Why are C-sections on the rise?

We are alarmed to learn that the number of caesarean deliveries in the country has gone up amid lack of proper guidelines and interventions from the health authorities. According to a report of Bangladesh Demographic and Health Survey (BDHS) published recently, the number of C-sections performed in Bangladesh increased to at least 45 percent of all deliveries during 2020-2021, while it was 34 percent during 2017-2018 and 18 percent in 2011. The upward trend has been witnessed in both private and government healthcare facilities, even though this practice puts the health of both mothers and newborn children at unnecessary health risks. The question is, has the government done anything to check the trend?

Details of the BDHS survey are quite eye-opening. It has found that, of all the C-sections performed, 84 percent are done in private healthcare facilities, 14 percent are done in government hospitals, and two percent in different NGO-run facilities. Understandably, as the usually understaffed, under-bedded but overloaded government hospitals fail to properly cater to the needs of expectant mothers, private facilities have come up with healthcare packages for them in exchange for huge profits. In the majority of cases, doctors there suggest expectant mothers to have a Caesarean delivery instead of going for a natural birth. This happens even if they do not have any prior health complications for them to require such a procedure. It is this profit-driven mindset of private healthcare facilities that is leading to an uncontrollable increase in C-sections across the country. This trend must stop.

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Unnecessary C-Sections: A major public health issue in Bangladesh

However, it must be acknowledged that in the last few decades, the government, with assistance from private organisations, took some much-needed initiatives including strengthening maternal and neonatal care at the upazila healthcare facilities, improving the midwifery services to ensure safe motherhood and decrease newborn deaths, and ensuring the availability of life-saving drugs, all of which have brought some positive results. We have seen a significant decrease in the maternal and child mortality rates. The BDHS survey has also revealed that the number of facility deliveries increased from 51 percent in 2017 to 65 percent in 2022, which is definitely a very positive achievement. But little has been done to discourage doctors from performing unnecessary C-sections, which is worrying.

We urge the government to formulate the necessary policy and guidelines to stop unnecessary C-sections. In this regard, there should be a mechanism in place to oversee the activities of private hospitals in particular, and all health facilities in general. According to the World Health Organization, the "ideal rate" for C-sections has to be between 10 and 15 percent of all deliveries – because on average, 10 to 15 mothers in every 100 pregnancies may experience some problem during childbirth. Our healthcare professionals must follow the WHO guidelines. C-sections should only be performed in cases where surgery is a must to save the life of expectant mother and child.