Rising overmedicalisation of births in India: a demand or supply phenomenon

Rising overmedicalisation of childbearing in low income countries is seen as a worrying phenomenon as resources are scarce and could create a further risk for mother and child’s health. Some Indian States have seen sky rocketing c-section rates reaching twice as high levels than the recommended WHO 15%. It is not clear whether this increase is determined by demand or supply. The aim of this study is to understand the interaction between health systems and individual socio-economic factors in determining the probability of a c-section .
Multilevel modelling at district and cluster level is used to analysed the 2007-8 Indian DHLS..
Results show that after controlling for key risk factors, private institutions have a higher risk to perform c-sections. On the demand side higher education levels rather than wealth seems to increase the likelihood of a c-section. While cluster level is not significant, district level effects are significant in all the states demonstrating the need to control for health systems factors. This research shows that at this stage supply factors might be stronger than demand. It confirms the need to invest in further research to understand whether the quest for increased institutional deliveries in a country with a high maternal mortality might not be compromised by a push for overmedicalisation.