Chennai: Almost every birth in Tamil Nadu, from coastal villages to industrial towns and crowded cities, now occurs in a hospital. With institutional deliveries at 99.7%, the state surpasses the national average of 90.6%. In rural areas, the rate stands at 99.6%, nearly matching the 99.8% recorded in urban areas. This equity, comparable to Kerala and highlighted in the sixth round of the National Family Health Survey (2023–24), indicates that Tamil Nadu has largely overcome its traditional public health challenges. However, a more concerning story lies beneath these celebrated numbers: a growing burden of non-communicable diseases.
Rising Obesity and Diabetes
Tamil Nadu is among the most obese states in India and records one of the highest rates of adult diabetes nationwide. At least 44.2% of women aged 15–49 are overweight or obese, up from 40.5% in the previous survey round (2019–21) and nearly 14 percentage points above the national average of 30.7%. In urban areas of Tamil Nadu, nearly one in two women is overweight or obese. Among men, 38.8% are overweight or obese, compared to the national figure of 27.3%.
The metabolic consequences are evident in blood sugar levels. A quarter of women in the state (25.2%) have high or very high blood sugar, well above the national 17.8%. For men, the figure is 26.7%, against a national 20.9%. Studies in peer-reviewed medical journals, the state’s own surveys, and senior public health experts warn that these trends will have serious long-term consequences, increasing hospitalizations, intensive care needs, and premature deaths.
Expert Insights on Prevention
Former WHO chief scientist Dr. Soumya Swaminathan emphasized that strengthening primary health services for prevention and early detection is the way forward. She noted that while investment in tertiary care matters, the priority must be to prevent disease or catch it early.
Caesarean Section Rates Soar
Rising rates of gestational diabetes and pregnancy-induced hypertension are also driving up caesarean sections in the state. At least 46.9% of all births in Tamil Nadu are now surgical deliveries, up from 44.9% in the previous survey and nearly double the national average of 27.2%. While caesarean rates in private hospitals have edged down to 60.3% from 63.8% in the last round, they have risen in public hospitals to 39.6% from 36.0%. Nationally, 54.1% of deliveries in private hospitals were by caesarean section, compared to 16.9% in public hospitals. In Tamil Nadu, 63.6% of all deliveries occur in government hospitals, where care is free and out-of-pocket expenditure is among the lowest in the country. Nationally, 58.6% of deliveries occur in public facilities.
Gynaecologists in state-run hospitals point out that caesarean sections are not always avoidable and that timely surgical intervention has contributed to the decline in maternal and infant mortality, sending mothers and babies home safely.
Declining Antenatal Care
Yet experts flag one number the state will find difficult to defend. Only 71.2% of Tamil Nadu mothers registered for antenatal care in the first trimester, down sharply from 77.4% in the previous round. The proportion of mothers completing at least four antenatal visits has also fallen, from 90.6% to 87.6%. Women are arriving in hospitals to deliver, but arriving too late for the care that shapes outcomes before birth.
