According to NFHS 4 (2015-16) survey data, 17.2% births are delivered by caesarean section while according to NFHS 3 (2005-06) survey data, 8.5% births are delivered by caesarean section.
WHO in its statement released in April 2015 states that at population level, caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates.
In this regard a communication vide OM M.12015/182/2015-MCH has been sent to all the State Principal Secretaries and Mission Directors of all States and UTs urging them to share the WHO statement with all the Obstetricians and Gynecologists working in their respective states. In addition, the States have been suggested to conduct periodic prescription audits in private sector which could also be extended to public sector.
Government of India also has written vide OM M.12015/182/2015-MCH to Federation of Obstetrical and Gynecologists in India (FOGSI) to share the WHO statement among the Obstetricians and Gynecologists under the umbrella of FOGSI.
The Government of India has enacted the Clinical Establishments (Registration and Regulation) Act, 2010 with the objective of registration and regulation of health care institutions including those in the private sector. Health being a state subject, it is the responsibility of the state to effectively implement the act, however the centre provides continuous guidance, strict monitoring and directives for the regulation of high caesarean section rates.
All CGHS empanelled hospitals are directed to display the information regarding ratio of deliveries by caesarean section vis-à-vis normal deliveries. A communication was sent in this regard vide OM Z15025/2017 to all the CGHS empanelled hospitals.
Reducing MMR
As per the latest Registrar General of India- Sample Registration System (RGI-SRS) Report (Special Bulletin on Maternal Mortality in India 2011-13); the Maternal Mortality ratio(MMR) of India is 167 per 100,000 live births.
The key steps taken under the National Health Mission (NHM) are:
v Promotion of institutional deliveries through Janani Suraksha Yojana.
v Janani Shishu Suraksha Karyakaram (JSSK) has been launched on 1st June, 2011, which entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section. The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements have been put in place for ante-natal and post–natal complications during pregnancy and all sick infants accessing public health institutions for treatment.
v The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) has been launched by the Ministry of Health & Family Welfare (MoHFW), Government of India to provide fixed-day assured, comprehensive and quality antenatal care universally to all pregnant women on the 9th of every month. As part of the Abhiyan, a minimum package of antenatal care services would be provided to pregnant women in their 2nd / 3rd trimesters, by OBGY specialists/ Radiologist/ Physicians at government health facilities, with support from private sector doctors to supplement the efforts of the government.
v Universal screening of pregnant women for anaemia is a part of ante-natal care and all pregnant women are provided iron and folic acid tablets during their ante-natal visits through the existing network of sub-centers and primary health centres and other health facilities as well as through outreach activities at Village Health & Nutrition Days (VHNDs).
v Every pregnant woman is given iron and folic acid, after the first trimester, to be taken 1 tablet daily till delivery and same is continued during the post-natal period. Pregnant women, who are found to be clinically anaemic, are given additional 1 tablet for taking two tablets daily. This has been now expanded to 6 months during ANC and 6 months during PNC.
v Capacity building of MBBS doctors in Anesthesia (LSAS) and Obstetric Care including C-section (EmOC) skills to overcome the shortage of specialists in these disciplines, particularly in rural areas.
v Capacity buildings of SNs & ANMs in Skilled Birth Attendant (SBA) and DAKSHATA programme to equip them for managing normal deliveries, identify complications, do basic management and then refer at the earliest to higher facilities.
v To strengthen the quality of training, a new initiative has been taken for setting up of Skill Labs with earmarked skill stations for different training programs in the states for which necessary allocation of funds is made under NHM.
v Operationalization of adequate number of Primary Health Centres for providing 24 x7 basic emergency obstetric care services.
v Operationalization of adequate number of FRUs to provide 24 X 7 comprehensive emergency obstetric care services.
v Establishing Maternal and Child Health (MCH) Wings at high caseload facilities to improve the quality of care provided to mothers and children.
v Name Based Web enabled Tracking of Pregnant Women and New born babies so that provision of regular and complete services to them can be ensured.
v Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children.
v Engagement of more than 9.15 lakhs Accredited Social Health Activists (ASHAs) to generate demand and facilitate accessing of health care services by the community.
v Operationalization of Comprehensive Abortion Care Services and Reproductive Tract Infections and Sexually Transmitted Infections (RTI/STI) at health facilities with a focus on “Delivery Points.
v Newer operational guidelines have been prepared and disseminated to the States for Screening for Diagnosis & management of Gestational Diabetes Mellitus, Hypothyroidism during pregnancy, Calcium supplementation during pregnancy and lactation, De-worming during pregnancy, Maternal Near Miss Review, Screening for Syphilis during pregnancy, Guidance note on use of Uterotonic during labor and Guidance note on prevention and management of PPH.
v Guidelines on standardization of Labor Rooms and creation of Obstetric HDU and Obstetric ICU at District Hospitals and Medical Colleges has also been prepared and disseminated to the States for improving quality of care during delivery and child birth.
v Reproductive Maternal Newborn Child Health + Adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes through continuum of care across life cycle.
The Minister of State (Health and Family Welfare), Sh Ashwini Kumar Choubey stated this in a written reply in the Rajya Sabha here today.