By Iqra Manzoor
LAHORE
Caesarean deliveries, once a life-saving procedure reserved for medical emergencies, are rapidly becoming routine in Pakistan. While the World Health Organisation (WHO) has long recommended that only 10–15% of births should require surgical delivery, Pakistan now sees C-section rates soaring as high as 50–70% in several hospitals, raising a critical question: Are mothers being cut open even when there is no medical need?
Globally, the trend is not new. Caesarean section rates have steadily increased over the past three decades, yet this rise has not translated into improved maternal or newborn health outcomes. On the contrary, WHO finds that when C-sections exceed the recommended threshold, risks for mothers and infants begin to increase rather than decrease. In Pakistan, where maternal mortality already stands at nearly 20,000 deaths per year, this escalating surgical culture could worsen the existing healthcare crisis.
“A serious violation of women’s basic rights”
Pakistan Medical Association (PMA) president-elect Dr. Sher Shah Syed recently raised alarm over the country’s rapidly rising C-section rates, calling the trend a “serious violation of women’s basic rights.” Speaking at a press conference in Peshawar, he criticised both public and private hospitals — especially tertiary care institutions — for performing “large numbers of caesarean sections without valid medical justification.
Dr. Syed warned that unnecessary surgical deliveries deprive women of their right to natural birth and expose both mothers and newborns to preventable complications such as infections, excessive bleeding, wound issues, and long-term problems in future pregnancies. He said the growing reliance on surgery is contributing to Pakistan’s already high maternal mortality burden.
He also emphasised the profit-driven nature of the practice in many private hospitals, where families are encouraged toward C-sections because they bring in higher fees. Dr. Syed urged the government to regulate institutional practices, develop strict delivery protocols, and train doctors and nurses in line with WHO guidelines to curb medically unjustified C-sections.
What is a C-section and when is it necessary?
According to WHO, a caesarean section is a major surgical procedure that can prevent maternal or newborn death when medically indicated. It is justified in cases of obstructed labour, fetal distress, placenta previa, severe maternal hypertension, or when continuing labour puts the mother or baby at risk. Beyond these situations, routine surgical births provide no additional benefit and often carry greater harm.
C-section is not risk-free. Women undergoing the procedure face potential complications including anaesthesia problems, heavy bleeding, infections, blood clots, organ injury, delayed wound healing, and neonatal breathing difficulties. The consequences can extend far beyond the current delivery, as women may encounter infertility, uterine rupture, placenta accreta, ectopic pregnancies, and hysterectomy in future pregnancies, with risks increasing with every repeat surgery. Children born via C-section are also found to have a higher likelihood of developing asthma or obesity later in life.
Global and regional trends: A procedure out of control
Worldwide, 18.6% of all births are now surgical, more than double the global rate three decades ago. In high-rate regions such as Latin America and the Caribbean, C-sections account for over 40% of births, followed by North America, Oceania, and Europe. Asia, including Pakistan, averages around 19%, though local surges often exceed this figure significantly.
Between 1990 and 2014, the global rate nearly tripled. Experts warn that once countries surpass the 10–15% range, maternal and neonatal mortality does not improve and may actually rise. Yet in Pakistan, certain hospitals report rates above 50%, suggesting a worrying acceleration of unnecessary surgical deliveries.
What counts as an “unnecessary” caesarean
WHO defines an unnecessary C-section as one performed without medical indication, often due to convenience, fear of labour pain, scheduling ease for doctors, or financial incentives for institutions. Healthy women with term, singleton, cephalic pregnancies are least likely to need a surgical birth, yet they contribute significantly to overall C-section rates. In Pakistan, this proportion is believed to be substantial.
Rawalpindi: When hospitals cut too soon
A WHO-guided study from Rawalpindi highlights how repeat C-sections are a major contributor to rising surgical births in tertiary care hospitals. Women with one previous scar were rarely given the opportunity for supervised vaginal delivery. Young doctors frequently lacked experience in interpreting labour complications, while high patient turnover and limited staffing encouraged hospitals to perform quick surgical interventions instead of monitored natural births. In breech pregnancies, external cephalic version, a globally recommended technique to turn the fetus, was seldom attempted, and immediate surgery often became the default.
The report recommends reforms including Robson classification training, improved fetal monitoring, updated labour induction protocols, consultant-level review of C-section decisions, and capacity building for hospital staff. Researchers note that implementing these measures could significantly reduce Pakistan’s burden of medically unnecessary C-sections.
The cost of convenience — and women’s bodies
Unnecessary surgical deliveries may shorten time in the labour room, but they extend recovery for weeks or months, increase complications in future pregnancies, and place strain on healthcare resources. They reduce hospital capacity for emergencies and turn a natural biological process into a commercialized procedure. Pakistan now stands at a critical juncture: Will childbirth remain a natural process unless medically unsafe, or will it drift further toward routine surgery?
Sehat card findings reveal profit-driven C-section explosion
According to reports, a 2024 official data review (reported by media) of the Sehat Sahulat Programme further exposes how financial incentives have fuelled Pakistan’s C-section surge. Between 2016 and January 2024, private hospitals in Punjab carried out over 525,000 C-sections under the Sehat Card, compared to only 142,000 in public facilities—a staggering 80% of all state-funded surgical births. During this period, private hospitals claimed Rs16.36 billion from the government for C-sections and normal deliveries, prompting independent medical experts to question whether thousands of women were unnecessarily pushed toward surgery.
The numbers reveal a dramatic spike after 2021, with private hospitals performing 281,137 C-sections in 2022 and 197,376 in 2023 alone. The volume of C-sections—and the billions billed for them—was so alarming that the caretaker Punjab government imposed a temporary ban on all C-sections under the Sehat Card at private hospitals in mid-2023. Officials concluded that private facilities had conducted nearly 478,513 C-sections in just two years, aggressively exhausting public funds while driving up surgical births without clear justification.
Authorities directed that only public hospitals would handle delivery cases under the scheme, but even government facilities later refused Sehat Card-linked cases, citing low payouts. The scandal underscored what health professionals have long warned: that Pakistan’s soaring C-section rates are not only a medical issue, but also a structural and financial one, in which systemic loopholes, weak regulation, and profit motives shape obstetric decisions.
“Patients are treated like cattle”: Inside labour wards
Voicepk spoke to one healthcare professional who described how institutional culture contributes to unnecessary surgeries.
“The C-section trend has been on the rise for years in both public and private hospitals. In public hospitals, medical students are under training and patients are often handled in large numbers, like cattle, because of the influx. Doctors suggest C-section either due to complications — which can be genuine — or because they do not have the time or patience to wait for a normal delivery, which takes longer.”
She explained that the private sector fuels the trend financially.
“In private hospitals, patients are charged more than double the cost of normal delivery. C-section brings higher profit, so the surgery becomes the more lucrative choice.”
The professional added that labour ward staff often lack adequate training. Midwives, rather than assisting and monitoring mothers, frequently conduct deliveries themselves.
“Midwives sometimes perform procedures without proper hygiene or supervision, which contributes to infections and, in worst-case scenarios, maternal deaths. C-sections performed by inexperienced hands also lead to long-term complications for mothers and the infants born through them.”
Voicepk also reached out to the federal health ministry for an official response on the rising C-section trend but received no reply till the filing of this report.