C-section deliveries and healthcare burden in Andhra Pradesh, India

Caesarean sections have been on a continuous rise in India and are particularly high in southern states, such as Andhra Pradesh. Medically indicated C-sections are life-saving; however, non-essential procedures inflict a high economic cost and increase the risk of catastrophic health expenditure among the vulnerable population. This study analyses the costs of institutional deliveries in Andhra Pradesh, compares the healthcare expenditure between normal and C-section deliveries in both public and private facilities, and assesses the magnitude of out-of-pocket expenditure (OOPE) and catastrophic health expenditure among the households. Descriptive cross-sectional survey was conducted on 511 postnatal women in four Andhra Pradesh districts from June to August 2024. Women’s background and health expenditure were collected using a structured questionnaire. Descriptive statistics, bivariate tests, and binary logistic regression were used for the analysis. 39% of respondents underwent CS, with two-thirds in private hospitals. The average healthcare expenditure per delivery (including C-sections) was ₹21,819, with CS exceeding normal deliveries at ₹43,410 and an OOPHE of ₹40,930. Average C-section health expenditure was 5.5 times normal deliveries. Private C-sections cost almost ten times more than government ones. 76.6% of households had catastrophic private C-section health costs at 10%. Lower income, private facilities, rural residence, and high financial autonomy increased catastrophic spending risk. Catastrophic healthcare expenditure disproportionately affects lower-income households, with the burden declining progressively across higher income quintiles at both 10% and 25% thresholds. C-sections, particularly in private facilities, inflict a considerable financial burden on households in Andhra Pradesh. Govt. to strengthen public obstetric services, regulate private facilities by controlling costs, and improve financial protection coverage to prevent unnecessary economic hardship and to assure equity in maternal health services.