Maharashtra’s Private C-Section Rate Soars to 56%: A Crisis in Maternal Healthcare

PUNE, Maharashtra — An alarming surge in cesarean section deliveries across Maharashtra’s private hospitals has triggered urgent concerns among health activists, medical experts, and policymakers. State health data reveals that C-section rates in the private sector have more than doubled in five years, jumping from 24% in 2021-22 to a staggering 56% in 2025-26. This rate is nearly five times the World Health Organization (WHO) benchmark, which pegs the ideal population-level C-section rate at 10% to 15%. While the state’s 14.13 lakh annual deliveries are split almost equally between public and private sectors, outcomes differ dramatically: 66% of public hospital births are normal deliveries, compared to just 43% in private institutes.

Key Findings: A Five-Year Surge

The Maharashtra health department data shows a consistent upward trajectory in private sector C-sections over the last five years:

In contrast, government hospitals have remained closer to global norms, with rates rising more modestly from 24% to 33% over the same period.

Understanding the WHO Benchmark

The WHO has considered 10% to 15% the ideal C-section rate since 1985. Research shows that when C-section rates rise toward 10% across a population, maternal and newborn deaths decrease. However, when rates exceed 10%, there is no evidence that mortality rates improve further. Recent research examining 194 countries suggests the optimal rate may be as high as 19% to save lives, but rates above this threshold show no further improvement in maternal and neonatal mortality. Maharashtra’s 56% private sector rate far exceeds even this more conservative threshold.

What’s Driving the Surge?

Health officials and experts point to a complex interplay of clinical, financial, and structural factors driving this trend:

• Clinical Factors: Dr. A.B. Gadikar, assistant director of state health services (maternal care), attributes part of the rise to late pregnancies and doctor discretion. “We conduct sample audits and issue guidelines, but we cannot mandate a prevention of the procedure as it is a life-saving intervention,” he said.

• Supplier-Induced Demand: Health activist Dr. Abhay Shukla labeled the trend “supplier-induced demand,” where the choice of surgery is driven by the provider rather than clinical necessity. An IIM-Ahmedabad study found 9 lakh “preventable” unplanned C-section deliveries in private hospitals across India in one year, driven mainly by financial incentives.

• Financial Incentives: Research published in Social Science & Medicine found that the odds of C-section among women delivering in private facilities were over four times higher than in public facilities, even after controlling for medical complications and patient characteristics. The study concluded that 21% over-supply of avoidable C-sections results from physician-induced demand and perverse financial incentives.

• Defensive Medicine: Dr. Sanjay Gupte, a veteran gynecologist, noted that fear of litigation or violence pushes doctors toward the “safer” legal bet of a C-section. “Doctors are often unwilling to take any risks during labour due to the fear of conflict or litigation if something goes wrong,” he said.

• Patient Factors: Dr. Ameya Purandare, president of the Association of Maharashtra Obstetrics and Gynaecological Societies, cited delayed childbearing, previous C-sections, and patient anxiety as contributing factors.

The Human Cost

The statistics represent real women experiencing long-term consequences. Vrushali (29), despite seeking a doctor known for normal deliveries, was pushed into surgery when her water broke.

“The doctor performed four C-sections in a few hours. When she claimed my baby’s heart rate was dropping, I had no way to verify it or seek a second opinion,” she recalled. Eight months later, she suffers from chronic back pain and a permanent scar.

Similarly, Nimisha (34) was denied a vaginal birth after Cesarean (VBAC) for her second child. “The doctor simply set a surgery date the moment I hit full term, insisting a normal delivery was impossible because of my history,” she said. Research shows VBAC success rates range from 47.9% to 85% in selected cases.

Health Risks of Unnecessary C-Sections

When medically justified, C-sections effectively prevent maternal and perinatal mortality. However, unnecessary surgical deliveries pose significant health risks:

For Mothers:

• Infection at the incision site, uterus, or pelvic organs.

• Increased blood loss (1 to 6 women per 100 require a blood transfusion).

• Injury to the bowel or bladder (2 per 100).

• Adhesions causing blockage, pain, and future pregnancy complications.

• Extended recovery time (weeks to months versus days for vaginal birth).

• Higher maternal mortality rate compared to vaginal delivery, with 1 in 14 reporting incisional pain six months or more after surgery.

• Increased risks in future pregnancies, including placenta previa (placenta covering the cervix) and uterine rupture.

For Babies:

• A 50% higher likelihood of lower APGAR scores (a quick test performed on a baby at 1 and 5 minutes after birth to determine physical health).

• Increased breathing and respiratory problems.

• Potential premature birth if gestational age is miscalculated.

• Rare fetal injury during incision (1 to 2 per 100).

Furthermore, vaginal birth provides newborns with a critical “microbiome jumpstart” for their immune systems—a natural advantage bypassed when surgery is performed without absolute necessity.

National Context

This trend reflects a broader national pattern. According to the National Family Health Survey (NFHS-5), C-section prevalence in India rose from 17.2% in 2015-16 to 21.5% in 2019-21. In the private sector nationally, rates reached 49.7% in 2021, meaning nearly one in two deliveries in private facilities is a C-section.

An IIT Madras study found that women delivering at private healthcare facilities were four times more likely to have a C-section between 2016-2021. In Chhattisgarh, women had a ten-times higher chance of C-section in private hospitals; in Tamil Nadu, three-times higher. Maharashtra itself shows 25.4% C-section prevalence according to NFHS-5, with 38.9% of deliveries in private healthcare settings versus 18.3% in public facilities.

Expert Calls for Regulation

Dr. Arun Gadre, a veteran gynecologist, noted that even in the US and UK, C-section rates hover around 30%. “The absurdly high rate in India is the result of unregulated private healthcare. We need strict controls similar to those in England,” he said.

Dr. Shukla suggested the government should mandate all private hospitals to publicly display their C-section versus normal delivery percentages. “This can only be controlled once the Clinical Establishment Act is enforced,” he said. Meanwhile, the Maharashtra Obstetrics and Gynaecological Societies advocate for “rationalisation” through scientific data rather than blaming mothers or doctors.

Limitations and Counterarguments

The medical fraternity emphasizes the issue’s complexity. Not all high C-section rates indicate malpractice—some hospitals serve high-risk populations requiring more surgical interventions. The WHO itself states it does not recommend a specific rate for countries or hospitals, as needs vary dramatically depending on the population served.

Dr. Gadikar acknowledged the state health department currently lacks the legal framework to penalize hospitals for excessive surgeries. Additionally, IIT Madras research confirmed that “clinical need” factors were not necessarily the primary reason for surgical deliveries, with the place of delivery having the greatest impact on whether a C-section occurred.

What This Means for Readers

For expectant mothers in Maharashtra and across India, navigating maternity care requires informed advocacy:

• Ask questions: Request clear medical justification for any recommended C-section.

• Seek second opinions: Especially for non-emergency situations or planned interventions.

• Understand VBAC options: Vaginal birth after Cesarean is successful in many selected cases.

• Consider facility choice: Public facilities show significantly lower C-section rates and closer alignment with global medical norms.

• Discuss timing: Avoid scheduling C-sections for convenience or “auspicious timings” without medical necessity.

The rise from 24% to 56% in just five years represents a fundamental shift in maternity care that demands urgent policy attention, transparent reporting, and informed patient choice.

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.

References

• Economic Times Health. “Private C-sections in Maharashtra skyrocket to 56%, five times WHO norms.” Published May 28, 2026.