New campaign to stop 'unnecessary' C-section launched in Bangladesh

A new campaign to stop 'unnecessary' caesarean section has been launched in Bangladesh with a meeting of the stakeholders including doctors, researchers, rights activists, representatives of donor agencies and media.

Deputy Country Director of Save the Children Dr Ishtiaq Mannan and an ICDDR, B director, Dr Shams El Arifeen, jointly launched the campaign on Sunday and said they are open to taking others on board for the fight.

They also launched a website www.stopuncs.org through which public can communicate directly with experts.

The rate of C-section in Bangladesh is termed “dangerously high". According to the WHO, caesarean sections are medically indicated in only 10 percent to 15 percent of deliveries. But in Bangladesh, it is 23 percent, according to the latest BDHS of 2014.

That survey also found that 80 percent of all deliveries in profit-driven private facilities were caesarean. The rate was highest among the rich families.

C-section is a lifesaving procedure which means that higher level of surgical deliveries will reduce delivery-related maternal deaths.

With 23 percent C-section rate, the maternal deaths were 176 per 100, 000 births in Bangladesh. But it is only 4 per 100,000 in Sweden where the C-section rate is 18 percent, and 7 in Netherlands where the C-section rate is 14 percent.

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 in a rare gesture, members of the Obstetrical and Gynecological Society of Bangladesh (OGSB) during the Sunday’s meeting acknowledged the fact.

OGSB Secretary General Prof Firoza Begum said the government should have monitored the issue.

“We need midwives to take care of normal deliveries. But it’ll take the time to create an adequate number of midwives as it’s a new profession in Bangladesh”.

She said junior doctors are not interested in learning normal deliveries. “As a doctor, we have to be ethically clear about what am I doing. C-section rate has gone up. We want to reduce the trend”.

She said they are ready to work with the new campaign.

“We have lost the art of normal delivery science,” Prof Fawzia Hossain of Bangabandhu Sheikh Mujib Medical University said.

“I’ll not deny the fact that unnecessary C-section is taking place. We have to set the clinical standards to check that,” she said.

Another Professor Dr Farhana Dewan said she found in some rural clinics that they were carrying out caesarean section “blindly without any indications to do that”.

“We try to make families understand that normal delivery is possible. But, then they go to another clinic for C-section,” she said, pointing to the fact that sometimes women decide on their own to have C-deliveries.

Prof Rowshan Ara Begum, former president of OGSB, said they had already started working to turn the tide.

She said delivery ward is the worst place in the public hospitals. “It's so filthy that it does not attract women. Then they go to private hospitals”.

Dr Mannan said their campaign is not only for discussion. “We’ll go forward. We’ll do what needs to be done to stop this unnecessary trend. It's not an unending movement. It’ll end. We want to achieve that goal”.

“From raising awareness to formulating guidelines and policies and helping the government enforcing those guidelines, we are ready to assist the government and others in every way,” he said.