The Soaring Surge of Caesarean Deliveries in Jammu and Kashmir

Bharti Dogra, Poonch, Jammu, and Kashmir | In recent years, India has witnessed a concerning surge in Caesarean deliveries, also known as C-sections, surpassing the recommended WHO percentage of 10-15. The WHO clearly states that there is no evidence supporting the necessity of C-sections for women who do not require the procedure on medical grounds. However, it has become increasingly common across the country. Women, who are well aware of the pros and cons of the procedure, are making the choice for themselves but in countries in rural regions where healthcare facilities and medical awareness are not very strong, women and their families are being forced into opting for C-sections. 

Approximately 250 kilometers from Jammu, in the border district of Poonch, many such incidences have come across. Magnar Village, located 6 kilometers from Poonch town, has a population of over 5000 and in the last two-three years almost every other woman from this village has given birth to a child through a C-section. Doctors referring every second pregnant woman with no medical justification for a C-section has raised many concerns among the women's community in this village.

Bharti Verma, 28, a resident of the village, shared her experience, highlighting that she did not benefit from the operation, but instead suffered losses.

"Initially, everything seemed fine for two weeks after the operation. However, subsequently, I had to make numerous visits to the doctor and spend at least twenty thousand rupees on medications due to a stomach wound caused by the stitches. It has been 8 months since the operation, but I am still not fully recovered," expressed Bharti.

According to a report, the rate of Caesarean deliveries in India stands at an average of 21.5%, indicating a concerning trend. However, the situation is particularly alarming in the Union Territory of Jammu and Kashmir, where the rate jumps significantly to 41.7%, surpassing the national average. Another report by National Family Health Survey, states that 26 percent of Caesarean delivery are undertaken without labor pain. The increase in such deliveries without a medical necessity has led to the emergence of various health issues that affect women in the long term.

Parveen, 29, a resident of the same village, has personally experienced the negative consequences of unnecessary Caesarean surgeries.

"I have undergone three major operations so far. While the first two procedures went smoothly, complications arising from faulty stitches during the third operation resulted in numerous problems both health-wise and financially. We had to carry an additional load due to the significant costs paid as a result of the problems,” Parveen shared.

As a consequence of her third operation, Parveen's ability to perform daily household tasks has been severely affected. Prior to the surgery, she was able to carry out her responsibilities without any hindrance. However, the physical challenges and post-operative complications have now rendered her unable to resume her previous level of activity.

Medically, a C-section is recommended when there are possible complications that make vaginal delivery unsafe. Such as problems with the placenta or the presence of an infection like HIV or genital herpes which can be passed down to a child during vaginal birth. Medical conditions such as diabetes or high blood pressure and cases of birthing multiples can also lead to doctors recommending a C-section. It is important to note that the lifestyle that the villagers follow in places like Magnar is different from urban areas. As it is located on a hill, every person has to trek through difficult trails every day. Women, like in every traditional, patriarchal household, are responsible for fetching water, taking cattle to the field, and managing other household chores - even when they are pregnant and that keeps them active and fit. It then becomes crucial to investigate instances where the procedure is frequently performed on women who do not have any record of such complications. For instance, Sakshi Verma, a 27-year-old woman from the village, shared her experience of undergoing a C-section despite not having any health issues. And she was not the only one, the writer met several such women.

When the writer tried to speak to the doctors of Maharaja Sukhdev Singh District Hospital, Poonch, to understand the reason behind increasing C-section deliveries, the doctors refused to speak.

The abovementioned cases reflect the larger issue at hand - the increasing prevalence of possible unnecessary C- section deliveries in India, particularly in remote villages of hilly regions like Jammu and Kashmir. This not only poses health risks to women with lifelong impacts but also places a significant financial burden on families, who must bear the cost of additional medical treatments and procedures.

Acknowledging the increasing number of C-section deliveries in Poonch, the writer previously highlighted this concern in Hindi and Urdu newspapers. Consequently, the higher medical authorities in the Union Territory took appropriate measures to address the issue. However, it is still important to discuss this topic, as there may be numerous rural areas where women are advised to undergo C-section deliveries despite the absence of any health complications.

With the changing lifestyles and increasing health issues, there might be major chances of C-sections being the safest option for deliveries. It, therefore, becomes imperative to thoroughly evaluate and re-examine the existing systems that determine delivery procedures, while also emphasizing the importance of obtaining informed consent from families regarding the nature of the delivery. When a C-section is being considered, healthcare providers must provide families with detailed information about the procedure, including its benefits, complications after the operation, and potential alternatives. Families should be involved thoroughly in the decision-making process which will allow them to make choices that align with their preferences.

The article was first published in Daily Excelsior.

The writer is Charkha’s Volunteer Trainer from Poonch, Jammu and Kashmir. Share your feedback on [email protected]

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