VIJAYAWADA : The State government has identified 104 private hospitals in the State that reported 100% Cesarean section (C-section) births in the financial year 2023-24, signifying that they did not follow the Robson Classification system. In mid-May, the Health and Family Welfare Department issued notices to these hospitals and sought them to submit an explanation for the same by May 27 (Monday).
Most hospital managements submitted their responses by the deadline. These responses will now be reviewed scientifically, and appropriate action will be taken. Medical authorities estimate that 25 to 50 hospitals will face penalties.
The action comes after the government, in collaboration with UNICEF, audited 278 primary C-section cases at 62 facilities and noticed that while 55% were necessary, 26% were deemed unnecessary and 19% were performed without insufficient evidence.
Notably, 104 network hospitals empanelled with Dr YSR Aarogyasri reported 100% C-sections in the State.
Of the total, highest of nine hospitals each have been identified in Vizianagaram and Prakasam districts, followed by eight hospitals in Nellore. According to the World Health Organisation (WHO) and State officials, 100% C-section rate is unethical.
WHO had proposed the Robson Classification system as a global standard for assessing, monitoring and comparing Caesarean section rates within healthcare facilities over time, and between facilities.
In 2023-24, over seven lakh deliveries were performed in the State — 2,67,083 at government hospitals and 4,48,144 at private facilities.
Of the total, government hospitals recorded 1,01,156 C-section deliveries, while private hospitals reported 2,26,810 Cesarean births.P4
Stern measures to curb unnecessary C-sections
Notices issued by the District Health and Medical Officers (DMHOs) to the private hospitals stated, “Information and evidence have been placed before the authority, charging you with violations of the Andhra Pradesh Private Medical Care Establishment Act. The charges include non-adherence to guidelines, unethical practices, excessive billing, unnecessary procedures, and denial of entitled cashless treatment.”
Speaking on the issue, additional director for Maternal and Child Health Dr KVNS Anil Kumar said, “We have identified hospitals conducting 100% C-sections and asked DMHOs to review case sheets and provide remarks.”
He stressed that unnecessary C-sections contribute to long-term morbidity in women, leading to various health complications.
Highlighting that the State government wants to promote normal deliveries by providing incentives to hospitals that conduct them while reducing compensation for institutes performing a number of C-sections, he explained that the State has positioned 60 midwives in high-volume hospitals to address high C-section rates in government hospitals. In 2023-24, midwives conducted 7,000 normal deliveries, up from 4,300 the previous year. The government aims to ensure private hospitals do not conduct unnecessary C-sections, the official added.
Elaborating on WHO norms on C-section births, he said, “Not more than 20% of pregnant women should go for Cesarean deliveries. However, what is happening now is that 56% C-Sections are happening in the private sector and 43% in government institutions. Doctors are neither counselling mothers nor educating them on birthing plans. So we wanted to go ahead and ensure that Cesarean deliveries are reduced. The aim is to enforce strict norms to ensure medically necessary C-sections are performed to protect women’s health and maintaining medical integrity in the State.
On the action to be taken on the hospitals, he explained that penalties or operational restrictions such as seizure of operation theatre or labour room will be announced following the decision of Commissioner of Health and Family Welfare Dr S Venkateswar.