Experts draft action plan to curb caesarean deliveries in Bangladesh

Obstetricians and public health experts have drafted an action plan aiming to arrest the rising trend of caesarean deliveries in Bangladesh.

Styled ‘Prevention of Unnecessary C-Section and Promotion of Normal Delivery in Bangladesh’, the draft was developed in consultation with the key stakeholders on Thursday in Dhaka.

As the next step, the plan which identified seven areas for further attention will be presented to the government.

Prioritisation of regulatory frameworks, strengthening of health system, awareness building on promotion of normal delivery, enhancement of skills of medical practitioners for normal delivery and facility readiness were some of the items on the draft action plan.

A campaign addressing unnecessary C-section started about a year ago, bringing together like-minded organisations to raise awareness about the risks of unnecessary caesareans.

It is calling for better regulation of the industry, more checks and balances, and greater funding for vital maternal health services.

Dr Ishtiaq Mannan, Deputy Country Director of Save the Children in Bangladesh and an expert in newborn and maternal health, said the situation was extremely worrying.

“Over 80 percent of all births in private hospitals in Bangladesh are now C-sections. C-sections must be an informed decision and shouldn’t be left to patients as choice,” he said.

“Patients should know the pros and cons of delivering through c-section,” said Dr Sham El Arifeen, Head, Child Health Unit, icddr,b.

The issue came to the fore in recent years when a study found dramatic increase of C-sections from 12 percent in 2010 to 31 percent in 2016.

It is an abnormal rise as the WHO says 10 to 15 percent of the total deliveries may be C-section because of complications.

In private facilities, C-sections accounted for 83 percent of deliveries, compared with 35 percent in public facilities and 39 percent in facilities run by NGOs, according to the Bangladesh Maternal Mortality and Health Care Survey or BMMS.

The health and family welfare ministry has also acknowledged that the rate of caesarean deliveries is increasing in Bangladesh and stepped in to contain the trend.

Director General of Health Services Abul Kalam Azad last month said they had introduced a form which must be filled up by the hospitals after a C-section is done. This is to know the reason.

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

With 31 percent C-section rate, the maternal deaths were 196 per 100, 000 births in Bangladesh. But it is only four per 100,000 in Sweden where the C-section rate is 18 percent, and seven in the Netherlands where the C-section rate is 14 percent.

A study of the Centre for Women and Child Health in Savar presented at Thursday’s meeting showed that it is possible to reduce the number of C-section deliveries through proper check-ups during pregnancy, training of doctors and nurses, and counsellling.

President of the Obstetric and Gynaecological Society of Bangladesh Laila Arjumand Banu acknowledged that it’s a “burning issue” now.

“Everywhere I go, people ask why are you doing this [C-section]? They have misperception and also biasness in their thoughts,” she said.

“On many occasions, patients prefer C-section. They don’t want to feel the pain. Some want guarantee that it will be a normal delivery. Many women become mother between 35 years and 40 years. They say, 'we don’t want to take any risk'.”

“Private sector also fears public wrath if anything goes wrong. There is no proper legal system to protect them,” Prof Banu added.

She, however, said they do not want do unnecessary C-section. “It is not safe even. Research shows that many complications can happen.”

She said they are working on a protocol for deliveries.

Selina Amin, Head, Midwifery Education Program, James P Grant School of Public Health, Brac University, said one of the biggest challenges is addressing “a major shortage of accredited midwives, who not only support natural child birth when healthy to do so, but help also reduce the burden faced by busy doctors”.

“We have to look into the issue why mothers now prefer C-section. There was a time even 20 years ago when mothers did not want to undergo the C-section procedure,” she said.