Unnecessary C-sections done in Bangladesh, says Save the Children director Ishtiaq Mannan

‘Unnecessary’ caesarian sections are being performed in Bangladesh, a public health expert has said, urging doctors and the health ministry to look into the issue.

“This is a life-saving procedure. So too many caesarian deliveries are as dangerous as too few,” Dr Ishtiaq Mannan, director of the Save the Children’s health, nutrition and HIV/AIDS wing, said at an orientation programme for journalists on Sunday.

Citing the 2014 Bangladesh Demographic and Health Survey (BDHS), he said 23 percent of facility deliveries in 2014 were caesarian, which was well above the recommended range.

According to international recommendations, caesarian sections are medically indicated in only 10 percent to 15 percent of deliveries.

The criticism of the rising trend is not new in Bangladesh. But gaynecologists and obstetricians have consistently denied any unnecessary use of the procedure.

Dr Mannan said 80 percent of all deliveries in private facilities were caesarean, giving rise to the question “whether all were medically indicated in those profit-driven private hospitals”.

“Both Obstetrics and Gynecological Society and the ministry of health must work together to review or investigate this and take appropriate measures to ensure judicious use of this life-saving intervention,” he said.

Dr Mannan also stressed care quality, saying there was evidence to show that a greater access to facilities without ensuring quality had failed to reduce mortality rates in many countries.

He said with the population projected to grow to 172 million by 2021 and 186 million by 2030, Bangladesh would face increasing challenges in providing quality maternal health services.

He said more investments would be needed to cope with the situation but also emphasised their optimum utilization.

The National Institute of Population Research and Training (NIPORT), US-based ICF International, and Bangladesh Health Reporters’ Forum (BHRF) jointly organised the orientation on the BDHS with the support of the US development agency, USAID.

The BDHS, conducted under the authority of the NIPORT and with the USAID support, is a comprehensive source of Bangladesh’s data on fertility, family planning, child mortality, child health, maternal health, nutrition of children and women, HIV, and women’s empowerment.

It is a nationally represented survey done every three years. The Ministry of Health and Family Welfare uses the data to set its targets and programmes.

Dr Mannan spoke on the results and policy implications on maternal, newborn, and child health, while Karar Zunaid Ahsan, senior monitoring and evaluation adviser to the health ministry’s Programme Management and Monitoring Unit, talked on family planning issues.

Ahsan urged the government to take a “differential” approach to the family planning programme, which he said, analysing BDHS, was weakening over time.

He said the Sylhet division had the highest level of unwanted fertility, followed by Dhaka and Chittagong.

“So we will have to take specific programmes targeting the Sylhet division, while they may not be needed in other divisions,” he said.

Chaired by Md Rafiqul Islam Sarker, director research of the NIPORT, President of the Health Reporters’ Forum Toufiq Maruf spoke at the programme.