The softest target in the country and the easiest to demonize has to be the medical profession. This manifested clearly in the unfortunate suicide of Dr Archana Sharma and the recent closure of private hospitals in Nirmal district for allegedly performing excessive Caesarian sections. No other profession perhaps faces this form of intense scrutiny and backlashes from every member of society starting from the man on the road to the most educated person sitting in high offices. Expecting more may be a factor but a doctor would always aim for the best result and a prompt resolution of the patient’s agony. This is unlike any other profession in the public or private sectors where greed and corruption thrive on delivering incompetency, inefficiency, and unconcerned with a quick resolution of anybody’s agony.
Caesarian Sections are the commonest means to demonize the doctors. Without discounting commercial motives, most debates on Caesarian Section rates show a tunnel-vision in understanding the problem. Is there a serious statistical study to compare the CS rates in government and public hospitals? The numbers might reveal a different picture. Some government teaching hospitals, where commercial motives do not perhaps stick, show CS rates of almost 80% and up. The second issue is that the Caesarian Section is rising the world over, and India is no exception. Recent statistics from 150 countries show a global Caesarian Section rate of 18.6% of all births. China stands at 47%, Italy at 36%, Australia at 33%, and the United States of America at 32.2% to name a few. Canada, UK, and New Zealand have figures around 26%. Also, the proportion of Caesarian Sections is increasing every year in all countries.
The financial, legal, and technical reasons for such increases are manifold: Increasing maternal age; increased numbers of multiple births; higher rates of obesity and Diabetes; medical-led view of pregnancy and birth leading to higher rates of interventions; fear of birth and labour pain; concerns about genital modifications after vaginal delivery; fear of medical litigation; low tolerance of anything less than the perfect birth outcome; Polycystic Ovarian Disease (PCOD) growing in epidemic proportions; infertility treatments in the latter and other conditions leading to multiple gestations; increased incidence of big babies; increased incidence of abnormal pelvises in mothers (CPD or Cephalopelvic Disproportion); and so on. Cultural considerations and horoscope considerations also play an important role in specific contexts; common in countries like India and China. Considering solely medical factors in this complex scenario is likely to be a futile effort. Factors associated with women’s fears; and societal and cultural beliefs are very likely contributing to the increase. The reasons for increasing CS rates goes much beyond the simple binary of ‘greed or no greed’. Due to the complexity of all these scenarios and the interconnected factors, interventions to reduce unnecessary CS have only shown moderate success to date.
The much-quoted World Health Organization figure of 10%-15 % as the ideal Caesarian Section rate needs an Indian perspective as well. Apparently, less than 10% implies that the health standards for the country are poor and more than 15% implies unnecessary CS, with risks outweighing benefits. The USA has a CS rate around 35%; and India (17.2 % in 2015–16) looks better here. However, these figures reflect something else too. Despite the obviously evident high Caesarian Section rates above 50% (and sometimes touching 90%) all around in the country, an overall figure of 17% points to pathetic health delivery standards of the country, averaging the country’s figure to such a respectable figure. It reflects poor healthcare across the country. The governments should be highly reflecting about its own performance over decades based on these numbers.
The World Health Organization Statement, reiterated by the Indian Obstetrician’s body FOGSI, emphasizes that every effort should be to provide Caesarean Sections to women in need, rather than striving to achieve a specific rate. Even if charges for normal vaginal delivery become equal to Caesarian Section charges (as some suggest as a solution), it is highly doubtful that such a strategy would reduce the CS surgeries. The debate requires more nuance and not bias.
RANDOM MUSINGS 