I am Neelu Paleti, a rising undergraduate senior studying Health and Societies with a concentration in Health Policy. This summer I will be conducting my senior thesis project, tentatively titled Modern Births?: The Construction of Power, Choice, and Safety of Caesarean Deliveries in South India. This research stems from my broader interests in maternal and child health, institutionalization of care, government-led health policy, and the evolving doctor-patient relationship in India. Though originally from Columbus, OH, I have experienced many different facets of India through my parents and extended family, who are all from the South Indian state of Andhra Pradesh. These experiences and stories of their interactions with the country’s medical system have piqued my interest to study the complexities of healthcare in this region.
When considering maternal healthcare and childbirth, one of the biggest patterns seen across many different parts of the world is the rise in C-section deliveries over traditional vaginal births. Over the past several decades, research has shown more and more mothers undergoing surgery to deliver their babies for a host of reasons. While a caesarean delivery has historically served as an emergency option during pregnancy complications, the World Health Organization deems that such “medically necessary” caesarean deliveries are required only for about 10-15% of all births. The problem that South India is facing is the rise of elective “medically unnecessary” caesarean deliveries that use more healthcare resources but do not necessarily contribute to any improvements in maternal mortality indices.
A 2015-16 version of India’s National Family and Health Survey has shown the rates of caesarean deliveries in Telangana and Andhra Pradesh to be 58% and 40.1% of all deliveries, the two highest rates across the nation. Moreover, 41% of all deliveries in private healthcare facilities in India are C-sections, increasing from 28% in the 2005-6 survey. This compares to around 30% C-section rates in the US. The question raised here asks why in particular are the rates in these South Indian states comparatively so high? What differentiates this procedure in this region of India that formulates this number? Such data has drawn the attention of providers, policymakers, and patients across the country who are now beginning to question the medical necessity of this procedure and the social forces shaping such trends of childbirth.
For the past several decades, India has been fighting to salvage its poor maternal mortality rates and ensure better patient outcomes. Many of the safe motherhood initiatives taken by the national and local governments aimed to raise the number of institutional births. As seen in the case of the Janani Suraksha Yojana, mothers were oftentimes even paid to deliver in a hospital, thereby equating institutionalization of childbirth with lower maternal deaths and safer outcomes. However, many of the secondary consequences, such as higher C-section rates, that came with this measure were never fully addressed.
My project will research the underlying themes of the power and agency of mothers and families in the decision-making process of childbirth, as well as the dynamic of the doctor-patient relationship, especially in private healthcare settings. Through remote interviews with providers, I will contextualize the already existing quantitative research on the rates of C-sections within the nuanced circumstances of pain, family intervention, governmental regulation, and provider convenience more qualitatively. Interviews with healthcare providers in the hospital will portray how the formal education of obstetricians, payment incentives, overall attitudes towards patient populations, and awareness of this rate of C-sections influence the methods of delivery they recommend and use. I hope to contextualize these current themes within the historical evolution of maternal healthcare and midwifery in postcolonial India. Ultimately, this research around caesarean deliveries in South India speaks to larger themes of choice, social control, modernity, and gender, amongst many more that draw from the disciplines of history and anthropology to contextualize health in these communities.