Caesarean concern in Bangladesh

Caesarean delivery takes place in 31% of births in Bangladesh, a trend which is troubling health experts.

The rate of infant delivery via caesarean section has been increasing worldwide, and Bangladesh is no exception to this trend. Improved access to medical services and a more affluent urban population has led to a surge in popularity for the delivery method, but there is growing concern at the number of interventions which are medically unnecessary.

“The World Health Organization recommends a caesarean section rate of 10% and 15% of all births in a country, based on needed medical interventions,” says Dr Mofi Islam, a senior lecturer in Epidemiology and Biostatistics at La Trobe University. “Bangladesh has seen a rapid increase in caesarean rates, from 3.5% of births in 2004 to 23% in 2014 (31% in 2016). This brings with it associated risks which vary significantly across regions and socio-economic groups.”

Dr Islam has been working with researchers across Bangladesh to analyse survey data collected between 2004 and 2014 by Bangladesh Demographic and Health Surveys (BDHSs). The data presented a cross-section of households across all administrative regions of Bangladesh, and included information on a wide range of indicators such as family size, household income, access to health services and levels of education.

His analysis highlighted a number of key factors in the increasing rate of Caesarean use, including urban living, wealthy, well-educated, advanced maternal age (over 35), higher education and maternal overweight and obesity.

“Clearly, the significant increase of caesarean sections for delivery is much higher than the WHO recommended upper limit,” says Dr Islam. “If this trend continues then it is very likely that caesareans will bring more harm than benefit at the population level.”

Dr Islam's findings are similar to those of studies in other developing countries. For example, retrospective analyses of data in India and Pakistan found a comparable rising trend with higher prevalence in private sector health facilities, higher educated mothers and those residing in urban areas.

“There could be any number of reasons for increasing average caesarean deliveries amongst these populations,” says Dr Islam. “An increase in availability and access in urban areas, generally women in urban areas are better off and can afford these services, more private facilities in urban areas, and a higher women employment rate in urban areas.”

His analysis emphasises the need for increased education and awareness amongst healthcare providers and expecting parents as to the use of caesarean delivery as a medical intervention, not a convenience.

"While it is encouraging that parents are engaging more in antenatal care, they are at risk of a growing private medical industry that often exploits maternal behaviour to undertake a costly medical procedure for financial gain," says Dr Islam. “It also burdens the system and creates an access problem, making it harder for those living in disadvantaged areas or of a lower socio-economic status find the maternal care they need.”

Dr Islam highlights the importance of close monitoring on compliance of relevant regulations and equitable distribution of caesarean sections across the country.