Caesarean sections as a share of institutional deliveries, Kerala

Caesarean-section deliveries as a percentage of all deliveries conducted in health facilities in the month.

Numerator

Item 3.1: total C-section deliveries performed

Denominator

Item 2.2: institutional deliveries (including C-sections)

Methodology

Source: HMIS Standard Report 'Data ItemWise Report for All India Across State', one file per month (hmis.mohfw.gov.in → Standard Reports → C2. Data Itemwise Monthly → 1. All India Across States), Total column = public + private facilities (equivalently rural + urban). Values are the facility reports aggregated by HMIS; IHO reads them as published and computes ratios from the stored components. Item 3.1 ÷ item 2.2 × 100. Values are stored as provisional; ratios with a denominator under 100 are marked low-sample. A value above 100% rejects the month's release.

Caveats

Neither high nor low is simply better: very low rates can mean poor access to emergency obstetric care and high rates can mean overuse (WHO has long cited roughly 10–15% at population level). Incomplete private-facility reporting, where C-section rates are higher, biases it downward. HMIS data after May 2021 is not publicly released; MoHFW restricts newer months to logged-in users. All figures are marked provisional by the publisher, and MoHFW regenerates whole financial years (each file carries a 'Status As On' date), so values can be restated. HMIS counts services reported by facilities, by place of service rather than residence: a state that treats many patients from its neighbours shows higher counts and ratios. Private-sector reporting is incomplete and uneven across states. April 2020 onward reflects the COVID-19 lockdowns and service disruption.

Comparability

Every month published here uses the HMIS reporting format introduced in April 2017 (the earlier format is not loaded). The files changed physical form (BIFF .xls for Apr–May 2017, SAS HTML for Jun 2017 – Mar 2020, .xlsx from Apr 2020) but not content. Geography: Jammu and Kashmir includes Ladakh until March 2020; Ladakh is reported separately from April 2020. Dadra and Nagar Haveli and Daman and Diu are published separately up to December 2019 and as the merged UT from April 2020; January–March 2020 is not published for either, because the files still report the two former UTs after the 26 January 2020 merger. Until March 2020 the files also carry columns for the Ministry of Defence's and Ministry of Railways' own facilities; they count in All India but belong to no state. If later months become public, two further format changes apply (April 2023: in-facility and outreach reported separately; April 2025: a revised format with renumbered items); the pipeline checks every item's label and will stop rather than mix formats.