery rates were at least twice as high among the wealthiest groups compared to the poorest in nearly 70 per cent of states, the study found.

Arunachal Pradesh had a relatively low C-section delivery rate of 14.5 per cent and showed low inequality, while southern states like Tamil Nadu and Telangana exhibited high rates C-section delivery with lower inequality.

The variation could be attributed to factors such as improved access to healthcare, higher literacy rates, and a stronger Gross Domestic Product (GDP), the authors suggested.

Cultural and social factors may also play a role in the higher number of caesarean deliveries, including fear of normal childbirth, a desire to deliver on an auspicious day, and preferences for painless deliveries or smaller families.

In Bihar, where much of the population belongs to lower wealth groups, there was a higher preference for vaginal deliveries due to their affordability and shorter recovery times, even when medical professionals recommended a C-section.

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