Objectives: To obtain an estimate of cesarean section rates and examine the indications and consequences at teaching hospitals in India. Methods: Information was obtained on total number of normal and cesarean deliveries during 1993–1994 and 1998–1999 from 30 medical colleges/teaching hospitals. In addition, prospective data were recorded for a period of 2 months on 7017 consecutive cesarean sections on indications for cesarean delivery, associated complications and mortality. Results: The overall rate of cesarean section increased from 21.8% in 1993–1994 to 25.4% in 1998–1999. Among the 7017 cesarean section cases, 42.4% were primigravidas, 31% had come from rural areas, 20.8% were referred including 8% with history of interference, 66% were booked cases, period of gestation was less than 37 weeks in 21.7% and in 18% the surgery was elective. Major indications for cesarean section included dystocia (37.5%), fetal distress with or without meconium aspiration (33.4%), repeat section (29.0%), malpresentation (14.5%) and PIH (12.5%). Maternal and perinatal mortality was 299/100 000 and 493/1000 deliveries, respectively, and is high in spite of the increase in the cesarean section rates. Conclusions: There is need for standardized collection of information on all aspects of childbirth to ascertain the incidence and indications of cesarean section nationally so that comparison and improvements of care can take place.