Too many yet too few caesarean section deliveries in Bangladesh

According to the World Health Organisation (WHO) data published in 2021, the number of cesarean sections (CS) performed continues to climb worldwide, representing 21 percent of all deliveries currently, with significant variation among countries.

Around 42 percent of all CS procedures performed worldwide are conducted without a medical necessity. As a result, they do not contribute to improving mother and child health in the world. Even more concerning, such inappropriate use of CS can result in a variety of undesirable effects, including hemorrhage and bleeding, in addition to linked maternal mortality and economic cost. Furthermore, it has been discovered that this is associated with a long-term loss of women's productivity and increased hospitalisation, both of which add to the strain on the formal healthcare delivery system.

The use of caesarean sections (CS) is growing rapidly in Bangladesh, despite the fact that CS use is still uncommon among women from disadvantaged backgrounds. Among low-income mothers, this raises the likelihood of long-term obstetric complications, as well as the possibility of maternal and child fatalities. According to a study published in the journal PLOS Global Public Health, the researchers sought to examine the interaction impacts of women's disadvantaged characteristics on their use of contraception in Bangladesh.

A study of a total of 27,093 women's data taken from five rounds of the Bangladesh Demographic and Health Survey conducted between 2004 and 2017/18 was conducted in order to reach this conclusion. A 751 percent increase in CS use was discovered during the study's 13-year period, with consumption rising from 3.88 percent in 2004 to 33 percent in 2017. Private health facilities accounted for about 80 percent of the total CS operations, with government health facilities coming in second (15 percent).

In rural regions with no participation in formal income-generating activities showed an 11 percent lower usage of CS in 2004 than women living in urban areas with no involvement in formal income-generating activities. Over time, this correlation has been more robust, and a 51 percent decrease in CS use was observed in 2017/18, indicating a more established relationship. In a similar vein, rural poor and poorer women were shown to have decreased chances of using CS by 12 percent to 83 percent.

CS use is increasing in Bangladesh, as evidenced by the fact that a group of women with improved socio-economic circumstances are utilising this life-saving therapy without a medical necessity, while their counterparts with disadvantaged characteristics are unable to access the service.

Therefore, government programmes and regulations are essential for determining the need for CS and controlling its use in general and private health facilities in particular. The government could also set regulations on private health facilities, requiring them to provide CS when medically essential among the disabled for a small fee or even free of charge when necessary.