51% increase in unnecessary C-sections in Bangladesh

Bangladesh is facing a massive boom in the number of medically unnecessary Caesarean section, commonly known as C-sections — between 2016 and 2018 the number of operations increased by 51 percent, new figures released by Save the Children reveal. The country saw an estimated 860,000 of these unnecessary operations last year, while up to 300,000 women who need a C-section are unable to afford or access it.

The findings highlight the extent of Bangladesh's burgeoning C-section problems, where the country's wealthy are turning to caesareans in record numbers, even though unnecessary C-sections place mother and baby at a needless risk.

Key findings of the analysis include:

• In 2018 Bangladeshi parents paid $483 million in out-of-pocket expenses for C-sections that were medically unnecessary. That's an average cost of $612 per case.

• 77 percent of all C-section operations — or an estimated 860,000 procedures in 2018 — were medically unnecessary, up from 570,000 in 2016.

• At the same time, up to 300,000 women who desperately need a C-section every year are unable to get one.

• Between 2004 and 2016 the C-section rate in Bangladesh increased from 4 percent to 31 percent.

Save the Children is calling for better regulation of the industry, more checks and balances on doctors who carry out the procedure and greater funding for vital maternal health services.

Dr Ishtiaq Mannan, Deputy Country Director of Save the Children in Bangladesh and an expert in newborn and maternal health, said, "This surge in popularity has created a situation where we have more and more affluent mothers lining up for unnecessary C-sections, under the belief that it'll be more comfortable or because they've been misled by their doctor, while poorer women who desperately need the operation can't access it. It's simply astonishing."

About 80 percent of all births in private hospitals in Bangladesh are now C-sections. This is in part due to poor regulation of the medical sector and some unscrupulous practitioners, for whom doing C-sections is a profitable business.

Dr Mannan continued, "Doctors and medical facilities are financially incentivised to deliver babies surgically rather than naturally, and face few repercussions if they provide misleading or incorrect advice.

Unnecessary C-sections put mothers and babies at needless risk, increasing the likelihood of infection, excessive bleeding, organ damage and blood clots as well as ensuring a significantly longer recovery time for the mother. It also takes away the benefits of a natural birth, which enables newborns to receive a dose of good bacteria that's believed to boost their immune system when they travel through the birth canal, and enables a mother and her baby to have physical contact earlier and breastfeeding to begin sooner."

One of the biggest challenges is addressing a major shortage of accredited midwives in Bangladesh, who not only support natural child birth when healthy to do so, but help reduce the burden faced by busy doctors. Across the country there are just 2,500 midwives, barely a tenth of the 22,000 recommended by a recent health sector review.

Save the Children supports a midwife training programme in partnership with the UN Population Fund to help address this shortage.

Dr Mannan concluded, "It's important that all women, regardless of their income, location or status in society, have access to the right information and services and can make informed decisions about how they choose to give birth. Increasing the number of midwives in Bangladesh is a big part of this. And if a C-section is medically required, all women must be able to have one, not just those who can afford it."

Many other countries have experienced caesarean booms too, including Thailand, Sri Lanka, and the United States. Where Bangladesh differs is that its boom has not corresponded with a matching reduction in maternal deaths as it should.