Introduction: Previous Indian studies have depicted disparities in the uptake of cesarean sections (CS) across states and health sectors using household survey data. However, granular multi-year analyses are missing. In this India-wide retrospective analysis using data from India’s Health Management Information System (HMIS), population-level CS rates, annual percent changes, and public-private differences across different geographic levels were estimated.Methods: HMIS count data were obtained for total, public, and private CS surgeries across 737 districts in 37 states for the nine financial years (2011-2019) from the National Data and Analytics Platform. Annual CS rates were defined as the number of CS surgeries per 100 live births reported. Unweighted average annual percent changes were computed for CS rates. The excess CS rate was defined as the WHO threshold of 10% CS per 100 live births. District-level data were aggregated for estimating state and national rates. Public-private CS rate comparisons were conducted using paired Wilcox tests.  Results: In 2019, total, public, and private CS rates were 19.56%, 14.20%, and 34.47%, respectively. The average annual changes were 8%, 5.83%, and 5.86% for total, public, and private-sector CS rates, respectively. In 2019, 32 of the 37 states crossed the excess threshold for total CS rates. In 2019, CS rates varied across districts. Of the 737 districts, 331 had excess CS surgeries. Private facilities in 530 districts had higher CS rates than public facilities in 390 districts. Zero CS uptake was observed in 24 districts, mostly in northeastern states. Most districts with excess sections were clustered in the southern states of Telangana, Tamil Nadu, and Kerala. The district-level comparison showed significantly higher CS rates in private than in public-sector facilities.  Conclusion: Excess cesarean sections in India are driven largely by the private sector in districts clustered in south and central India, while several states in North and Northeast India lack CS delivery capacity in public facilities. To ensure quality care, India needs a targeted policy approach that regulates the private sector and simultaneously strengthens the public system.