Trends in caesarean section rates in a rural block of southern India

Divya Elizabeth Muliyil, Manjunath K., Jasmin Helan, Shantidani Minz, Kuryan George, Vinod Joseph Abraham, Anuradha Bose, Anne George herian


Background: Over the last decade many programmes have been implemented to improve the health of pregnant women and neonates. This study aims to look at the changes in modes of delivery and perinatal mortality rates in a rural block of Tamil Nadu between 2006 and 2015.

Methods: Data on all the births that have occurred in this rural block of Tamil Nadu that has been prospectively collected between 2006 and 2015 was analysed. A longitudinal analysis was done to calculate the primary and overall caesarean section rate and the average annual rate of increase. The perinatal mortality rate was also calculated.

Results: The primary LSCS rate has increased from 9.08% in 2005 to 16.1% in 2015. The overall caesarean section rate has increased from 11.7% to 19.2% in the same time with an average annual rate of increase of 5.1%. During this period the perinatal mortality has decreased from 33 per 1000 live births to 17 per 1000 live births.

Conclusions: Though the overall caesarean section rate is higher than the 15% prescribed by WHO the rates are lower than the rest of the country and rural Tamil Nadu.


Caesarean section rates, Intrapartum care, Modes of delivery

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Maine D. Monitoring emergency obstetric care : a handbook. WHO. 2009. Available at Accessed 25 May 2018.

Betrán PA, Ye J, Moller AB, Jun Z, Gülmezoglu A, Torloni M. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. Plos One. 2016;11:e0148343.

WHO. WHO statement on caesarean section rates. 2015. Available at;jsessionid=87942CF1FD09E2E619A189C37AFF7473?sequence=1 Accessed on 25 May 2018.

Althabe F, Sosa C, Belizán JM, Gibbons L, Jacquerioz F, Bergel E. Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: an ecological study. Birth Berkeley Calif. 2006;33(4):270-7.

Manoranjitham SD, Rajkumar AP, Thangadurai P, Prasad J, Jayakaran R, Jacob KS. Risk factors for suicide in rural south India. Br J Psych. 2010;196(1):26-30.

Nair H, Panda R. Quality of maternal healthcare in India: has the national rural health mission made a difference? J Glob Health. 2011;1(1):79-86.

Jacob ME, Abraham S, Surya S, Minz S, Singh D, Abraham VJ, et al. A community health programme in rural Tamil Nadu, India: the need for gender justice for women. Reprod Health Matters. 2006;14(27):101-8.

Radhakrishnan T, Vasanthakumari KP, Babu PK. Increasing trend of caesarean section rates in India: Evidence from NFHS 4. JMSCR. 2017;05(08):26167-76.

Pai M, Sundaram P, Radhakrishnan KK, Thomas K, Muliyil JP. A high rate of caesarean sections in an affluent section of Chennai: is it cause for concern? Natl Med J India. 1999;12(4):156-8.

Sreevidya S, Sathiyasekaran BWC. High caesarean rates in Madras (India): a population-based cross-sectional study. BJOG Int J Obstet Gynaecol. 110(2):106-11.

Khan MN, Islam MM, Shariff AA, Alam MM, Rahman MM. Socio-demographic predictors and average annual rates of caesarean section in Bangladesh between 2004 and 2014. PloS One. 2017;12(5):e0177579.

Krishnamoorthy MS, Muthusamy C, Dakshinamoorthy R, Mothilal R. Tamil Nadu health indicator at a glance. Directorate of Family Welfare, Chennai. 2015. Available at Accessed on 27 May 2018.