Jammu and Kashmir is witnessing an upward trend in cesarean section deliveries. Over the past few years, the maternity hospitals in Kashmir mostly reported deliveries by C section, while the trend of vaginal deliveries has drastically dwindled. Medical experts raise alarm about its rise.
In the Valley, there is a startling increase in caesarean sections and a sharp decline in spontaneous births at both public and commercial private hospitals. The World Health Organization (WHO) recommends an ideal rate of C-sections between 10 to 15 percent, a threshold significantly surpassed in J&K.
A matter of choice
Simran Akhter, 33, (name changed) is the mother of two children from Srinagar’s Shalteng area. She is about to give birth to a third baby. Simran still recalled the pain of labour she underwent during earlier pregnancies. “I don’t want to bear the labour pain again, so I want to do a cesarean section to get rid from the pain,” she told. She has been in the third trimester of her pregnancy and her last ultrasound scan showed the fetus’s cephalic presentation, which is considered a good sign for normal vaginal delivery. However, Akhter prefers cesarean despite knowing chances of normal delivery. “I go to one of the private hospitals in Srinagar for medical check ups and want to do a cesarean rather than waiting for a normal delivery in government hospitals,” she revealed.
Every day, Kashmir valley reported high-risk pregnancies, due to several factors, says Farhat Jabeen, a prominent gynaecologist and former HOD, Gynaecology, GMC, Srinagar. She said that late marriages are one of the main causes for the rise of cesarean sections in Kashmir. “Patients are not prepared to endure the labour pain, nevertheless, these facilities are not available here. Many go to private hospitals, when they are unable to handle labour pain,” she added.
What the Data says
A cesarean section involves a horizontal or vertical incision through the abdomen and uterus to facilitate the delivery of the baby. Physicians resort to this approach in cases where vaginal delivery is complicated by conditions including central placenta previa, vaginal obstruction, failed labor induction, advanced cervical cancer, bladder rupture, fetal distress, maternal comorbidities, hypertension, and fetal malposition or malpresentation.
According to the lancet Journal’s report Caesarean delivery (CD) is the most commonly performed surgical procedure globally and is vital to safeguard the lives of both mothers and neonates. Globally, 21% of women give birth by CD, and reports suggest that this figure is expected to increase to 28% by 2030.
Based on data from the National Family Health Survey-5 (NFHS-5) for 2019–2021, the Lancet Journal found that the caesarean delivery (CD) rate in Jammu and Kashmir is 41 per cent, which is far higher than the national average.
Health risks for mothers and babies through C Section
Reacting to the alarming surge on caesarean sections in Kashmir, Srinagar based renowned gynecologist Dr Asif told THIP Media that the more C-sections a woman has, the greater her chance of complications in following pregnancies, such as placenta issues and uterine rupture. “A pregnant woman may feel less pain in a caesarean, but it involve risks, including infection, severe bleeding, and lengthier recovery times.
He also said that caesarean section babies are more likely to have respiratory problems because they do not go through the birth canal. Babies born through caesarean section may also be more susceptible to allergies, asthma, and other health issues because they are not exposed to the vaginal canal bacteria, which is crucial for the development of their immune systems.
He added that the rise is associated with late marriages, which are typical in Kashmir and increase the risk of C-sections. Additionally, a gap between urban and rural locations has been noted, with urban areas having greater rates of C-sections than rural ones.
Continuous surge and measures to counter C Section
In the year 2023, Kashmir’s biggest maternity hospital Lal Ded reported 22,697 delivery cases, 15,951 happened through C-sections, only 6746 were vaginal deliveries (VD).
The same surge reported in the year 2020, in which the hospital reported 15,406 deliveries, only 7305 were normal, while the remaining deliveries were conducted through C-sections mode.
The same kind of data was reported from Shere Kashmir Institute of Medical Sciences (SKIMS) maternity hospital wing. The hospital recorded 4458 deliveries between October 2022 and October 2023, in which 3249 happened through cesarean section, while only 835 were normal deliveries.
According to the research study based on the National Family Health Survey-4 Data and the fact sheets of NFHS-5, the likelihood of conception declines with late marriages, making even the first pregnancy valuable. The relatives, family members believe that the C-section is the only way to ensure that the woman is safe and the baby is born alive. However, comorbidities such as hypertension, diabetes, hypothyroidism, and other medical complications are more likely to occur in older women as they grow. These issues become more complicated during pregnancy, and for these women, C-sections are the best course of action to save the mother and the unborn baby.
In Jammu and Kashmir, there are more than 12,000 Accredited Social Health Activists who provide counselling to pregnant women and help them to prepare for normal deliveries, teach them about breastfeeding and supplemental feeding, and teach them about family planning, vaccinations, contraception, and the prevention of common infections like reproductive tract infections.
Awareness and education is must
The percentage of caesarean sections was “much higher” in private hospitals in Kashmir, where out of 10 deliveries, only one normal delivery is gets reported. This is happening at the behest of mutual consent between patients and doctors.
Earlier, Dr. Mir Mushtaq, who was the spokesperson for the Directorate of Health Services Kashmir, raised similar concerns on counselling and educating pregnant mothers about the advantages of vaginal deliveries.
He said that awareness should be given to pregnant women, stating that many variables contribute to Kashmir’s high rate of C-section deliveries, but one significant reason is the pregnant women’s and their families’ strong preference for surgical procedures. This perception is influenced by the belief that caesarean procedures are less risky and uncomfortable than vaginal deliveries.
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