ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND
FAMILY WELFARE
(SHRI FAGGAN SINGH KULASTE)
(a): Caesarean section is one of the most common surgeries in the world. It is assumed that 15% of the pregnancies will land into complication and will require surgical intervention.
However as in other surgeries, caesarean section deliveries also have inherent risk of surgical and anaesthetic complication.
(b) & (c): Health being a State subject, the monitoring & implementation of Clinical Establishments Act is in the purview of the State and UT Government. The Government of India has enacted the Clinical Establishments (Registration and Regulation) Act & Rules 2010 with the objective of registration and regulation of health care institutions including those in the private sector. Further, clinical establishments are required to ensure compliance of Standard Treatment Guidelines for registration and continuation. This Act has been adopted by 10 States of Himachal Pradesh, Sikkim, Arunachal Pradesh, Mizoram, Uttar Pradesh, Bihar, Jharkhand, Uttarakhand, Rajasthan and Assam and six Union Territories (all except NCT of Delhi).
The Medical officers, staff nurses and ANM are being trained regularly in improving their skills for intrapartum care and early detection of complications.
World Health Organisation (WHO) in its new statement released in April, 2015 has said that at population level, Caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates.
Government of India (GoI) has already written to all States and UTs sharing the latest WHO statement. In addition, States have been informed to conduct periodic prescription audit in the private health facilities under the Clinical Establishment Act. They have also been informed that prescription audits can be extended to public health facilities.
A communication has also gone to Federation of Obstetrical &Gynecological Societies of India (FOGSI) which is the largest profession body of Obstetricians and Gynecologists in India for sharing the WHO guidance note to all their State chapters and the Obstetricians and Gynecologists registered under them.
All CGHS Empanelled hospitals are directed to display the information regarding ratio of deliveries by Caesarean section vis-à-vis normal deliveries.
(d) & (e): Prophylactic antibiotics in fixed dosage are routinely administered to all pregnant women undergoing caesarean section to prevent infection, however there are no cases reported of side effect of these antibiotics on the immune system of newborn.
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