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Feature Health in South Asia

Balancing the knife: India debates the pros and cons of pushing caesarean sections

BMJ 2022; 378 doi: (Published 03 August 2022) Cite this as: BMJ 2022;378:o1915
  1. Kavitha Yarlagadda, freelance journalist
  1. Hyderabad
  1. y.kavitha105{at}

Indian doctors are weighing up the need for caesarean sections, as success in widening access and lowering maternal mortality is clashing with a push to reduce “unnecessary” procedures. Kavitha Yarlagadda reports

Lakshmi was due to deliver her baby in a week, so her in-laws called an astrologer to find the perfect “muhurat”—an auspicious time and day—to have the baby delivered through caesarean section.

Muhurat deliveries have become a trend in India, with families believing that a task performed at a certain time on a given day gives a positive result. This belief, mixed with other reasons such as fear of labour and desire for a painless delivery, is pushing more Indian women to opt for caesarean sections to deliver their babies.

The rate of caesarean deliveries in India more than doubled from 8% in 2005 to 17% in 2016. According to the most recent (2019-21) data from the National Family Health Survey conducted by the Ministry of Health and Family Welfare, the number of caesareans performed in India rose from 17.2% in the previous (2017-19) survey to 21.5%. (For comparison, in the US 31.8% of live births were caesareans in 2020,1 while in the UK one in four women giving birth has a caesarean.2)

With one of the highest rates of infant mortality in the world—27 deaths out of every 1000 live births in 2021, according to data from the Organisation for Economic Co-operation and Development—the rise in caesareans should be a good thing. But measures seeking to make them more available to women in need are clashing with moves to cap the trend …

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