Jammu and Kashmir's Alarming C-Section Rates Demand Urgent Attention and Reform

The recent analysis published in The Lancet sheds light on a concerning trend in Jammu and Kashmir, where Caesarean Section (CS) deliveries are alarmingly high, regardless of socioeconomic status. The findings reveal that the state stands out in India for its relatively consistent CS rates among various wealth quintiles, with only a slight 2 to 3 percent difference between the richest and poorest households. In Jammu and Kashmir, a staggering 82.1 percent of deliveries in private hospitals are via CS, while the percentage in public facilities stands at 42.7 percent. Both these figures are well above the World Health Organization's recommended range of 10 to 15 percent for such surgical deliveries. The high rates, as the analysis indicates, cannot be attributed to economic disparities but are rather symptoms of deeper-rooted societal and medical practices unique to the region. Interviews with local gynaecologists provide insight into the complex web of factors contributing to the high CS rates. For many women in Jammu and Kashmir, late marriages often lead to pregnancies in their 30s or even 40s. The risks associated with advanced maternal age can complicate vaginal deliveries, prompting many families to consider CS as a safer option. Prof. Farhat Jabeen, a leading gynaecologist, explains the challenges posed by older maternal age, stating, "Advanced maternal age brings risks that make vaginal deliveries more challenging." Moreover, infertility issues are becoming increasingly common, often leading to pregnancies that are deemed "precious" by families. This heightened emotional and financial investment makes families reluctant to take any risks during delivery, further fueling the preference for CS. The phenomenon of "CS on demand" becomes prevalent when the aim is to ensure a controlled and perceived safer birthing experience. Health conditions such as polycystic ovary syndrome (PCOS), obesity, and hypertension are also widespread among women in the region. These factors contribute to complications that may necessitate CS deliveries. The misconception that CS is a painless and complication-free option further complicates the issue. Prof. Shahnaz Taing, an infertility expert, emphasizes the need for better education regarding the risks associated with unnecessary CS procedures and the benefits of vaginal deliveries. Both public and private healthcare systems in Jammu and Kashmir show a bias towards CS deliveries, with financial incentives in the private sector influencing medical practices. The lack of resources and trained staff in public hospitals can often lead to a preference for surgical interventions over managing the complexities of vaginal births. Faizan Mir, President of the J&K Private Hospitals and Dialysis Centers Association, acknowledges that many private hospitals lack full-time gynaecologists who can provide the necessary monitoring during labor, which further drives the trend toward CS. Despite the rising institutional deliveries, there appears to be a growing expectation among women that delivering in a hospital must involve some form of medical intervention, often translating to a CS. This trend raises concerns about the long-term implications of such high rates of surgical births. Prof. Jabeen warns that unnecessary CS deliveries can lead to serious complications for both mothers and babies, such as infections, extended recovery times, and respiratory issues for infants. As the prevalence of CS deliveries continues to strain both families and healthcare facilities, experts point to the urgent need for comprehensive strategies to address this issue. The rising demand for CS has already begun to overburden tertiary care facilities, such as Lal Ded Hospital, leading to unnecessary referrals and increased pressure on healthcare resources. In conclusion, the high rates of CS deliveries in Jammu and Kashmir call for a multifaceted approach, one that requires addressing medical practices, cultural attitudes toward childbirth, and the provision of adequate healthcare resources. As the region grapples with this pressing issue, it is imperative to foster a better understanding among families and healthcare providers about the natural birthing process and the risks associated with unnecessary surgical interventions.