Objective: To estimate the population caesarean section rate in urban India.
Design: Population-based cross sectional study.
Setting: Madras City (Chennai), India. Seven hundred and eighty resident women who delivered in Madras between June 1997 and May 1999.
Methods: Cluster sampling was done using streets as cluster units. Thirty clusters were selected from 1255 clusters by the probability proportion to size method and 26 women were selected randomly from each cluster.
Main outcome measures: Total and primary caesarean rates.
Results: Total population caesarean section rate was 32.6% (95% CI 27-38) and primary caesarean section rate was 25% (95% CI 20-30). Total caesarean section rates in the public, charitable and private sectors were 20%, 38% and 47%, respectively. Private sector deliveries had an odds ratio of 2.4 (95% CI 1.5, 3.8) of a primary caesarean section delivery in comparison with the public sector after adjustment for parity, age at delivery of mother and educational status.
Conclusions: Forty-seven percent of births by caesarean section in the private sector is alarming and could implicate private sector care as the main contributing factor behind the high population caesarean section rates. Policymakers should urgently institute systems for accountability and ethical practice and regularly monitor all medical interventions, before large scale exploitation of the rural markets begins.