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Abstract Increasing caesarean births is a global trend and of recent origin in India. Besides its utility and disutility, increasing caesarean births exert higher economic burden on households and the nation. Using 148,746 births from the National Family Health Survey, 2015–16, this paper examines the correlates and provides comparable estimates of out of pocket expenditure (OOPE) on caesarean births in public and private health centres in India. The monthly state specific rural-urban consumer price index and the OOPE on births over seven years are used to derive comparable OOPE estimate at 2016 prices. A composite variable combining type of birth and place of delivery is computed and classified as private and caesarean, public and caesarean, private and non-caesarean, public and non-caesarean. Descriptive statistics, logistic and tobit regression model were used to understand the differentials and determinants of OOPE on caesarean births. Caesarean births were significantly higher among mothers belonging to higher socioeconomic status, first order births, mothers with high BMI, pregnancy complications, repeat caesarean and in private health centres confirming that both maternal demand and institutional factors are leading to the increasing in caesarean rates in India. The mean OOPE of caesarean births in public health centres of poorer states was higher than that in the richer states of India (US$107 in low performing states compared to US$88 in high performing states) while such differentials across private health centres are small. The marginal effect of a caesarean birth in private health centres in low performing states was US$296 dollar higher than that of non-caesarean births. Improving the public health centres for conducting caesarean births, developing standard guideline for clinical practices in conducting caesarean births and creating awareness on comprehensive pregnancy care can reduce the caesarean rates and OOPE on caesarean birth in India. Highlights • Incraese in caesarean births are due to both maternal and clinical factors. • Three of ten first-order births were caesarean; higher than any subsequent order. • Caesarean rate among mothers with prior caesarean births was above 90 percent. • OOPE of a caesarean birth in public health centre of poorer states was high. • Medicine and test accounts larger share of OOPE in public health centers in India. [ABSTRACT FROM AUTHOR]

Demographers have carefully analyzed intersecting aspects of identity beyond religious category that influence fertility patterns in India, such as region, access to wealth, sex ratios, and gender dynamics (Padmanabhan, 2015). Drawing on interviews and participant-observation conducted during 15 months of field research on infertility in Lucknow, Uttar Pradesh, north India, between 2005-07 and 2016–17, this study shows how nuances of demographic change categorized by religion, such as changes in fertility and mortality rates, ripple through public discourse and imagination less powerfully than overall shifts in population percentages. This paper connects media and political discourse about religion, demography, and fertility in large-scale reports, such as the 2011 Census of India and the Sachar Committee Report on status of Muslims in India (Sachar et al., 2006), to the health care services and advice provided to Muslim women and children. While the Sachar Report drew attention to economic and social disadvantage among Muslims, political discourse in response to the 2011 Census continues a trend of labeling disparities in fertility rates across religious categories as a social problem. Such discourse renders individual fertility and infertility experiences invisible and reinforces longstanding negative representations of Muslims' fertility, with important implications for health, identity, and ultimately, governance (Sangamoorthy and Benton, 2012). Ethnographic data from health outreach efforts led by and serving Muslim women in Lucknow demonstrate the diversity of Muslim women's positions relative to health and fertility services as well as the intersections of various aspects of identity with fertility management experiences. By bringing these perspectives together, the paper shows how ethnographic work matters for making sense of quantitative population data. The political uses of large-scale quantitative data demonstrate how social science analysis can be used both to create "Others" and argue for neo-eugenics, and to bolster arguments for resources and reform that benefit the disadvantaged. • Large-scale research on population in India leaves out experiences of infertility. • Qualitative research can bring perspectives on infertility to light. • Political uses of religious demography of fertility show up in clinical encounters. • Situating infertility requires mixed methods and interdisciplinary inquiry. [ABSTRACT FROM AUTHOR]