Three women are often forced to share a single bed at Kashmir’s lone maternity care hospital. The situation at the overcrowded Lal Ded hospital in Jammu and Kashmir’s summer capital Srinagar is a matter of concern as it threatens the wellbeing of the women who require utmost sanitation and nursing. But a more serious, unnoticed and undiscussed catastrophe has already touched the feet of ailing maternity care service in Kashmir.

Nearly 75 percent women in Srinagar deliver the baby through an abdominal incision rather than a normal vaginal delivery. The surgical procedure called caesarean section, or C-section, is locally known as ‘bod operation’.

The trend is high across the ten districts of Kashmir valley with Srinagar leading the way at an alarming level. The absolute figure of 75 percent may not be alarming enough unless compared to other places. This is where Srinagar stands among all districts in India.

The C-section rate in Srinagar is nearly six times higher than the ideal rate of 10 to 15 percent, recommended by the World Health Organization (WHO).

The alarming rise in C-section rate came to fore in the National Family Health Survey 4, conducted in the year 2015-16. The survey provides information on population, health and nutrition for India and each of its states and union territories based on various indicators, one of them being the maternity care.

In the present healthcare scenario, where the governments and private hospitals boast about the specialized surgical procedures they conduct, the C-section is not a trend to be proud of, for all bad reasons.

Where do you stand?

Search your district to know the total caesarean section rate there (public and private sectors combined). You can search the state as well to list all its districts at once. You can also sort the rate in increasing or decreasing order

DistrictStateRate (%)
KarimnagarTelangana81.1
SrinagarJammu & Kashmir74.7
WarangalTelangana69.2
NalgondaTelangana69
KhammamTelangana65.6
HyderabadTelangana62.2
West GodavariAndhra Pradesh60.8
RangareddyTelangana58.7
KollamKerala57
PulwamaJammu & Kashmir56.1
PathanamthittaKerala52.1
Sri Potti Sriramulu NelloreAndhra Pradesh51.3
KanniyakumariTamil Nadu51.3
GunturAndhra Pradesh51.1
KrishnaAndhra Pradesh50.8
NizamabadTelangana50.4
KaraikalPuducherry50
GanderbalJammu & Kashmir49.9
BudgamJammu & Kashmir49.8
UdupiKarnataka47.2
MedakTelangana47.1
IdukkiKerala47.1
PerambalurTamil Nadu44.9
East GodavariAndhra Pradesh44.6
AlappuzhaKerala43.6
VirudhunagarTamil Nadu43.2
ThanjavurTamil Nadu43
MahePuducherry42.9
SivagangaTamil Nadu42.8
ShopianJammu & Kashmir42.3
ThiruvarurTamil Nadu42
BaramullaJammu & Kashmir41.5
SrikakulamAndhra Pradesh41.4
CoimbatoreTamil Nadu41.4
ThiruvananthapuramKerala41
RamanathapuramTamil Nadu40.9
Kamrup MetropolitanAssam40.8
AhmadabadGujarat40.5
CuddaloreTamil Nadu40.4
ChikmagalurKarnataka40.3
KarurTamil Nadu40.1
Imphal WestManipur40
ErnakulamKerala40
AdilabadTelangana39.9
AriyalurTamil Nadu39.9
PudukkottaiTamil Nadu39.9
HugliWest Bengal39.8
NagapattinamTamil Nadu39.8
North Twenty Four ParganasWest Bengal39.3
NagpurMaharashtra39.3
HaoraWest Bengal39.1
Sahid Bhagat Singh NagarPunjab38.4
PrakasamAndhra Pradesh38.4
YanamPuducherry38.4
TirunelveliTamil Nadu37.6
TiruchirappalliTamil Nadu37.3
ThiruvallurTamil Nadu37.1
ThoothukkudiTamil Nadu37.1
MaduraiTamil Nadu37
Fatehgarh SahibPunjab36.3
VisakhapatnamAndhra Pradesh35.7
KancheepuramTamil Nadu35.5
KolkataWest Bengal35.1
TiruppurTamil Nadu35
VizianagaramAndhra Pradesh34.9
TheniTamil Nadu34.8
BandiporaJammu & Kashmir34.6
PalakkadKerala34.4
NadiaWest Bengal33.9
KozhikodeKerala33.8
ThrissurKerala33.7
KannurKerala33.6
MahbubnagarTelangana33.5
TumkurKarnataka33.4
MysoreKarnataka33.3
MandyaKarnataka33.2
JalandharPunjab33.1
HassanKarnataka33.1
ChittoorAndhra Pradesh32.9
North GoaGoa32.9
NamakkalTamil Nadu32.6
KapurthalaPunjab32.5
KulgamJammu & Kashmir32.3
AnantnagJammu & Kashmir32.1
KolarKarnataka32.1
West TripuraTripura32
PuneMaharashtra31.9
KupwaraJammu & Kashmir31.6
ShimogaKarnataka31.4
SangliMaharashtra31.3
ErodeTamil Nadu31.2
FaridkotPunjab31.1
GurdaspurPunjab31
KolhapurMaharashtra30.7
Bangalore RuralKarnataka30.5
SalemTamil Nadu30.5
DindigulTamil Nadu30.4
Y.S.R. CuddapahAndhra Pradesh30.2
EastNCT Delhi29.9
South GoaGoa29.3
JorhatAssam29.1
SataraMaharashtra29
GadagKarnataka29
Dakshina KannadaKarnataka29
BarddhamanWest Bengal28.9
PuducherryPuducherry28.9
South WestNCT Delhi28.8
ChennaiTamil Nadu28.8
Purba MedinipurWest Bengal28.7
MumbaiMaharashtra28.5
JammuJammu & Kashmir28.4
KottayamKerala28.3
Rup NagarPunjab28.1
ChitradurgaKarnataka28.1
DavanagereKarnataka27.7
KurnoolAndhra Pradesh27.6
AnantapurAndhra Pradesh27.6
SambaJammu & Kashmir27.5
BangaloreKarnataka27.5
RamanagaraKarnataka27.3
DharmapuriTamil Nadu27.3
UnaHimachal Pradesh27.2
Imphal EastManipur27.2
East DistrictSikkim27
DarjilingWest Bengal26.8
MahesenaGujarat26.5
SouthNCT Delhi26.3
KasaragodKerala26.3
The NilgirisTamil Nadu26.3
HoshiarpurPunjab26.2
DiuDaman & Diu25.9
WardhaMaharashtra25.9
BhandaraMaharashtra25.9
LucknowUttar Pradesh25.8
VelloreTamil Nadu25.7
AmritsarPunjab25.3
CuttackOdisha25.3
PuriOdisha25.3
WestNCT Delhi25.1
ChikkaballapuraKarnataka25.1
PoonchJammu & Kashmir24.8
KodaguKarnataka24.7
SangrurPunjab24.6
NainitalUttarakhand24.6
DibrugarhAssam24.3
JamnagarGujarat24.3
KrishnagiriTamil Nadu24.1
PatialaPunjab24
MalappuramKerala24
BathindaPunjab23.7
AkolaMaharashtra23.7
BishnupurManipur23.4
SuratGujarat23.3
RaigarhMaharashtra23.3
NavsariGujarat23.1
South AndamanAndaman & Nicobar Islands23.1
RajouriJammu & Kashmir22.9
JharsugudaOdisha22.8
SindhudurgMaharashtra22.8
WayanadKerala22.8
KamrupAssam22.5
ThaneMaharashtra22.5
BellaryKarnataka22.5
DharwadKarnataka22.4
LudhianaPunjab22.3
RatnagiriMaharashtra22.3
Sahibzada Ajit Singh NagarPunjab22.2
Leh(Ladakh)Jammu & Kashmir22.1
NorthNCT Delhi22.1
PapumpareArunachal Pradesh22.1
GandhinagarGujarat22.1
KhordhaOdisha22
KathuaJammu & Kashmir21.8
North EastNCT Delhi21.7
IndoreMadhya Pradesh21.6
KangraHimachal Pradesh21.5
HamirpurHimachal Pradesh21.3
RanchiJharkhand21.2
BarnalaPunjab21.1
Paschim MedinipurWest Bengal21.1
Tarn TaranPunjab20.9
CentralNCT Delhi20.7
AizawlMizoram20.7
AnandGujarat20.6
KinnaurHimachal Pradesh20.2
JalgaonMaharashtra20.2
BargarhOdisha20.1
SambalpurOdisha20
NalbariAssam19.9
KurukshetraHaryana19.7
JagatsinghapurOdisha19.7
BhopalMadhya Pradesh19.4
BijapurKarnataka19.4
ThoubalManipur19.3
MansaPunjab19.1
SivasagarAssam18.9
Mumbai SuburbanMaharashtra18.9
BaksaAssam18.7
JabalpurMadhya Pradesh18.7
HaveriKarnataka18.7
TiruvannamalaiTamil Nadu18.7
Koch BiharWest Bengal18.6
JalpaiguriWest Bengal18.5
JajapurOdisha18.5
DhenkanalOdisha18.5
BidarKarnataka18.5
RajkotGujarat18.4
AmravatiMaharashtra18.4
UdhampurJammu & Kashmir18.1
ChamarajanagarKarnataka18.1
BankuraWest Bengal18
VaranasiUttar Pradesh17.8
JunagadhGujarat17.8
Uttara KannadaKarnataka17.8
DhanbadJharkhand17.6
ReasiJammu & Kashmir17.5
GorakhpurUttar Pradesh17.5
TinsukiaAssam17.5
YamunanagarHaryana17.3
SirsaHaryana17.3
BirbhumWest Bengal17.3
North DistrictSikkim17.1
SolanHimachal Pradesh16.9
South Twenty Four ParganasWest Bengal16.9
Dakshin DinajpurWest Bengal16.8
AhmednagarMaharashtra16.8
North WestNCT Delhi16.7
DehradunUttarakhand16.6
RaipurChhattisgarh16.6
MeerutUttar Pradesh16.5
MurshidabadWest Bengal16.5
NashikMaharashtra16.5
SolapurMaharashtra16.5
ShimlaHimachal Pradesh16.4
ChandauliUttar Pradesh16.4
KodarmaJharkhand16.4
BhadrakOdisha16.4
BelgaumKarnataka16.4
SirmaurHimachal Pradesh16.3
MogaPunjab16.3
AgraUttar Pradesh16.3
GondiyaMaharashtra16.3
GhaziabadUttar Pradesh16.1
BaleshwarOdisha16.1
Purbi SinghbhumJharkhand16
RamgarhJharkhand16
South DistrictSikkim15.9
LaturMaharashtra15.9
BilaspurHimachal Pradesh15.7
HazaribaghJharkhand15.7
NayagarhOdisha15.7
PatanGujarat15.7
PatnaBihar15.6
VadodaraGujarat15.6
JaipurRajasthan15.5
PorbandarGujarat15.4
KishtwarJammu & Kashmir15.3
HisarHaryana15.3
KotaRajasthan15.2
GwaliorMadhya Pradesh15.2
OsmanabadMaharashtra15.2
Gautam Buddha NagarUttar Pradesh15
CacharAssam15
KarnalHaryana14.9
JhansiUttar Pradesh14.8
DewasMadhya Pradesh14.8
SubarnapurOdisha14.7
BalaghatMadhya Pradesh14.7
KendraparaOdisha14.6
ChandrapurMaharashtra14.5
RewariHaryana14.4
FaridabadHaryana14.4
ValsadGujarat14.4
AurangabadMaharashtra14.4
BagalkotKarnataka14.4
MuktsarPunjab14.3
East Khasi HillsMeghalaya14.3
North & Middle AndamanAndaman & Nicobar Islands14.3
Udham Singh NagarUttarakhand14.2
LakhimpurAssam14.2
Lahul and SpitiHimachal Pradesh14.1
KaithalHaryana14.1
DhemajiAssam14.1
TapiGujarat14
BijnorUttar Pradesh13.9
DhuleMaharashtra13.9
BuldhanaMaharashtra13.9
SonitpurAssam13.8
GanjamOdisha13.7
SabarkanthaGujarat13.7
ParbhaniMaharashtra13.7
Kanpur NagarUttar Pradesh13.6
NandedMaharashtra13.6
DurgChhattisgarh13.5
FirozpurPunjab13.4
BokaroJharkhand13.4
GanganagarRajasthan13.3
AligarhUttar Pradesh13.3
BhavnagarGujarat13.3
ViluppuramTamil Nadu13.3
ChampawatUttarakhand13
HardwarUttarakhand13
DhamtariChhattisgarh13
HardaMadhya Pradesh13
DamanDaman & Diu12.9
AllahabadUttar Pradesh12.8
MorigaonAssam12.6
Uttar DinajpurWest Bengal12.6
MandsaurMadhya Pradesh12.5
SaharanpurUttar Pradesh12.4
MathuraUttar Pradesh12.4
BareillyUttar Pradesh12.4
MahendragarhHaryana12.3
DimapurNagaland12.3
PanchkulaHaryana12.2
South TripuraTripura12.2
KendujharOdisha12.2
RampurUttar Pradesh12.1
JehanabadBihar12.1
LungleiMizoram12.1
DodaJammu & Kashmir12
MoradabadUttar Pradesh12
Lower SubansiriArunachal Pradesh12
BharuchGujarat12
DausaRajasthan11.9
SerchhipMizoram11.9
HoshangabadMadhya Pradesh11.8
SurendranagarGujarat11.8
RambanJammu & Kashmir11.7
BongaigaonAssam11.7
KachchhGujarat11.7
BalangirOdisha11.6
AmreliGujarat11.6
RaichurKarnataka11.6
MuzaffarnagarUttar Pradesh11.5
HingoliMaharashtra11.5
KhedaGujarat11.4
Dima HasaoAssam11.3
AurangabadBihar11.2
GolaghatAssam11.2
Uttar Bastar KankerChhattisgarh11.2
KargilJammu & Kashmir11.1
PanipatHaryana11.1
KoreaChhattisgarh11.1
BidMaharashtra11.1
GarhwalUttarakhand11
New DelhiNCT Delhi11
Bara BankiUttar Pradesh11
WashimMaharashtra11
GadchiroliMaharashtra11
SikarRajasthan10.9
West DistrictSikkim10.9
Khargone (West Nimar)Madhya Pradesh10.9
SonipatHaryana10.8
BhiwaniHaryana10.8
MaldahWest Bengal10.8
KulluHimachal Pradesh10.7
AjmerRajasthan10.7
BundiRajasthan10.7
SundargarhOdisha10.7
AnugulOdisha10.7
BurhanpurMadhya Pradesh10.7
RohtakHaryana10.6
Jyotiba Phule NagarUttar Pradesh10.6
Janjgir ChampaChhattisgarh10.6
JalnaMaharashtra10.6
RudraprayagUttarakhand10.5
North TripuraTripura10.5
ChambaHimachal Pradesh10.4
ChatraJharkhand10.2
JodhpurRajasthan10.1
SaranBihar10.1
PalamuJharkhand10.1
MandiHimachal Pradesh10
KoppalKarnataka10
AmbalaHaryana9.9
GoalparaAssam9.9
KalahandiOdisha9.9
BetulMadhya Pradesh9.9
JhajjarHaryana9.8
BaghpatUttar Pradesh9.8
KolasibMizoram9.7
NarsimhapurMadhya Pradesh9.7
Khandwa (East Nimar)Madhya Pradesh9.7
NalandaBihar9.6
ChurachandpurManipur9.6
YavatmalMaharashtra9.6
GayaBihar9.5
RaisenMadhya Pradesh9.5
KokrajharAssam9.4
SurgujaChhattisgarh9.4
UjjainMadhya Pradesh9.4
NarmadaGujarat9.4
PilibhitUttar Pradesh9.3
KohimaNagaland9.3
KorbaChhattisgarh9.3
BhilwaraRajasthan9.2
MaharajganjUttar Pradesh9.2
ChanglangArunachal Pradesh9.2
NagaonAssam9.2
FatehabadHaryana9.1
FirozabadUttar Pradesh9.1
West KamengArunachal Pradesh9.1
MokokchungNagaland9.1
DarrangAssam9.1
GajapatiOdisha9
PaliRajasthan8.8
ChhindwaraMadhya Pradesh8.8
BageshwarUttarakhand8.7
AlmoraUttarakhand8.7
GurgaonHaryana8.7
HanumangarhRajasthan8.7
HardoiUttar Pradesh8.7
MahasamundChhattisgarh8.7
GopalganjBihar8.6
SehoreMadhya Pradesh8.6
PalwalHaryana8.5
Mahamaya NagarUttar Pradesh8.5
DebagarhOdisha8.5
BanaskanthaGujarat8.5
YadgirKarnataka8.5
UdaipurRajasthan8.4
Rae BareliUttar Pradesh8.4
FaizabadUttar Pradesh8.4
KatniMadhya Pradesh8.4
GulbargaKarnataka8.4
NagaurRajasthan8.3
BulandshahrUttar Pradesh8.3
AzamgarhUttar Pradesh8.3
DhalaiTripura8.3
ChamphaiMizoram8.2
RaigarhChhattisgarh8.2
RajsamandRajasthan8.1
ShahjahanpurUttar Pradesh8.1
Kanpur DehatUttar Pradesh8.1
PratapgarhUttar Pradesh8.1
JaunpurUttar Pradesh8.1
West SiangArunachal Pradesh8.1
Upper SiangArunachal Pradesh8.1
South Garo HillsMeghalaya8.1
BarpetaAssam8.1
UdalguriAssam8.1
Tehri GarhwalUttarakhand8
BaranRajasthan8
Ambedkar NagarUttar Pradesh8
RohtasBihar8
Saraikela KharsawanJharkhand8
KandhamalOdisha8
PanchmahalGujarat8
KishanganjBihar7.9
LohardagaJharkhand7.9
MayurbhanjOdisha7.9
SagarMadhya Pradesh7.9
DeoriaUttar Pradesh7.8
HailakandiAssam7.8
GiridihJharkhand7.8
JhalawarRajasthan7.7
HamirpurUttar Pradesh7.7
BikanerRajasthan7.6
KarauliRajasthan7.6
AuraiyaUttar Pradesh7.6
BilaspurChhattisgarh7.6
TikamgarhMadhya Pradesh7.6
ChirangAssam7.5
SheopurMadhya Pradesh7.5
SeoniMadhya Pradesh7.5
AlwarRajasthan7.4
MuzaffarpurBihar7.4
BhojpurBihar7.4
NawadaBihar7.4
PithoragarhUttarakhand7.3
BastiUttar Pradesh7.3
KushinagarUttar Pradesh7.3
JashpurChhattisgarh7.3
DharMadhya Pradesh7.3
GumlaJharkhand7.2
DatiaMadhya Pradesh7.2
MauUttar Pradesh7.1
VaishaliBihar7.1
Upper SubansiriArunachal Pradesh7.1
JindHaryana7
BanswaraRajasthan7
Dibang ValleyArunachal Pradesh7
SenapatiManipur7
BaudhOdisha7
BharatpurRajasthan6.9
ChittaurgarhRajasthan6.9
SonbhadraUttar Pradesh6.9
NeemuchMadhya Pradesh6.9
UnnaoUttar Pradesh6.8
Sant Ravidas NagarUttar Pradesh6.8
ChandelManipur6.8
KabirdhamChhattisgarh6.8
DungarpurRajasthan6.7
EtawahUttar Pradesh6.7
ArwalBihar6.7
KarimganjAssam6.7
DeogharJharkhand6.7
UmariaMadhya Pradesh6.7
RatlamMadhya Pradesh6.7
NuapadaOdisha6.6
RajnandgaonChhattisgarh6.6
JhunjhununRajasthan6.5
BalliaUttar Pradesh6.5
BuxarBihar6.5
LohitArunachal Pradesh6.5
MungerBihar6.4
TonkRajasthan6.3
PuruliyaWest Bengal6.3
KheriUttar Pradesh6.2
West Garo HillsMeghalaya6.2
LateharJharkhand6.2
KhuntiJharkhand6.2
BijapurChhattisgarh6.2
ShivpuriMadhya Pradesh6.2
SatnaMadhya Pradesh6.2
RajgarhMadhya Pradesh6.2
ShahdolMadhya Pradesh6.2
MadhubaniBihar6.1
PerenNagaland6.1
MorenaMadhya Pradesh6.1
DohadGujarat6.1
FarrukhabadUttar Pradesh6
SultanpurUttar Pradesh6
MirzapurUttar Pradesh6
JalorRajasthan5.9
WokhaNagaland5.9
ChhatarpurMadhya Pradesh5.9
AnuppurMadhya Pradesh5.9
SirohiRajasthan5.8
GondaUttar Pradesh5.8
Sant Kabir NagarUttar Pradesh5.8
TawangArunachal Pradesh5.8
RibhoiMeghalaya5.8
DamohMadhya Pradesh5.8
DhaulpurRajasthan5.7
EtahUttar Pradesh5.7
ArariaBihar5.5
DarbhangaBihar5.5
SheikhpuraBihar5.5
Karbi AnglongAssam5.5
ZunhebotoNagaland5.4
KaimurBihar5.3
JalaunUttar Pradesh5.2
MahobaUttar Pradesh5.2
Kanshiram NagarUttar Pradesh5.2
BhagalpurBihar5.2
LakhisaraiBihar5.2
Lower Dibang ValleyArunachal Pradesh5.2
TamenglongManipur5.2
BarmerRajasthan5.1
UkhrulManipur5.1
Pashchim ChamparanBihar5
RayagadaOdisha5
ShajapurMadhya Pradesh5
MandlaMadhya Pradesh5
MainpuriUttar Pradesh4.9
SitapurUttar Pradesh4.9
JamuiBihar4.9
East SiangArunachal Pradesh4.9
East Garo HillsMeghalaya4.9
DhubriAssam4.9
GoddaJharkhand4.9
DumkaJharkhand4.9
BhindMadhya Pradesh4.9
Sawai MadhopurRajasthan4.8
GhazipurUttar Pradesh4.8
AnjawArunachal Pradesh4.8
AshoknagarMadhya Pradesh4.8
UttarkashiUttarakhand4.7
ChamoliUttarakhand4.7
GarhwaJharkhand4.7
Dakshin Bastar DantewadaChhattisgarh4.7
PannaMadhya Pradesh4.7
JaisalmerRajasthan4.6
BudaunUttar Pradesh4.6
FatehpurUttar Pradesh4.6
BankaBihar4.6
Jaintia HillsMeghalaya4.6
NicobarAndaman & Nicobar Islands4.6
NandurbarMaharashtra4.5
KannaujUttar Pradesh4.4
SimdegaJharkhand4.4
SamastipurBihar4.3
KoraputOdisha4.3
MewatHaryana4.2
SiddharthnagarUttar Pradesh4.2
KaushambiUttar Pradesh4.1
SiwanBihar4.1
JamtaraJharkhand4.1
BarwaniMadhya Pradesh4.1
PhekNagaland4
SheoharBihar3.9
PurniaBihar3.9
Pashchimi SinghbhumJharkhand3.9
GunaMadhya Pradesh3.9
ChuruRajasthan3.7
SaharsaBihar3.7
SingrauliMadhya Pradesh3.7
Purba ChamparanBihar3.6
SitamarhiBihar3.6
SaihaMizoram3.6
NabarangapurOdisha3.5
RewaMadhya Pradesh3.5
JhabuaMadhya Pradesh3.5
The DangsGujarat3.5
LalitpurUttar Pradesh3.4
SupaulBihar3.4
West Khasi HillsMeghalaya3.4
KatiharBihar3.2
East KamengArunachal Pradesh3.2
LawngtlaiMizoram3.2
MadhepuraBihar3.1
KhagariaBihar3.1
MamitMizoram3.1
BegusaraiBihar2.9
SahibganjJharkhand2.9
NarayanpurChhattisgarh2.9
BastarChhattisgarh2.8
PratapgarhRajasthan2.7
PakurJharkhand2.7
VidishaMadhya Pradesh2.7
SidhiMadhya Pradesh2.6
ChitrakootUttar Pradesh2.5
BahraichUttar Pradesh2.5
TirapArunachal Pradesh2.5
Kurung KumeyArunachal Pradesh2.1
BalrampurUttar Pradesh1.9
TuensangNagaland1.7
ShrawastiUttar Pradesh1.6
KiphireNagaland1.6
MalkangiriOdisha1.6
AlirajpurMadhya Pradesh1.6
MonNagaland1.3
DindoriMadhya Pradesh1.1
BandaUttar Pradesh1
LonglengNagaland0.3

 

Situation not well across Kashmir

Jammu and Kashmir’s overall caesarean rate is two to three times higher than the ideal, but not extraordinarily high. It appears in the list of 29 states and union territories at seventh position with total C-section rate of 33.1 percent.

However, the situation is quite alarming in the ten districts of Kashmir valley. Among the 22 districts in Jammu and Kashmir, 10 districts of Kashmir region have the highest C-section rate.

Ten districts of Jammu region and two of Ladakh region trail at a considerably low rate with highest being 28.4 percent in Jammu district and lowest 11.1 percent in Kargil district of Ladakh region.

Four mountainous districts—Kishtwar, Doda, Ramban and Kargil—fall within the ideal C-section rate of 10 to 15 percent. Moreover, it is evident that the low C-section rates in Jammu and Ladakh regions have brought down the state’s total rate.

The map of Jammu and Kashmir shows the highest rates of C-section in Kashmir region, lower rates in border areas of Jammu region and Leh district, and the lowest in Kargil district.

Steep rise in a decade

The C-section rate has considerably increased across India, including Jammu and Kashmir, since the survey was last conducted in 2005-06. However, the nation-wide rate has decreased in public sector, but considerably increased in private sector, thereby increasing the total rate.

In Jammu and Kashmir, the total rate and that in private sector have nearly doubled. Hover the mouse or click on the bars to know the difference.

 

Is it required?

WHO, in its report, says a C-section can save the mother or the unborn baby’s life “if medically justified”.

It says there is no evidence showing the benefits of caesarean delivery for women or infants who do not require the procedure. “As with any surgery, caesarean sections are associated with short and long term risk which can extend many years beyond the current delivery and affect the health of the woman, her child, and future pregnancies,” the report reads.

The C-section rate in Srinagar in public sector is 70.1 percent, the highest in India. It is nearly six times more than the nation-wide rate of 11.9 percent.

What’s responsible?

The reasons behind the alarming figure vary widely, from medical complications to fashion, experts say.

Dr. Shahnaz Taing, who heads the Department of Gynaecology and Obstetrics at Lal Ded hospital, says the C-section rate at the hospital is high as it receives high-risk patients from across Kashmir valley, being the only tertiary care centre in the region.

“So when all these patients are in a very bad condition, it’s risky to operate them in the periphery because they sometimes need multiple blood transfusions… In some cases the baby doesn’t deliver normally, they are also referred here,” she says.

Dr. Shahnaz says another factor contributing to the rising C-section rates is that the young generation is not ready to undergo the labour pain.

“Labour pain is one of the severest pains which a human being can undergo, like breaking at least 40 bones of the body. It’s not like that a patient comes in and delivers. It takes time. Our today’s generation, our girls, they are not ready for it,” she says.

She says the government hospitals in Kashmir lack the facility of Epidural Anesthesia, which makes labour pain easy. Epidurals block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body.

Dr. Shahnaz says the labour pain would be tolerable if a patient is administered Epidural Anesthesia. “But such patients need one-to-one observations, you need nursing staff, you need anaesthetist, you need intensive monitoring. It’s not possible here. First, there are a lot of patients here, three women on a single bed, and where from will we get so many anaesthetists, so many sisters, and drugs,” she says.

She says the doctors also face pressure from the patients and their families if the labour prolongs for long.

“Once a patient is in labor for 16 hours, you are under pressure. The families ask why she didn’t deliver yet when they see other patients delivering. They say ‘beware that nothing happens to her’,” Dr. Shahnaz says.

“I am saying in general, there’s family pressure. Definitely we don’t succumb to that pressure, but somewhere we have this in mind that if a woman doesn’t deliver normally for a particular time then better is to give her safe abdominal delivery rather than traumatic vaginal delivery,” she adds.

Dr. Nisar-ul-Hassan, who heads an association of doctors, blames the overburden on the government hospitals for the undue rise in C-section rates. He says a doctor can perform multiple C-sections in the time it takes to monitor a normal delivery.

He accuses the government of being negligent about the issue, saying the postgraduate students perform C-sections at government hospitals to learn the procedure even if a patient does not require it.

However, Dr. Shahnaz refutes the allegations. “It’s not that caesarean is easy. It’s still a risky procedure, it needs anaesthetics, it needs theatre, it needs recovery. It’s not that a doctor just wants to eliminate the burden by operating a patient.”

“Normal delivery, in comparison, is much much easier. Our residents conduct normal delivery while caesarean needs specialists. Sometimes there is a possibility of life threatening complications during caesarean, so consultants need to be present,” she adds.

Surge in private sector

In private hospitals or nursing homes in Srinagar, 94.6 percent births take place through a C-section, the second highest rate in India after Murshidabad in West Bengal.

The rising rate in private sector is a nation-wide trend attributed to non-medical reasons like increasing commercialization of medical services.

Data of both public and private sectors is available for six districts of Kashmir region. The C-section rate is higher in private sector in all six districts.

Hover the mouse or click on the bars to know the rate in the particular district.

 

Dr. Nisar says private hospitals aim for higher profits and a “nexus between doctors and private hospitals” is responsible for the high C-section rates. “So what drives the caesarean is money. It’s always money, financial gains,” he says, adding the doctors earn more money by conducting multiple C-sections than monitoring a single natural birth in the same period of time.

Another reason, he says, is that the doctors in the private hospitals do not have enough time to wait for a patient’s normal delivery due to the dual practice they do. “In Kashmir, there is no segregation of sectors (public and private) like in Delhi,” he says. “The doctors spend only the mornings and evening in the private hospitals.”

Speaking about the lack of awareness among people, Dr. Nisar says a perception has been deliberately generated among women that C-section is a better option as it bypasses the pain and takes less time.

Nawaz Ashraf Mir, administrator at privately-owned Shifa Medical Centre, says nearly 100 women gave birth at the hospital since it opened a year back. Out of them, around 85 women underwent a C-section, making the rate 85 percent.

Mir cites two broad reasons for the high C-section rate.

He says the doctors are not available at the hospital round-the-clock to monitor a normal delivery, which usually takes a long time. They rather conduct C-sections during their visiting hours.

Mir also says many patients prefer to deliver the child through C-section because they see it as a fashion and are not ready to undergo labour pain.