DHS points to abnormal rise of C-section in Bangladesh

New data shows C-section or caeserian deliveries are rising in Bangladesh to “unusual” levels and experts suggest a close look at it.

The preliminary results of Bangladesh Demographic and Health Survey (DHS) released on Saturday found 23 percent births through C-section in 2014, six percentage points higher than the 2011 data.

It is also eight percentage points higher than the WHO’s maximum prescribed limit.

The UN health agency says there is no justification for any country to have C-section accounting for more than 10-15 percent of the total births.

C-section is generally done when normal delivery is not possible, or when life-threatening problems are anticipated for both mother and foetus.

The recent increase is perhaps due to private nursing homes where 80 percent of the total deliveries are carried out by C-section.

Of the total 37 percent births at health facilities in Bangladesh, 22 percent are delivered at private facilities, according to the DHS.

It is widely believed that clinic managers as well as some doctors motivate would-be mothers to undergo C-section for making money, an allegation that obstetricians always deny.

But Obstetrical and Gynaecological Society of Bangladesh (OGSB)'s vice-president Prof Ferdousi Begum agreed that the C-section trend was on the rise.

“Many women, mostly educated, opt for C-section. They pressurise doctors, rather than the other way round,” she told bdnews24.com.

C-section accounted for 4 percent of the child births in 2004, 9 percent in 2007, before rising to 17 percent in 2011 and the current level of 23 percent in 2014.

“This is an issue that all health professionals and stakeholders should seriously look at,” Dr Ishtiaque Mannan, Chief of Party of USAID's maternal and child health project MCHIP, said, as he found the increase “unusual”.

He said given the current level of maternal mortality of around 170 per 100,000 births, the “actual C-section rate should be less than 10 percent in Bangladesh”.

“As clients get richer, the C-section rates go up. How the obstetricians will explain this?” he asked, suggesting an intense discussion among health professionals about C-section.

The gynaecologist Prof Begum said they try to convince would-be mothers not to have surgical births. “ But many women, particularly educated mothers, want it ”.

“There are multiple factors at work here. You cannot blame doctors,” she said.

WHO in a 2010 report estimated the global cost of “excessive” C-section at approximately $2.32 billion, while the cost of the “needed” C-section was $432 million.

The report concluded: “Medically unnecessary C-section arguably function as a barrier to universal coverage with necessary health services”.