A new analysis of National Family Health Survey (NFHS) data reveals that caesarean section (C-section) rates in India are highly concentrated in specific districts and skewed toward private hospitals. In West Bengal’s Murshidabad and Nadia districts, over 90% of private hospital deliveries are C-sections, while Karimnagar in Telangana records 91%—the highest rates in the country.

The study, conducted by researchers from Harvard University, Korea University, and Pune-based Flame University, highlights a growing public-private divide: national C-section rates in public hospitals declined slightly by 1.2 percentage points between 2016 and 2021, whereas private hospitals saw a 2.1 percentage point increase. Telangana and Jammu & Kashmir consistently recorded the highest rates across both sectors, while states like Bihar, Jharkhand, and Uttar Pradesh reported the lowest in public hospitals. Rajasthan maintained the lowest C-section prevalence in private facilities.

The World Health Organization recommends C-sections only when medically necessary, with population-level rates above 10% offering no added maternal or newborn survival benefit. Despite this, India’s rising rates indicate systemic factors beyond medical need, including infrastructure, urbanisation, and socio-cultural practices.

The study found that districts with high C-section prevalence in 2016 largely remained high in 2021, suggesting persistent patterns. In southern states like Tamil Nadu, Telangana, and Kerala, public hospitals show consistently high rates, while in private facilities, Telangana, West Bengal, Assam, and Andhra Pradesh dominate the high-prevalence category. Nearly all districts in Telangana reported high C-section prevalence across both public and private hospitals in both years.

In contrast, northern states such as Bihar, Jharkhand, and Uttar Pradesh show low rates in public hospitals, and Rajasthan consistently reports the lowest in private facilities.

The findings underscore significant health risks: maternal deaths following C-sections are nearly 100 times higher in low- and middle-income countries like India compared to high-income nations. Researchers emphasize the urgent need for targeted policy interventions, including delivery audits, resource allocation, and public awareness campaigns, rather than a one-size-fits-all approach.