Caesarean procedures rise sharply, comprise 72.5% of deliveries in private hospitals: Study

Higher C-section rates push up employers' group health insurance premiums, says study

The share of caesarean deliveries in private hospitals has risen to 72.5 percent, while normal deliveries have dropped from 51.6 to 27.5 percent between 2019-20 to 2024-25, as per a study of over 3,000 claims by Prudent Insurance Brokers, which analysed data linked to employers’ group health insurance covers.

“The findings have surprised us, especially the virtual halving of normal deliveries,” said Surinder Bhagat, Head of the company’s Large Account practice.

How c-secs have grown

According to a 2015 World Health Organisation (WHO) report, "the international healthcare community believes that caesarean sections should be between 10 percent and 15 percent of total deliveries." However, WHO does not recommend any specific  number at the country level.

WHO does not recommend any specific c-section percentage at the hospital-level either. “The need for caesarean sections at each hospital can vary dramatically depending on the type of population served by the hospital. For example, larger hospitals tend to receive referrals of most complicated pregnancies or deliveries, which in turn may need more caesarean sections. On the other hand, some small facilities may not even be equipped to conduct caesarean sections. Recommending a caesarean section rate for all hospitals would be inappropriate,” the WHO has said.

Dr Tripti Raheja, Lead Consultant, Obstetrics and Gynaecology, CK Birla Hospital, Delhi, pointed out that this was not an issue unique to India. “It's a global phenomenon driven by several factors. Modern sedentary lifestyles often lead to women not going into spontaneous labour, requiring induction after the due date. However, induced labour has a lower success rate than natural labour, leading to more C-sections,” she said.

Also read: Most companies offer group health insurance coverage of Rs 5 lakh, maternity benefits of Rs 50,000: study

Maternity expenses part of corporate claims

While several retail policies cover maternity expenses, they come with higher premiums and a waiting period of up to four years. Therefore, a majority of the claims pertain to employers’ group covers, where maternity coverage is more common.

“C-sections are roughly 30 percent costlier than normal deliveries and greatly impact premium outflows. Maternity claims comprise the biggest chunk  — 35 percent — of group medical claims, with c-sections constituting around 70 percent of maternity claims. The increased payouts lead to insurers raising premiums for the subsequent year,” said Bhagat.

“While a caesarean section can be an essential and lifesaving surgery, it can put women and babies at unnecessary risk of short- and long-term health problems if performed when there is no medical need,” WHO had said in a 2021 report.

The higher rates of c-sec deliveries have roots in both medical and non-medical factors. Monetary gain by hospitals is not always the primary reason behind this trend. The study lists increase in maternal age and body mass index, as well as changes in obstetric practice and technology among the medical factors. Voluntary preference of patients, higher maternal age and gestational diabetes play a role, according to Bhagat, who feels that increased incentives for doctors/hospitals is also a key reason for this trend.

“The notion that doctors or hospitals push for caesarean sections due to financial incentives is entirely incorrect. In corporate hospitals, the package cost for both normal delivery and C-section is the same, so there is no monetary gain for the doctor or hospital in choosing one over the other,” said Dr Raheja, countering the study's conclusions.

Moneycontrol has also reached out to Association of Healthcare Providers India (AHPI) for comments, and the report will be updated once they send a response.

Also read: Planning for a kid? Ensure you get the right maternity insurance plan

Non-medical reasons for the rise in c-secs

Explaining how monetary factors play a role and emphasising the need for clear guidelines around c-secs, the Prudent study said: “While a c-section takes approximately 45 minutes, a normal delivery can stretch for up to 10 hours. All this while, the hospital keeps the operation theatre and its staff on standby, the cost of which cannot be billed to the patient.

Dr Raheja, on the other hand, said that operation theatres in corporate hospitals are not kept on standby for a single case, but run round the clock. “The incidence of complications such as gestational diabetes has risen due to unhealthy dietary habits. A significant number of women today prefer C-sections to avoid the pain and unpredictability of natural labour. Pain tolerance has reduced, and voluntary requests for caesarean deliveries have noticeably increased. Therefore, the rise in C-section rates is multifactorial and should be understood in a balanced, evidence-based context,” she added.

The Prudent study emphasised the need for clear rules to lower the C-section rates. “This could include uniform remuneration for both caesarean and vaginal deliveries, active management of labour, audit, and mandatory second opinions,” it stated.