LAHORE, Pakistan — Punjab’s government-backed health card program is under fresh scrutiny after data showed private hospitals completed nearly four out of five insured C-sections, putting Pakistan’s C-section rate back in the spotlight. Doctors and officials say payment incentives and weak oversight are encouraging surgery even when a vaginal delivery would be safe, driving up claims and risk for mothers and newborns, Jan. 4, 2026.
Official figures covering deliveries from 2016 through January 2024 show private hospitals claimed Rs16.36 billion for C-sections and normal deliveries under the Sehat Sahulat Programme, commonly known as the Sehat Card, according to official data reported by Dawn.
C-section rate data from Punjab’s Sehat Card
The figures show a total of 668,238 C-sections recorded at public and private hospitals empaneled for the scheme in Punjab during the period. Private facilities accounted for 525,619 of those procedures, compared with 142,619 in government hospitals, the data shows. Most of the payouts were concentrated in 2022 and 2023, when the data lists claims of Rs8.16 billion and Rs7.19 billion, respectively, for C-sections and normal deliveries.
An official cited in the data said Punjab’s caretaker government imposed a mid-2023 ban on Sehat Card-funded C-sections at private hospitals after claims surged, and instructed state-run facilities to absorb delivery cases. The same account said some public hospitals later stopped entertaining health card delivery cases, arguing their share from each case was too low.
Why the C-section rate keeps climbing
Across Pakistan, clinicians point to a mix of staffing shortages, patient preference and financial incentives that make surgery feel like the “default” option. In The Express Tribune’s reporting, patients described pressure to agree to surgery and high, upfront costs in private facilities, while doctors warned of complications tied to unnecessary C-sections. “Sadly, no central data exists across the country to monitor their statistics,” said Dr. Erum Majid of Jinnah Hospital’s gynecology department.
Pakistan Medical Association leader Dr. Shershah Syed called unnecessary procedures a rights and safety issue, warning that “rates in some hospitals reach 50-70 per cent, especially in private facilities,” even as experts stress that a C-section rate should not be driven by convenience or billing.
Reforms aimed at bringing the C-section rate down
Global guidance offers a roadmap for Pakistan’s regulators as they weigh audits and payment reforms. The World Health Organization has said the “ideal” population-level range has long been 10% to 15%, noting that mortality benefits level off as the C-section rate rises beyond that, in its WHO statement on caesarean section rates.
In a separate WHO update, the agency urged practical steps that mirror what Pakistan’s health experts are now demanding: routine facility audits, feedback to clinicians, and second-opinion requirements where feasible, along with payment approaches that reduce incentives to favor surgery over vaginal delivery. WHO also warned that the global C-section rate has climbed to about 21% of births and is projected to keep rising, according to its 2021 analysis.
Warnings about Pakistan’s C-section rate predate the health card surge. A 2020 analysis of Demographic and Health Surveys found the share of recent births delivered by C-section rose from 3.2% in 1990-91 to 19.6% in 2017-18, with private facilities more likely to perform the procedure. In 2022, The News International reported Sehat Sahulat’s CEO said equalizing fees for normal deliveries and C-sections reduced surgical births, underscoring how pricing can shape the C-section rate. A year later, Dawn reported the scheme’s insurer warned Punjab’s program could face closure over unpaid premiums, highlighting how maternity costs can destabilize the wider insurance model.
Health officials say the challenge now is to keep C-sections available for emergencies while lowering the C-section rate where surgery is driven by weak oversight or perverse incentives—and to publish reliable data so families can make informed decisions.
