Up mostly on greed

The number of caesarean births has almost doubled in the last eight years largely due to lack of accountability of profit-hungry private healthcare providers and absence of proper rules and regulations.

The figure rose to 690,000 or 23 percent of total deliveries last year from 355,000 or 9 percent of total deliveries in 2007, according to Bangladesh Demographic and Health Survey 2014.

The World Health Organization recommends that a country should keep births through caesarean section below 15 percent, as it is a major operation that carries risks and takes a lot longer for a patient to recover compared to a normal delivery.

Some doctors claim that many expectant mothers prefer c-section to normal delivery, but many experts blame the rise in c-section on private healthcare providers.

“Patients want a lower risk procedure. They also don't want to withstand labour pain,” said a gynaecologist at a private hospital in the capital, seeking anonymity.

However, Dina Farhana, nutritionist of a Dhaka-based NGO, said c-section might be necessary in some cases, but the fact is private clinics and hospitals are largely responsible for the increase in caesarean births.

Child and women health expert Prof MQK Talukder said c-section is a life-saving option only in some complicated cases. It is unnecessary in many other cases.

Physicians sometimes don't want to wait for several hours to perform a normal delivery, and they opt for surgery, he said.

A private hospital in the capital charges a patient around Tk 10,000 on average for a normal delivery and up to Tk 50,000 for a c-section.

An icddr,b study on hospitals in 24 districts shows private hospitals performed more than double the c-sections done in public hospitals in 2012.

The 2012 study found that private hospitals had used partograph, a graphical record of key data (maternal and foetal) during labour, only in three percent of total deliveries.

“This low use of partograph proves that physicians don't adequately assess the patients before performing a c-section,” said Dr Lumbini Roy, researcher at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).

Ishtiaq Mannan of Mamoni Project of Save the Children said around 80 percent of c-section is performed at private clinics and hospitals. This rate is very high by any standard.

Absence of a quality assurance system in healthcare centres and lack of accountability in clinical practice are partly responsible for this, he said.

Lumbini Roy said the Private Clinic Act mentions nothing about the procedure for reaching a decision on c-section delivery.

Dr Jamaluddin Chowdhury, secretary general of Bangladesh Private Medical Practitioners Association, stressed the need for enacting a law and enforcing it to keep the number of caesarean births to a minimum level.

IMPLICATIONS

Prof Talukder said a newborn baby, delivered through c-section, might miss exclusive breastfeeding which would hamper its brain development.

Caesarean patients, he pointed out, are also required to take a lot of medicine. If not taken properly, it might lead to antibiotic resistance in the patient's body.

As a surgical procedure, c-section carries a risk of damage to the mother's organs as well as blood loss and complications from anaesthesia.

Khadija Yasmin, a college teacher in Tangail, had c-section twice, but the stitching in the second surgery was not perfect. It was detected during a recent surgery for removing her uterus.

Her daughter Farhana Urmee said the latest surgery turned out to be very risky due to the earlier complications her mother had, and it took her two months to recover.