**Executive Summary**
This document presents the Government of India's response to Lok Sabha Unstarred Question No. 1292, concerning the rise in C-sections in private hospitals. The response provides data on normal and caesarean deliveries, infant and maternal mortality rates, reasons for increased C-sections, and measures taken to regulate unnecessary C-sections. The question was slated to be answered on February 6, 2026.
**Key Points / Main Content**
* **Data on Deliveries and C-sections:**
* Year-wise total numbers of reported deliveries and C-sections in the country are available in Annexure I.
* **Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) Data:**
* IMR data from 2006-2023 can be found in the "SRS Statistical Report" in Annexure II. The link to the report is provided.
* MMR data from 2007-2023 is available in the publication "Special bulletin on Maternal Mortality in India” in Annexure III, with a link provided.
* **Reasons for Increased C-section Rates:**
* A study by the Population Research Centre (PRC) identifies clinical decision-making by doctors (maternal age, multiple pregnancies, fetal distress, previous C-sections, prolonged labour, placenta previa, maternal complications) and patient/community preferences as the primary reasons for increased C-section rates.
* **Government Initiatives to Regulate C-sections and Improve Maternal Outcomes:**
* Under the National Health Mission (NHM), various steps have been taken:
* CGHS empanelled hospitals must prominently display the ratio of deliveries by C-section vs. normal deliveries.
* Data reporting and monitoring have been strengthened at healthcare facilities.
* A dedicated C-section audit component is embedded in the LaQshya assessment checklist for Maternity OTs for all Government Hospitals.
* Training programs (Daksh, Dakshta, Skilled Birth Attendant, Nurse Practitioner Midwifery) have been implemented to ensure the availability of well-trained human resources to promote normal deliveries.
* Other initiatives under NHM:
* Janani Suraksha Yojana (JSY): demand promotion and conditional cash transfer scheme for promoting institutional delivery.
* Janani Shishu Suraksha Karyakram (JSSK): free delivery, including C-section, in public health institutions.
* Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): fixed day, free, assured and quality antenatal check-up.
* Extended PMSMA (e-PMSMA): strategy for individual tracking of high-risk pregnant women till a safe delivery.
* LaQshya: improving the quality of care in labour rooms and maternity operation theatres.
* Surakshit Matritva Aashwasan (SUMAN): assured, dignified, respectful and quality healthcare at no cost.
* Optimizing Postnatal Care: detection of danger signs in mothers and incentivizing ASHAs.
* Monthly Village Health, Sanitation and Nutrition Day: maternal and childcare nutrition at Anganwadi centers.
* Outreach camps: improving the reach of healthcare services.
* Capacity Building of staff: training programs to provide comprehensive care during delivery.
* Strengthening of infrastructure: functionalization of First Referral Units and establishment of Maternal and Child Health Wings.
* Establishment of Special Newborn Care Units (SNCUs) and Newborn Stabilization Units (NBSUs).
* ASHAs conduct scheduled home visits under Home-Based Newborn Care (HBNC).
**Impact Analysis**
**Healthcare Providers**
* **Impact:**
* CGHS empanelled hospitals are required to display delivery ratios.
* Healthcare facilities are subject to strengthened data reporting and monitoring.
* Maternity OTs in government hospitals are subject to LaQshya assessments.
* Doctors must be aware of reasons for increased C-section rates and are encouraged to promote normal deliveries through training programs.
* **Action Required:**
* Ensure compliance with display requirements for CGHS empanelled hospitals.
* Improve data reporting and monitoring practices.
* Prepare for LaQshya assessments for Maternity OTs.
* Participate in training programs to promote normal deliveries.
**Pregnant Women and Infants**
* **Impact:**
* Increased access to institutional deliveries and maternal healthcare services.
* Improved quality of care during labour and post-partum.
* Reduced out-of-pocket expenses for delivery and related services through JSSK and SUMAN.
* Access to antenatal check-ups through PMSMA.
* **Action Required:**
* Utilize available government schemes for institutional delivery and maternal care.
* Attend antenatal check-ups and follow medical advice.
* Seek timely medical attention for high-risk pregnancies.
**Government and Policy Makers**
* **Impact:**
* Need to monitor C-section rates and the effectiveness of interventions.
* Responsibility for achieving SDG targets related to maternal and neonatal outcomes by 2030.
* **Action Required:**
* Continue to implement and monitor NHM and related initiatives.
* Analyze data on C-section rates and adjust strategies as needed.
* Ensure sufficient resources are allocated to maternal and child health programs.
**ASHAs (Accredited Social Health Activists)**
* **Impact:**
* Incentivized for detection, referral and treatment of high-risk postpartum mothers.
* Conducting home visits to support and identify sick newborns.
* **Action Required:**
* Need to perform their duties effectively.
Key Entities Referenced
National Health Mission (NHM): A flagship program of the Government of India to improve healthcare access and outcomes, especially for women and children.
Janani Suraksha Yojana (JSY): A conditional cash transfer scheme under NHM to promote institutional deliveries.
LaQshya: An initiative to improve the quality of care in labour rooms and maternity operation theatres.
Ministry of Health and Family Welfare: The central ministry responsible for health and family welfare policies and programs in India.
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): A scheme that provides pregnant women a fixed day, free of cost assured and quality antenatal check up by a Specialist/Medical Officer on the 9th day of every month.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH AND FAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO.1292
TO BE ANSWERED ON6thFEBRUARY2026
RISE OFC-SECTIONS IN PRIVATEHOSPITALS
1292#SHRIMADDILAGURUMOORTHY:
Will the Minister of HEALTHANDFAMILYWELFARE be pleased tostate:
(a) the number of Normal Vaginal Deliveries (NVDs) and Caesarean Sections (C-sections)
recordedannuallyduring the last two decadesinthe country;
(b) the corresponding Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR)
trendsoverthe last two decadesin the country,State/UT-wise;
(c) whether the Government has assessed the reasons behind the continuous rise in C-section
deliveriesinprivate hospitals comparedtopublic hospitals andif so, the detailsthereof; and
(d) the steps being taken by the Government to regulate unnecessary C-sections, improve
maternal andneonatal outcomes andstrengthen institutional deliveries underJanani Suraksha
Yojana and LaQshya programmes to achieve the Sustainable Development Goal (SDG)
targets by2030?
ANSWER
THE MINISTER OFSTATE IN THE MINISTRYOFHEALTH AND FAMILY
WELFARE
(SHRIPRATAPRAO JADHAV)
(a) The year-wise total number of reported deliveries and caesarean sections during the last
twodecadesinthe countryisplacedat AnnexureI.
(b) Asperthe informationreceivedfrom theOfficeofthe RegistrarGeneral ofIndia,Ministry
of Home Affairs, the data on Infant Mortality Rate (IMR) from the year2006 till 2023 is
available in “SRS Statistical Report” placed at Annexure II and may be accessed at the
following link: https://censusindia.gov.in/census.website/data/SRSB
The data on Maternal Mortality Ratio (MMR) from the year2007 till 2023 is available in the
publication “Special bulletin on Maternal Mortality in India” placed at Annexure III and may
be accessed at the following link: https://censusindia.gov.in/census.website/data/SRSMMB(c) As per the report of Population Research Centre (PRC) - JSS Institute of Economic
Research Dharwad, Karnataka, under Ministry of Health & Family Welfare (MoHFW),
Government of India, a study conducted on “Understanding the Context of Caesarean
Delivery from the Providers’ and Receivers’ Perspectives” in 2022, mentions the main
reasons behindthe increasedrate of C-section Deliveriesinthe countryas:
Clinical Decision-Making by Doctor: Clinical indications, such as maternal age,
multiple pregnancies, fetal distress, previous C-sections, prolonged labour, placenta
previa, as well as maternal complications have a greater likelihood of caesarean
delivery.
Patient/Community Preferences: Thesehave decision-makingroleinthematter
(d) Under the National Health Mission (NHM), the Government of India has taken various
steps toregulate unnecessary c-sections which include:
CGHS empanelled hospitals are required to prominently display information
regardingthe ratioof deliveries byCaesarean section vis-à-visnormal deliveries.
Data Reportingandmonitoring hasbeenstrengthened at healthcare facilities.
Under LaQshya initiative, a dedicated C-section audit component is embedded in the
LaQshya assessment checklist for Maternity OTsfor allGovernment Hospitals.
Various training programs, including Daksh, Dakshta, Skilled Birth Attendant (SBA)
and Nurse Practitioner Midwifery (NPM) have been instituted to ensure the
availability of well-trained human resources, especially in remote areas in order to
promote normal deliveries.
To improve the maternaland neonatalhealthoutcomes, strengthen institutional deliveries and
to achieve the Sustainable Development Goal (SDG) targets, the Government of India has
takenfollowing initiatives underNHM:
Janani Suraksha Yojana (JSY) isa demand promotion andconditional cash transfer
scheme for promotinginstitutional delivery.
Janani Shishu Suraksha Karyakram (JSSK) under which every pregnant woman
andsick infant isentitled tofree delivery, includingcaesareansection, inpublic health
institutions along with provision of free transport, diagnostics, medicines,blood,other
consumables& diet.
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) provides pregnant
women a fixed day, free of cost assured and quality antenatal check up by a
Specialist/Medical Officeronthe 9thdayof everymonth.
ExtendedPMSMA(e-PMSMA) strategy was launched for individual tracking of
high-risk pregnantwomen till a safe delivery.
LaQshya improves the quality of care in labour room and maternity operation
theatres to ensure that pregnant women receive respectful and quality care during
deliveryandimmediate post-partum.
Surakshit Matritva Aashwasan (SUMAN) aims to provide assured, dignified,
respectful and quality healthcare at no cost and zero tolerance for denial of servicesfor every woman andnewborn visiting the public health facilityto endall preventable
maternalandnewborn deaths.
OptimizingPostnatal Care aims tostrengthen the quality of postnatal care by laying
emphasis on detection of danger signs in mothers andincentivizing Accredited Social
HealthActivists (ASHAs) for prompt detection,referral & treatment of such high-risk
postpartum mothers.
Monthly Village Health, Sanitation and Nutrition Day is an outreach activity at
Anganwadi centers for provision of maternal and childcare including nutrition in
convergence with the IntegratedChild DevelopmentScheme (ICDS).
Outreach camps are provisioned to improve the reach of health care services,
especially in tribal and hard-to-reach areas. This platform is used to increase
awareness for Maternal andChild health services andcommunitymobilizationaswell
astotrackhigh-risk pregnancies.
Capacity Building of staff in Skilled Birth Attendance (SBA), Daksh, Dakshata
along with BEmONC, CEmONC and LSAS to provide comprehensive quality care
during deliveryat a health facility.
Strengthening of infrastructure, includingfunctionalization of First Referral Units
(FRUs), setting up of Maternal and Child Health (MCH) Wings, operationalization
of Obstetric High Dependency Units & Intensive Care Units (Obst. HDU & ICU),
establishment of Birth WaitingHomes (BWHs) in difficult terrain, remote and tribal
areastoimprove accesstohealthcare facilitiesandpromote institutional delivery.
The establishment of Special Newborn Care Units (SNCUs) and Newborn
Stabilization Units (NBSUs) under Facility Based Newborn Care (FBNC) program
to provide specialized care to sick and small newborns at district and sub-district
levels, addressing neonatalhealth complications.
ASHAs conduct scheduled home visits under Home-Based Newborn Care (HBNC)
for improvingchild-rearing practicesandidentifyingsick newbornsfor timely referral
andcare.
*********************Annexure referred in reply to part (a) of Lok Sabha Unstarred Q. No 1292 to be
answered on06.02.2026
Annexure I
TotalNumberof
TotalNumberof
FinancialYear C-SectionDeliveries
DeliveriesReported
Reported
2008-2009 18826605 1202889
2009-2010 20786400 1526241
2010-2011 21254165 1704625
2011-2012 21126731 2098326
2012-2013 20228338 2319517
2013-2014 20457293 2479381
2014-2015 20218688 2726757
2015-2016 21172780 3252142
2016-2017 20710361 3462386
2017-2018 20783191 3588587
2018-2019 21118228 3949027
2019-2020 21410780 4152335
2020-2021 20386280 4098969
2021-2022 20410730 4533190
2022-2023 20963598 4993291
2023-2024 20351261 5143156
2024-2025 19789406 5434735
Source:DataasreportedbyState/UTsonHMISPortalAnnexure referred inreply to part(b)of Lok SabhaUnstarred Q.No 1292to beansweredon06.02.2026
Annexure II
S.No. India/States 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
INDIA 57 55 53 50 47 44 42 40 39 37 34 33 32 30 28 27 26 25
1 AndhraPradesh 56 54 52 49 46 43 41 39 39 37 34 32 29 25 24 22 20 19
2 Assam 67 66 64 61 58 55 55 54 49 47 44 44 41 40 36 34 32 30
3 Bihar 60 58 56 52 48 44 43 42 42 42 38 35 32 29 27 27 26 23
4 Chhattisgarh 61 59 57 54 51 48 47 46 43 41 39 38 41 40 38 38 38 37
5 Delhi 37 36 35 33 30 28 25 24 20 18 18 16 13 11 12 12 12 14
6 Gujarat 53 52 50 48 44 41 38 36 35 33 30 30 28 25 23 21 20 20
7 Haryana 57 55 54 51 48 44 42 41 36 36 33 30 30 27 28 27 26 26
8 HimachalPradesh 50 47 44 45 40 38 36 35 32 28 25 23 19 19 17 17 17 14
9 J&K 52 51 49 45 43 41 39 37 34 26 24 23 22 20 17 16 14 14
10 Jharkhand 49 48 46 44 42 39 38 37 34 32 29 29 30 27 25 25 25 29
11 Karnataka 48 47 45 41 38 35 32 31 29 28 24 25 23 21 19 17 15 14
12 Kerala 15 13 12 12 13 12 12 12 12 12 10 10 7 6 6 6 7 5
13 MadhyaPradesh 74 72 70 67 62 59 56 54 52 50 47 47 48 46 43 41 40 37
14 Maharashtra 35 34 33 31 28 25 25 24 22 21 19 19 19 17 16 15 13 14
15 Odisha 73 71 69 65 61 57 53 51 49 46 44 41 40 38 36 35 32 30
16 Punjab 44 43 41 38 34 30 28 26 24 23 21 21 20 19 18 18 16 17
17 Rajasthan 67 65 63 59 55 52 49 47 46 43 41 38 37 35 32 31 30 29
18 TamilNadu 37 35 31 28 24 22 21 21 20 19 17 16 15 15 13 12 11 12
19 Telangana 35 34 31 29 27 23 21 20 18 18
20 UttarPradesh 71 69 67 63 61 57 53 50 48 46 43 41 43 41 38 37 38 37
21 Uttarakhand 28 33 33 34 38 32 31 27 24 23 21 20
22 WestBengal 38 37 35 33 31 32 32 31 28 26 25 24 22 20 19 18 17 17
Source:SampleRegistrationSystem(SRS),Registrar General of IndiaAnnexure referred inreply to part(b)of Lok SabhaUnstarred Q.No 1292to beansweredon06.02.2026
Annexure III
MaternalMortalityRatio (per1,00,000 live births)
S.No. India/States 2007-09 2010-12 2011-13 2014-16 2015-17 2016-18 2017-19 2018-20 2019-21 2020-22 2021-23
India 212 178 167 130 122 113 103 97 93 88 88
1 Andhra Pradesh 134 110 92 74 74 65 58 45 46 47 30
2 Assam 390 328 300 237 229 215 205 195 167 125 110
3 Bihar 261 219 208 165 165 149 130 118 100 91 104
4 Jharkhand 76 71 61 56 51 50 54
5 Gujarat 148 122 112 91 87 75 70 57 53 55 51
6 Haryana 153 146 127 101 98 91 96 110 106 89 89
7 Karnataka 178 144 133 108 97 92 83 69 63 58 68
8 Kerala 81 66 61 46 42 43 30 19 20 18 30
9 Madhya Pradesh 269 230 221 173 188 173 163 173 175 159 142
10 Chhattisgarh 141 159 160 137 132 141 146
11 Maharashtra 104 87 68 61 55 46 38 33 38 36 36
12 Odisha 258 235 222 180 168 150 136 119 135 136 153
13 Punjab 172 155 141 122 122 129 114 105 98 92 90
14 Rajasthan 318 255 244 199 186 164 141 113 102 87 86
15 Tamil Nadu 97 90 79 66 63 60 58 54 49 38 35
16 Telangana 81 76 63 56 43 45 50 59
17 Uttar Pradesh 359 292 285 201 216 197 167 167 151 141 141
18 Uttarakhand 89 99 101 103 100 104 91
19 West Bengal 145 117 113 101 94 98 109 103 109 105 104
20 Other States 160 97 96 85 77 77 71 81 86
Source: SampleRegistrationSystem(SRS),Registrar General of India