AHMEDABAD: The latest National Family Health Survey (NFHS-6) has reflected a contrasting picture of Gujarat's healthcare system, where impressive government statistics stand alongside troubling indicators that expose structural weaknesses in public health delivery.
While the state projects a remarkable 97.1% institutional birth rate as a major healthcare achievement, the survey simultaneously highlights widening nutritional disparities, growing dependence on private hospitals for maternal care and a sharp rise in Caesarean deliveries.
The findings raise serious questions over policy implementation and regulatory oversight.
At first glance, Gujarat appears to have achieved near-universal institutional childbirth, with 97.1% of babies being delivered in hospitals.
However, a closer examination of the data reveals that only 39.7% of these deliveries take place in government hospitals, while the majority occur in private healthcare institutions.
The divide is equally evident across regions, with 44.7% of rural institutional deliveries occurring in government hospitals compared to just 31.6% in urban areas, indicating an increasing dependence on private healthcare, particularly in cities.
The survey further exposes a surge in Caesarean-section deliveries, which have climbed from 21.1% in the previous NFHS to 29% in NFHS-6.
The increase becomes even more striking in urban Gujarat, where 40.6% of births are now performed through surgery, compared to 21.7% in rural areas.
Private hospitals dominate this trend.
According to the survey, 39.8% of all births in the state are conducted through Caesarean sections in private hospitals, including 49.4% in urban private facilities and 32% in rural private hospitals.
By contrast, only 15.6% of deliveries in government hospitals involve Caesarean procedures, including 24.4% in urban government hospitals and 11.7% in rural government facilities.
The Gujarat figures closely mirror a growing national concern.
NFHS-6 estimates India's overall Caesarean-section rate at 27.2%, with rates approaching 40% in urban private hospitals, far exceeding the World Health Organisation's recommended benchmark of 10% to 15% of all deliveries.
Public health experts have repeatedly cautioned that while Caesarean surgery is lifesaving when medically necessary, unnecessary procedures expose mothers to avoidable surgical risks, increase healthcare expenditure and can complicate future pregnancies.
The NFHS-6 data show a sharp rise in Caesarean-section deliveries in Gujarat, with the rate increasing from 21.1% in the previous survey to 29.0%.
Ahmedabad-based physician Dr Yogesh Gupta said the rising Caesarean rate reflects "a combination of medical risk, delayed referrals, patient expectations and differing practice patterns between public and private facilities."
He further observed, "It's higher concentration in urban and private settings suggests that non-clinical factors may also be influencing decision-making alongside genuine obstetric need. Caesarean delivery remains a lifesaving procedure when properly indicated, but avoidable surgery can increase maternal morbidity, affect future pregnancies and add financial burden."
"The solution lies not in blame but in stronger audits of indications, standardised obstetric protocols, transparent counselling for women and families, second-opinion systems for elective cases and strict adherence to evidence-based medical care." he added.
Beyond maternal healthcare, the NFHS-6 survey exposes Gujarat's growing battle with the double burden of malnutrition and obesity, highlighting sharp nutritional inequalities between rural and urban populations.
Statewide, 23.6% of women and 21.8% of men have a Body Mass Index (BMI) below the normal level, reflecting persistent undernutrition.
The situation is significantly more alarming in rural Gujarat, where 30.1% of women and 26.6% of men fall below the normal BMI threshold.
In contrast, urban areas report comparatively lower levels of undernutrition, with 14.5% of women and 15.6% of men having a BMI below the healthy range.
At the same time, obesity has emerged as an equally serious public health challenge. In rural Gujarat, 23.2% of women and 21.8% of men are overweight.
The problem intensifies sharply in urban areas, where 44.3% of women and 40.2% of men are overweight, exposing a widening nutritional imbalance.
The figures suggest that while rural populations continue to battle undernutrition, cities are increasingly confronting lifestyle-related obesity, reflecting the uneven impact of existing nutrition programmes.
Family planning data also points to a continuing gender imbalance in reproductive healthcare responsibilities. The survey shows that 33.9% of women undergo sterilisation as the primary method of contraception, including 41.3% of rural women and 24% of urban women.
In contrast, male sterilisation remains virtually absent, with only 0.2% of men opting for the procedure statewide, underscoring the overwhelming burden placed on women in family planning programmes.
Reacting to the findings, Congress spokesperson Dr Hiren Banker alleged that the soaring Caesarean rates demonstrate weak regulatory oversight of private hospitals.
"The increase in Caesarean deliveries from 21.1% to 29%, and particularly the 49.4% rate in urban private hospitals where nearly one out of every two deliveries is surgical, clearly shows the absence of effective government regulation and medical audit. Instead of preserving childbirth as a natural process wherever medically possible, deliveries have increasingly become a profitable business model in the private sector, while the Health Department has failed to prevent unnecessary surgical interventions," he said.
High institutional delivery rates undoubtedly reflect improved access to medical facilities, yet the accompanying rise in surgical births, persistent rural malnutrition, growing urban obesity and overwhelming dependence on female sterilisation suggest that access alone is not translating into balanced public health outcomes.
The data ultimately underscores the need for stronger regulation of private healthcare, evidence-based maternal care, equitable nutrition policies and greater investment in public health infrastructure to bridge the widening gap between official achievements and healthcare realities on the ground.