Unnecessary Caesarean Sections in India: A Socio-Legal Analysis of Medical Practice, Maternal Rights and Institutional Accountability

Abstract

India has witnessed a near four-fold increase in caesarean section (C-section) deliveries over the past decade and a half, rising from approximately 6.4 per cent of institutional deliveries in 2008-09 to 27.46 per cent in 2024-25, and reaching over 47 per cent in private healthcare facilities per National Family Health Survey-5 (NFHS-5, 2019-21), far exceeding the World Health Organisation's clinically justified ceiling of 10-15 per cent. This paper undertakes a socio-legal examination of the phenomenon of medically unnecessary caesarean sections in India, situating the issue at the intersection of medical jurisprudence, consumer protection law, constitutional health rights and institutional regulatory failure. The paper argues that the unchecked rise in non-indicated C-sections in India is not merely a clinical or public-health anomaly but a manifestation of systemic legal and institutional deficits: the absence of binding, enforceable clinical protocols across most States; the commercialisation of obstetric care under a largely unregulated private hospital sector; inadequate implementation of the Clinical Establishments (Registration and Regulation) Act, 2010; weak enforcement of informed-consent standards articulated by the Supreme Court in Samira Kohli v. Dr. Prabha Manchanda; and the practical difficulty women face in establishing medical negligence under the Consumer Protection Act, 2019 and the tort standards affirmed in Jacob Mathew v. State of Punjab. Employing doctrinal legal analysis alongside secondary quantitative data (NFHS-4, NFHS-5, Health Management Information System data placed before Parliament, and recent State-level audit initiatives such as Andhra Pradesh's 2026 mandatory C-section audit circular), the paper evaluates the adequacy of India's existing regulatory and rights-based framework governing maternal healthcare. It further examines the right to health and reproductive autonomy under Article 21 of the Constitution, the doctrine of informed consent, and the accountability gap created by fee-for-service payment structures and defensive medical practice.