Catastrophic household expenditure on caesarean deliveries in India

The objectives of our study were to examine the (1) trends and patterns of caesarean deliveries in India and; (2) differentials in catestrophic household expenditure on caesarean deliveries. The paper used data from 71st round of the National Sample Survey, India. The analysis included 14,310 women, hospitalised for delivery during the last 365 days preceding the survey. The proportion of caesarean sections among institutional deliveries in India was 2.5% in 1992–1993, which increased to 23.9% in 2014. In private facilities, 47.8% deliveries were conducted through caesarean section, while in public facilities, this proportion was 8%. OOPE per delivery was US$157 which was 64.9% of the total cost of maternal health care. OOPE varied by type of delivery; US$283 for caesarean and US$77 for non-caesarean delivery. About 60% of households incurred the expenditure on caesarean section exceeding 40% of their capacity to pay. The incidence of catastrophic delivery expenditure declined with increased education and per-capita expenditure. Caesarean delivery in private facilities and a hospital stay of more than 48 h increased the chances of catastrophic expenditure. Interventions and regulations are necessary for both public and private sector to check unwarranted caesarean deliveries and hospital stays to reduce catastrophic expenditure.