The currentC-section rates in Kashmir are alarmingly high. Although, World health Organization(WHO) has recommended a cut-off value of less than 10-15%, Kashmir has aprevalence which approximates three out of four deliveries done and is on therising titre. The WHO's statement on C-section (2015) has clearlyrecommended; Caesarean sections are effective in saving maternal andinfant lives, but only when they are required for medically indicated reasons.At population level, as research corroborates, caesarean section rates higherthan 10% are not associated with reductions in maternal and new-born mortalityrates rather, they can cause permanent complications, disability or death,particularly in settings that lack the facilities and/or capacity to properlyconduct safe surgery and treat surgical complications. The Primary health carein J&K is in shambles and not a popular vote among the people. Therefore,informal (un-institutional) and private providers at are large. Global researchdata reports with the advent in private sector, the C-section rates alsospike-up. On the other hand, literature reveals that majority of the deliveriesin Kashmir are institutionalized i.e. occur in a facility with at least onetrained/skilled birth attendant present thereby. Therefore, this could be thepocket where most of the c-sections are taking place. Although, there isshallow research data available in this area from J&K, but it is viable toclaim that the current picture of health system is also somewhat cognizant ofthe C-section indicator.
As aconsequence, C-sections exhibit exhaustive physical, social, mental andfinancial implications for a woman and the family. Women, who developcomplications after a mishandled C-section have minimum support due to pooraccess to the health and long-standing conflict which is a major determinant ofaccess-to-health in Kashmir. As a result, depending upon the 'financialstrength of the family', 'woman's position in the family' and 'husband'sdesire', most of the women resort to private providers for health-seeking andimbricate 'Out of pocket expenditures' (OPE). OPEs are exhaustive expenditureswhich cripple the economy of a state at both 'micro and macro levels' and oftenlead to a financial catastrophe. For people belonging to lower and middlewealth quintiles, this catastrophic health expenditure disrupts the day to daybalance of a family thereby trapping them further into poverty. This loss ofincome reverberates in the financial network of our state but never replenishesthe resources of our health care system. Furthermore, a result, affectedmothers do not get sufficient reasonable care, leading to morbidity therebypushing them further into the deep roots of vulnerability. This is in synergywith the status of Maternal mortality ratio (MMR) in Kashmir which is beingreported to be alarmingly high. Globally, C-sections continue to be one of theleading determinants for Maternal deaths. Hence, it may be hypothesized thatC-sections in Kashmir are influencing maternal deaths.
Onesolution to this public health problem could be – having a proper 'birth plan'.World Health Organization, recommends a birth plan immediately after theconfirmation of pregnancy. This birth plan includes; the place of delivery,mechanism of funding, antenatal care visits, provision of transport uponemergency and post-natal care directives. It plays a crucial role in minimizingthe complexities of delivery and should be made by the couple together, inpresence of a health-care professional. Unfortunately, in our society, thesedecisions are enforced by in-laws and husbands. Therefore, micro levelinterventions are needed to curb out the unnecessary C-sections from the healthcare system of J&K. Global research suggests that women accompanied bytheir husbands for antenatal care visits tend to suffer less maternal deaths.Under this cynic, husbands and in-laws can take matters in their hands andstart breaking the barriers towards a sustainable and healthy Kashmir.
Ateeb Ahmad Parray is Tropical Diseases Research Fellow, WHO