C-section surge

The Caesarean section is one of modern medicine's undeniable triumphs. It has saved millions of lives by intervening when childbirth turns perilous. Yet, like many medical advances, its misuse can hollow out its original purpose. In Pakistan, the C-section increasingly appears less as a life-saving last resort and more as a routinised, even commercialised, mode of delivery.

Global health standards are unambiguous. WHO has long held that Caesarean deliveries should not exceed 10–15% of total births, as higher rates show no corresponding improvement in maternal or neonatal outcomes. Pakistan, however, has drifted far beyond this threshold. In some hospitals - particularly private ones - C-section rates hover between 50% and 70%. The reasons are neither hidden nor complex.

Caesarean surgeries are predictable, faster and more convenient for doctors juggling overwhelming caseloads. They reduce the uncertainties of prolonged labour and, in private settings, offer significantly higher financial returns. But convenience and commerce cannot be allowed to override clinical judgment.

C-section deliveries carry substantial risks. Normal delivery, when medically feasible, remains the safer option for both mother and child. Even more alarming is the absence of credible, centralised data. In Sindh, the financial burden of these procedures strains already under-resourced public hospitals. In Punjab, private hospitals recorded over half a million C-section surgeries between 2017 and 2024, with numbers surging further thereafter. Between 2016 and 2024, Rs16.36 billion was paid out in claims for C-section births.

Yet the blame cannot rest solely with hospitals or doctors. Structural deficiencies have created conditions where surgical births become the path of least resistance. In this vacuum, informed consent often collapses into psychological coercion, with women frightened into surgery under the guise of safety or convenience. What is urgently required is a multi-pronged response, which includes mandatory reporting of delivery data and stricter enforcement of clinical and international guidelines.