Real data

Why we all need to know how many C-sections each hospital in India is conducting

The rising number of c-section is driven not by necessity but by hospital profits or convenient schedules.

A petition to make it mandatory for all medical institutions to publicly declare their percentage of Caesarean sections against all live births in that facility has elicited heated discussions. The Minister for Women and Child Development Maneka Gandhi has supported the move while some doctors have protested it. In fact, the World Health Organisation recognised the need to make such numbers public in a statement in 2015.

The number of C-section deliveries has been rising across the world and an expert panel met in October 2014 in Geneva to deliberate on this trend. They revisited the recommended WHO norm of keeping c-section rates at between 10% and 15% – a figure that was arrived at in 1985 on the basis that maternal and infant mortality improves as the percentage of C-sections rises to about 10%.

After reviewing country-level studies and analysing worldwide data, this panel agreed that while no woman who needs a c-section should be denied access to it just to maintain a particular rate, neonatal or maternal mortality rates in a population did not decline further when C-section rates rose above 10%. In other words, saving lives cannot be cited as the primary cause for Caesareans when the rates cross the 10 to 15 per cent mark. The expert panel confirmed and reiterated the 1985 norm.

The number of C-section for a region or country gives important information about access to life-saving interventions and emergency obstetric resources, which is critical to maternal health. Health systems can, however, be overburdened if expensive interventions like C-sections are performed when they are not absolutely needed. This also affects equal access to healthcare across all sections of a society. Thus, monitoring macro-level data on C-sections rates for an entire population helps policymakers.

However, data required to make these macro-level calculations are generated at a micro-level or at the level of individual medical facilities. In order to compare trends and find solutions, a standardised system of data generation must be followed. The WHO has provided this standardised system in the form of the 10 group Robson classification that helps doctors classify the C-section surgeries along five distinct parameters – whether the woman is giving birth for the first time or has given birth previously with or without a C-section, the onset of labour, whether the foetus has come to term, the position of the foetus and whether there is more than one foetus.

Every woman undergoing the surgery can be classified along these parameters, making the data easy to assess and compare. Whether at the secondary or tertiary level of care, this data clearly tells us whether clinical management protocols are followed in a facility. The WHO also recommends that the results of the Robson classification categories be available to the public, as does the petition to the government.

The information gap

National Family Health Survey data clearly reveals that the percentage of C-section births is higher in the private facilities across states. The pressures of profiteering, the convenience of being able to schedule a birth or sometimes even have a baby born at an “mahurat” or auspicious time can supercede medical requirement and turn a regular vaginal birth into a surgical event. C-sections have becomes so common that instead of being a life-saving, emergency recourse, it is now being accepted as the new “normal” and a supposedly pain-free, risk-free, modern way of childbirth. This perception is the result of a huge information gap. Few are aware the mother faces risks of excessive blood loss, blood clots, heart attacks, difficulty in breastfeeding and increased chances of repeat c-section births. The baby has higher risk of asthma, obesity and diabetes. Unfortunately, when doctors discuss risks associated with childbirth only selectively, mothers cannot make informed decision. This gap needs to be addressed by making information easily and publicly available.

A Harvard Medical School report by assistant professor Dr Neel Shah states that an important determinant of whether a C-section is performed “may simply be which hospital a mother walks into to deliver her baby”. If each hospital published its c-section trends, a mother might be able to make a better informed decision. Declaring data publicly and providing the midwifery model of care, have been identified as key factors in reducing avoidable interventions during childbirth.

The biggest challenge is to ensure reproductive health without compromising the reproductive rights of women. Women’s felt experiences of pregnancy and birth are often undermined. Even WHO acknowledges that there is lack of evidence of the relationship between the mode of delivery and psychological and social wellbeing of women. From being a life-event, birth is now treated like a disease. Alienating women from the experience of birth facilitates control over women’s bodies and choices and the mechanism of power is “technology”. While technology is important and potentially life-saving, using technology as a blanket response cannot work.

More than just medicine

Fertility, reproduction and birth have always been a socially-defined territory. The socio-economic, political and cultural conditions in which technology is used make a big difference. In a culture where silencing is a part of socialisation, voicing one’s need for information to protect the right to informed consent, autonomy and self-determination during childbirth may seem like a war cry to many. It is a challenge to an elite club that believes that it has exclusive rights over information about medically-assisted childbirth.

It is high time that women’s voices get heard and women are put at the centre of maternity care, everywhere. The petition to declare c-section rates of medical facilities is rooted in the concern about heightened intervention and increasing costs, but it does not seek to destroy the fine balance defining the symbiotic relationship between care-providers and care-seekers. This may well be a significant step for medicine to look beyond the scientific and become more social.

The writer is the petitioner who has asked for all hospitals to publicly declare their Caesarean section percentages. She volunteers for the NGO Birth India and is a scholar at Research Centre for Women’s Studies, SNDT Women’s University.

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The next Industrial Revolution is here – driven by the digitalization of manufacturing processes

Technologies such as Industry 4.0, IoT, robotics and Big Data analytics are transforming the manufacturing industry in a big way.

The manufacturing industry across the world is seeing major changes, driven by globalization and increasing consumer demand. As per a report by the World Economic Forum and Deloitte Touche Tohmatsu Ltd on the future of manufacturing, the ability to innovate at a quicker pace will be the major differentiating factor in the success of companies and countries.

This is substantiated by a PWC research which shows that across industries, the most innovative companies in the manufacturing sector grew 38% (2013 - 2016), about 11% year on year, while the least innovative manufacturers posted only a 10% growth over the same period.

Along with innovation in products, the transformation of manufacturing processes will also be essential for companies to remain competitive and maintain their profitability. This is where digital technologies can act as a potential game changer.

The digitalization of the manufacturing industry involves the integration of digital technologies in manufacturing processes across the value chain. Also referred to as Industry 4.0, digitalization is poised to reshape all aspects of the manufacturing industry and is being hailed as the next Industrial Revolution. Integral to Industry 4.0 is the ‘smart factory’, where devices are inter-connected, and processes are streamlined, thus ensuring greater productivity across the value chain, from design and development, to engineering and manufacturing and finally to service and logistics.

Internet of Things (IoT), robotics, artificial intelligence and Big Data analytics are some of the key technologies powering Industry 4.0. According to a report, Industry 4.0 will prompt manufacturers globally to invest $267 billion in technologies like IoT by 2020. Investments in digitalization can lead to excellent returns. Companies that have implemented digitalization solutions have almost halved their manufacturing cycle time through more efficient use of their production lines. With a single line now able to produce more than double the number of product variants as three lines in the conventional model, end to end digitalization has led to an almost 20% jump in productivity.

Digitalization and the Indian manufacturing industry

The Make in India program aims to increase the contribution of the manufacturing industry to the country’s GDP from 16% to 25% by 2022. India’s manufacturing sector could also potentially touch $1 trillion by 2025. However, to achieve these goals and for the industry to reach its potential, it must overcome the several internal and external obstacles that impede its growth. These include competition from other Asian countries, infrastructural deficiencies and lack of skilled manpower.

There is a common sentiment across big manufacturers that India lacks the eco-system for making sophisticated components. According to FICCI’s report on the readiness of Indian manufacturing to adopt advanced manufacturing trends, only 10% of companies have adopted new technologies for manufacturing, while 80% plan to adopt the same by 2020. This indicates a significant gap between the potential and the reality of India’s manufacturing industry.

The ‘Make in India’ vision of positioning India as a global manufacturing hub requires the industry to adopt innovative technologies. Digitalization can give the Indian industry an impetus to deliver products and services that match global standards, thereby getting access to global markets.

The policy, thus far, has received a favourable response as global tech giants have either set up or are in the process of setting up hi-tech manufacturing plants in India. Siemens, for instance, is helping companies in India gain a competitive advantage by integrating industry-specific software applications that optimise performance across the entire value chain.

The Digital Enterprise is Siemens’ solution portfolio for the digitalization of industries. It comprises of powerful software and future-proof automation solutions for industries and companies of all sizes. For the discrete industries, the Digital Enterprise Suite offers software and hardware solutions to seamlessly integrate and digitalize their entire value chain – including suppliers – from product design to service, all based on one data model. The result of this is a perfect digital copy of the value chain: the digital twin. This enables companies to perform simulation, testing, and optimization in a completely virtual environment.

The process industries benefit from Integrated Engineering to Integrated Operations by utilizing a continuous data model of the entire lifecycle of a plant that helps to increase flexibility and efficiency. Both offerings can be easily customized to meet the individual requirements of each sector and company, like specific simulation software for machines or entire plants.

Siemens has identified projects across industries and plans to upgrade these industries by connecting hardware, software and data. This seamless integration of state-of-the-art digital technologies to provide sustainable growth that benefits everyone is what Siemens calls ‘Ingenuity for Life’.

Case studies for technology-led changes

An example of the implementation of digitalization solutions from Siemens can be seen in the case of pharma major Cipla Ltd’s Kurkumbh factory.

Cipla needed a robust and flexible distributed control system to dispense and manage solvents for the manufacture of its APIs (active pharmaceutical ingredients used in many medicines). As part of the project, Siemens partnered with Cipla to install the DCS-SIMATIC PCS 7 control system and migrate from batch manufacturing to continuous manufacturing. By establishing the first ever flow Chemistry based API production system in India, Siemens has helped Cipla in significantly lowering floor space, time, wastage, energy and utility costs. This has also improved safety and product quality.

In yet another example, technology provided by Siemens helped a cement plant maximise its production capacity. Wonder Cement, a greenfield project set up by RK Marbles in Rajasthan, needed an automated system to improve productivity. Siemens’ solution called CEMAT used actual plant data to make precise predictions for quality parameters which were previously manually entered by operators. As a result, production efficiency was increased and operators were also freed up to work on other critical tasks. Additionally, emissions and energy consumption were lowered – a significant achievement for a typically energy intensive cement plant.

In the case of automobile major, Mahindra & Mahindra, Siemens’ involvement involved digitalizing the whole product development system. Siemens has partnered with the manufacturer to provide a holistic solution across the entire value chain, from design and planning to engineering and execution. This includes design and software solutions for Product Lifecycle Management, Siemens Technology for Powertrain (STP) and Integrated Automation. For Powertrain, the solutions include SINUMERIK, SINAMICS, SIMOTICS and SIMATIC controls and drives, besides CNC and PLC-controlled machines linked via the Profinet interface.

The above solutions helped the company puts its entire product lifecycle on a digital platform. This has led to multi-fold benefits – better time optimization, higher productivity, improved vehicle performance and quicker response to market requirements.

Siemens is using its global expertise to guide Indian industries through their digital transformation. With the right technologies in place, India can see a significant improvement in design and engineering, cutting product development time by as much as 30%. Besides, digital technologies driven by ‘Ingenuity for Life’ can help Indian manufacturers achieve energy efficiency and ensure variety and flexibility in their product offerings while maintaining quality.

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The above examples of successful implementation of digitalization are just some of the examples of ‘Ingenuity for Life’ in action. To learn more about Siemens’ push to digitalize India’s manufacturing sector, see here.

This article was produced on behalf of Siemens by the Scroll.in marketing team and not by the Scroll.in editorial staff.