'Preventable' C-section births in pvt hosps for financial
incentives: IIM-A study
    Ahmedabad, Dec 2 (PTI) There were as many as nine lakh
"preventable" unplanned Caesarean section (C-section)
deliveries out of 70 lakh in private hospitals in India in one
year, driven mainly by "financial incentives," says a study by
Indian Institute of Management-Ahmedabad.
    Such "medically unjustified" births not just cause
"large out-of-pocket expenses" but also "delayed
breastfeeding, lower birth-weight, respiratory morbidities"
among other troubles for the newborn, it says.
    The study is titled "Too much care? Private health
care sector and surgical interventions during childbirth in
India," and was carried out by IIM-A faculty member Ambrish
Dongre and doctoral student Mitul Surana.
    The study finds "a woman opting for private facility
is 13.5-14 percentage points more likely to undergo an
unplanned C-section (compared to public facilities)".
    The figure is based on the fourth round of the
National Family Health Survey (NFHS), carried out in 2015-16,
which found that 40.9 per cent births in private facilities in
India were through C-section as against 11.9 per cent in
public facilities.
    The study observes that "supplier-induced demand" for
unplanned C-section births in private facilities is mainly
driven by "financial incentives."
    "Even though private providers might be more
responsive to patients and exert more effort, they are also
more likely to provide over-intensive treatments either as a
response to demand from patients or due to financial
incentives," it says.
    Quoting NFHS, the IIMA study says that a natural birth
in private facility costs, on an average, Rs 10,814, while a
C-section costs Rs 23,978.
    "The supplier-induced demand driven by financial
incentives especially when patient has limited information is
probably an important explanation" for higher rate of C-
section birth in private facilities, it further says.
    "When medically justified, C-sections prevent maternal
and perinatal mortality and morbidity. But if performed when
not needed, they impose huge burden on the mother and the
child that go beyond large out-of-pocket expenses," the study
    "For the newborn, it means delayed breastfeeding,
lower birth weight, respiratory morbidities, increased rate of
hospitalisation, lower Apgar scores and its implication in the
long run," it says.
    The study seeks "to evaluate whether the private
sector can be an effective partner in providing health
services," especially in the light of the National Health
Policy 2017, which provides cover of Rs 5 lakh for poor
households to seek secondary and tertiary health care in
public or empanelled private hospitals.
    In order to bring down the number of "C-sections that
are not needed," the government will have strengthen "public
sector facilities, not just in terms of equipment and
staffing, but also in terms of facility timings, absenteeism
and attitudes of service providers," it concludes. PTI KA PD