Religious advice in any religion will be kept on high priority for Telanganites. The custom of needless caesareans surgeries religious advice too Karimnagar district gullible people to count on priority. This custom adopted in certain temple priests and performed by some doctors on auspicious day to for the C-section surgeries to the pregnant women.

In the month of April, Karimnagar district collector issued instructions to doctors and priests against needless surgery. Hope is if ‘auspicious date’ perk is removed, parents will opt for natural birth.

Temple priests will no longer choose an auspicious date for babies to be born via Caesarean sections,’ says a poster at the Tapala Lakshmi Narasimha Swamy Temple in Thimmapur mandal of Telangana’s Karimnagar district. The poster also informs devout parents-to-be that the decision has been taken following orders from the district administration.

Similar banners have also appeared recently at other temples in the district, as a measure to counter the high number of surgical deliveries here. The hope is that parents will be more willing to take a chance on natural births if the ‘perk’ of an auspicious date and time is removed.

In the last week of April, Karimnagar collector R.V. Karnan held a meeting of doctors and around 35 priests from different temples across the district. The idea was to instruct doctors, particularly those from private hospitals, to encourage vaginal deliveries, and for priests to withhold divine blessings for unnecessary surgeries.

According to data accessed by ThePrint, of the 6,693 births in private hospitals in the district from January 2019 to May 2022, a staggering 90.91 per cent — 6,085 — were through C-section.

In its 2021 report on district hospitals, the central government’s policy think-tank NITI Aayog highlighted that Telangana has the second-highest rate of surgical deliveries in the country — 53.51 percent, which is more than double the national average of 20.8 per cent. It is topped only by Tamil Nadu, where 55.15 per cent of births are via C-section. Within Telangana, Karimnagar and Khammam reported the highest rate of C-sections, at 69.93 per cent and 65.42 per cent respectively.

The report outlines that while surgical deliveries can be necessary and “lifesaving” in some cases, they can also be harmful for mother and baby if performed without a sound medical reason. “Lack of awareness regarding the benefits of a normal delivery and fear of labour pains” were among the reasons listed for unnecessary C-sections.

As of May 2022, there are 102 private healthcare centres — ranging from small nursing homes to large hospitals — in the district. The data from government hospitals is from three major district-run hospitals, 18 rural primary healthcare centres (PHCs), and six urban PHCs. On average, every PHC sees one childbirth per month.

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ThePrint spoke to district officials and medical professionals to understand the appeal of surgical deliveries in Karimnagar.

Why district officials approached priests?

Thirunagari Venkatdhri Swamy, chief priest of Tapala Lakshmi Narasimha Swamy temple, was part of the meeting with the district collector last month, but he seemed bemused by the directive to stop dispensing auspicious dates for C-sections.

“We don’t go door-to-door asking people if they need an auspicious time for surgeries. Only if people request, we suggest. People tell us doctors have asked them to choose a date for the operation, and so they approach us. How are we to blame?” Swamy asked.

He added that he was “astonished” when he learned the agenda for the collector’s meeting.

“We were wondering why the collector suddenly called us. We thought it must be for a peace meeting, but were astonished to see that doctors were a part of it. When we were told about the scenario, we were surprised,” he said.

Swamy acknowledged, however, that a majority of priests present at the meeting accepted that they saw cases weekly where they were “asked to choose an auspicious time for an operation”.

According to district medical and health officer (DMHO) Dr Juwaria (who goes by only one name), priests were co-opted because of the story told by data from an internal health department study/survey.

“Our study shows that 15 per cent of those opting for C-sections pick an auspicious time and then go for the operation. This is why we thought it was necessary to talk to priests,” Juwaria told ThePrint.

Health officials also noticed from birth records that certain dates and times did not have any deliveries at all, prima facie due to religious reasons.

“We went back and saw all records of births in the district and observed that certain dates did not have any deliveries in private hospitals and very low deliveries in government hospitals. For instance, an Amavasya (new moon day) on Sunday had no deliveries at all and immediately in the next two days, we saw a high number,” Juwaria said.

Speaking to ThePrint, Karimnagar collector R.V. Karnan said that while the auspicious date was just a “modest factor” in the proliferation of C-sections, it still needed to be addressed.

‘Doctors ask us to choose an auspicious time’

About a kilometre from Tapala Lakshmi Narasimha Swamy Temple is Mahatmanagar village, where 27-year-old Geetha Rani lives with her family. Her firstborn, now five years old, was born via C-section, which meant that her second child too had to be delivered surgically.

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Geetha recalls that when she was pregnant for the first time, the local government hospital encouraged a vaginal delivery while a private facility pushed for a C-section.

“We had gone to a private hospital, where doctors said that the baby’s alignment was not proper and natural birth might be a risk and suggested a C-section. I then went to a government hospital where doctors told me that the baby’s condition was normal and a natural birth is a safe option,” she said.

In Geetha’s case, fears brought on by the private hospital’s advice led her to choose a C-section. “I could not trust [the government hospital]. I was very scared. So, I went to a private hospital and got a C-section done,” she said.

Before doing so, her family made sure to ask a priest for the best time for the surgery.

“The doctors asked us to choose an auspicious time. My brother called up the temple priest and we decided on a date based on his suggestions,” Geetha’s father Ganesh said.

Lack of confidence in government hospitals and doctors is a major reason why many rush to private hospitals, pointed out Prof. Surepally Sujatha, head of the Department of Sociology at Satavahana University in Karimnagar.

“Poor infrastructure and shortage of doctors is also a reason why people prefer private hospitals for medical emergencies, they’re ready to spend any kind of money then,” she said. “When health becomes a package, an ad, then a woman becomes a product.”

Sujatha’s words were directed at posters advertising “packages” for “Caesarean and natural delivery”, which ThePrint found at all four nursing homes it visited in Karimnagar town. However, each advertised package clearly laid emphasis on C-sections, with costs inclusive of surgery, room rent, medicines, and doctor charges.

One such place was Latha Maternity and Nursing Home, which was offering a package for Rs 24,000. A staff member here told ThePrint on the condition of anonymity that at least 55 per cent of deliveries last month were through C-section. The chief doctor here, Srilatha, did not respond to ThePrint’s calls or text messages.

At another private clinic, a doctor speaking on the condition of anonymity said she did not think it was fair to hold private hospitals responsible for the high rate of C-section deliveries.

“The blame is being put on doctors, as if we’re forcing them to do C-sections — that is not true. There are a lot of factors. We have noticed a trend that women do not want to bear the excruciating pain of natural birth and they want to opt for an operation. But, there are also cases where people want C-sections due to superstitions,” she said.

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According to this doctor, patients sometimes use religion to pressurise doctors.

“Last month, I dealt with a case where the family believed that the baby, if not born on an auspicious date, would cause harm to the family’s male members. I tried convincing them that this is not right and they started blackmailing me saying I am abandoning them in the ninth month. They do not tell us all these things in the first few months and at the end — when we advise against a C-section — they say they will go for another doctor,” she claimed.

‘A vicious circle’

Last month, Telangana Health Minister Harish Rao expressed concerns over the high rate of C-sections, and the state government is now considering action against private facilities that performed an excessive number of surgeries for childbirth.

the state government is now considering action against private facilities that performed an excessive number of surgeries for childbirth.

Karimnagar collector Karnan also believes that a rise in private medical colleges and facilities has contributed to the problem in his district.

‘It’s a vicious circle. Women are preferring to avoid pain during natural birth, and are seeing other family members also opt for Caesarean sections. The rise of private medical professionals and colleges are also contributing to this over the years… Once a trend starts, it just keeps going,” he told ThePrint.

According to DMHO Dr Juwaria, Covid has also contributed to the problem.

“In 2019, pre-pandemic, the Caesarean rate was around 80 per cent or less. With government hospitals becoming Covid centres, we observed people preferred going to private hospitals or nursing homes for deliveries, and they mostly opted for C-sections,” she said.

The collector added that government as well as private hospitals and nursing homes have been asked to maintain an audit report on the number of C-sections being done, along with the reasons for doing them.

“We have told them that we’re monitoring them and that itself has made a difference. In about two months we saw a 15 percent drop to 75 per cent Caesareans and less.  We’re looking at audit reports and looking at reasons and in case we find an unnecessary number of C-sections, we will take action,” Karnan said.

The district administration has also distributed posters and informative material explaining the benefits of natural birth, which are being displayed at all healthcare centres and hospitals.

“Ever since we have had meetings with the collector’s office, we are also trying to explain to every patient that natural birth should be their preference,” a staff member at Latha Maternity Nursing Home said. #KhabarLive #hydnews