Bangladesh’s caesarean rate more than double the WHO-recommended level

The overall prevalence of caesarean delivery among Bangladeshi mothers reached 33.22% in 2018, significantly higher than the WHO-recommended level of 15% and the global average of 21%, revealed a study by the Bangladesh Institute of Development Studies (BIDS).

The rate was just 3.99% in 2004 and it jumped by more than eight times, leading Bangladesh to surpass its neighbouring countries such as India, Pakistan, Nepal and Myanmar, which range between 16% and 22%.

The BIDS published the report titled "Massive Boom of C-section Delivery in Bangladesh: A Household Level Analysis (2004-2018)" at its fortnightly seminar on Wednesday.

Md Abdur Razzaque Sarker, a research fellow of the autonomous organisation, presented the keynote at the event, saying the rate of caesarean delivery is higher in urban areas and the trend is growing rapidly in rural areas of the country.

The influences of brokers and a class of doctors are encouraging people to have caesareans, he said adding the rate of C-sections is increasing among the educated class.

A number of factors such as maternal age, maternal and paternal education, working status of the mother, maternal BMI, age at first pregnancy, ANC utilisation, administrative division and wealth status had a significant impact on the growth rate of caesarean delivery in Bangladesh, said the report.

"Mothers with higher educational background were 2.87 times more likely to utilise caesarean delivery and mothers with a secondary level of education 2.16 times more likely to utilise caesarean delivery compared to mothers with no formal education," said Abdur Razzaque Sarker.

He added that the rate of caesarean delivery is 17.26% among mothers having no formal education and the rate is 60% among mothers having higher education.

The rate of caesarean delivery is higher for higher-level education of fathers, also.

The report found significant involvement of monetary issues behind the influence of the higher rate of caesarean delivery.

A normal delivery at home costs on average Tk1,379, while it cost Tk20,062 for a C-section delivery.

The cost for a C-section delivery at public facilities is around Tk13,622 compared with Tk21,506 at private facilities.

The caesarean delivery was 52% in private facilities significantly higher than the 10.6% in public facilities.

The organisers informed that the report had been prepared based on data from the five most recent Bangladesh Demographic and Health Surveys by the National Institute of Population Research and Training.

A total of 27,328 ever-married women aged 15 to 49 years who had a live birth in the two years preceding the survey were included in this study.

The report found that the prevalence of caesarean delivery in rural areas jumped to 29% in 2018 from 2% in 2004. The annual percentage change of caesarean delivery was 10% among urban mothers while it was 21% for rural mothers.

Citing the data of Save the Children, Dr Abdur Razzaque said in 2018, there were 860,000 unnecessary caesareans in Bangladesh.

He also said at public hospitals in Bangladesh, the out-of-pocket cost is 65% which is 100% at private facilities. In Bangladesh, government doctors are working at private hospitals and carrying out operations.

Speakers at the seminar said currently doctors are unwilling to go for normal deliveries. They opt for caesarean to save time which also increases their income.

How many women die in childbirth and their overall condition after operations are not known in most cases. It is not possible to identify the effect on mothers and children after operations.

BIDS Director General Binayak Sen said delivery at home is no longer possible. Most of cases, women are taken to private hospitals or clinics. In this case, people are suffering economically as well as physically.

Abdus Sattar Mandal, the former vice-chancellor of the Bangladesh Agricultural University, said earlier money was used to go to urban areas through litigations. Now that space has been taken over by delivery operations. After arranging cash by any means, people are now opting for caesareans. Thus a lot of money is taken out of people's pockets.