*Pulwama reports highest among J&K distts
Govind Sharma
JAMMU, May 13: In a major concern for Maternal & Child Health, Union Territories of Jammu and Kashmir and Ladakh have reported 2nd and 3rd most caesarean section (C-Section) deliveries among all India States/Union Territories with experts saying that the increasing trend of C-Section deliveries is not a good sign as this procedure come with risks for the mother, including risks from anesthesia, blood loss, infection, a longer recovery period and potential for a higher risk of postpartum depression.
As per the National Family Health Survey (NFHS)-5 which was released recently by the Government of India, Telangana reported the most C-Section deliveries in the public health institutions during the past half-decade – a stunning 44.5 of all deliveries, followed by Jammu & Kashmir (42.7%) and Ladakh (39.3%).
“When we come to private health institutions, this data is worse for J&K as the UT reported 82.1 % C-Section deliveries which means for every 100 cases, 82 deliveries were done through C-Section. However, Ladakh reported zero cases of C-Section in private health institutions which can be attributed to absence of such health institutions in the UT.
The NFHS-5 further revealed that Pulwama reported the most 59.7 % of C-Section deliveries in public health institutions among J&K districts, followed by Srinagar (56.1 %), Anantnag (55.2 %), Bandipora (52.2%), Kupwara (50.7%), Baramulla (49.6%), Ganderbal (46.6%), Kulgam (43.7), Budgam (43%), Jammu (41.8%), Udhampur (41.6%), Kishtwar (36.9%), Samba (35.9%), Poonch (34.6%), Reasi (33.1%), Rajouri (30.7%), Shopian (29.7%), Kathua (28.9%), Doda (23.5%) and Ramban (20%).
However, for private health institutions, the survey was done only in 4 districts of J&K and among them Srinagar reported highest 91.3 % C-Section deliveries, followed by Baramulla (85.1%), Kupwara (80.7%) and Bandipora (49.2%).
As per the experts, a C-Section delivery is a lifesaving surgical procedure for mothers and babies when certain complications appear during pregnancy or labor. They said the ideal rate for C-Sections in a given population should be 10-15% as per WHO. This rate represents the fact that when they’re performed when they’re necessary, C-Sections can effectively prevent maternal and neonatal mortality, they added.
“Emergency C-Sections are a boon for mothers and babies – but there is no evidence supporting a similar conclusion for elective C-Sections. In fact, the latter could become life-threatening,” experts said and expressed concern over alarming increase in C-Section deliveries in J&K, which they attributed to the greed of private health institutions and rush of patients in public health institutions.
There are several risks associated with elective C-Sections, including of iatrogenic infections, ectopic pregnancies, even miscarriage. “C-Sections also pose a 2.84-times higher risk of maternal mortality than after vaginal births. Mothers electing for C-Sections also endanger subsequent pregnancies and reduce the chances of vaginal deliveries in future. Risks for babies include being accidentally cut by the surgeon’s knife, increased prevalence of atopy, allergies, childhood obesity, respiratory distress and lower gut-microbiome diversity,” they said.
Experts regretted that being very well averse with all these risks of elective C-Sections, doctors in private health institutions prefer C-Section deliveries as C-Section costs more than the normal delivery. “On an average, in a private hospital, the charges for delivery procedure (C-Section) which include hospital stay and medicines, is about Rs 25,000 to Rs 1 lakh while charges of the normal delivery is very nominal and that is the reason, private nursing homes/hospitals lays thrust on C-Section deliveries,” they added.
The similar trend is now being followed in public hospitals and there is no accountability for the same. “Government should intervene and fix responsibility of doctors. Moreover, there should be proper audit of normal and C-Section deliveries in the health institutions, both public as well as private and action should be taken against those doctors who unnecessarily go for C-Section deliveries,” experts opined.
When contacted, Mission Director, National Health Mission J&K, Yasin M Choudhary admitted that the increasing trend of C-Section deliveries is a major public health concern which results in risks associated with maternal and perinatal problems. He said they have taken the issue very seriously and only yesterday, on the directions of the Principal Secretary Health & Medical Education Department Navin Kumar Choudhary, he chaired a meeting of HoDs of Obst/Gynae of Associated Hospitals of GMCs, Chief Medical Officers and Medical Superintendents of district hospitals and Programme Management units of Maternal & Child Health (NHM J&K).
He said direction have been passed to the officers to take all measures to address the issue of increasing trend of caesarean births. “Directions have also been passed that all facilities must ensure C-Section Audit which is one of the effective non clinical interventions to curb the rising trend of caesarean births,” the MD NHM asserted.
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