Unnecessary caesarean sections cost Bangladesh Tk4,057cr annually

Unnecessary caesarean deliveries are rising sharply in Bangladesh, placing a heavy financial burden on households and the health system, with annual costs estimated at Tk4,057 crore, health experts said.

Nearly 17 lakh women gave birth through caesarean section last year, while 79% of hospital deliveries in the country are now conducted through the procedure – the highest rate globally. If the trend continues, the rate could exceed 90% by 2030, experts warned.

The findings were shared today (28 January) at a national dissemination meeting titled "Reducing Unnecessary Caesarean Sections in Bangladesh (RUCSB)", organised by Ashulia Women and Children Hospital (AWCH) at the CIRDAP auditorium in Dhaka.

Experts identified weak regulatory oversight, reluctance to follow evidence-based childbirth practices, and widespread fear of normal vaginal delivery among expectant mothers as the main drivers of unnecessary caesarean sections. Four research papers were presented at the event.

Presenting one of the studies, Professor Anjuman Ara Rita of the Department of Obstetrics and Gynaecology at AWCH, citing a 2019 Save the Children report, said caesarean delivery costs nearly five times more than normal childbirth.

"In 2018 alone, Bangladesh spent approximately $483 million, equivalent to Tk4,057 crore, on caesarean deliveries," she said.

She added that many healthcare facilities have effectively turned into surgery-focused centres, driven largely by financial incentives rather than patient safety. This has distorted public perception, portraying normal vaginal delivery as risky and painful, while physiological labour processes are often ignored, leading to premature surgical interventions.

Scope to reduce caesareans

Sharing AWCH's experience, Prof Rita said unnecessary caesarean sections can be safely reduced through strong clinical governance and midwife-led care models.

Between 2008 and 2016, caesarean rates at AWCH ranged from 58% to 73%. An operational research programme later introduced 11 evidence-based interventions, including antenatal counselling, Robson classification, strengthened labour monitoring, consultant audits, and provision of VBAC (vaginal birth after caesarean).

As a result, the hospital's caesarean rate declined to 42%, marking a 20% relative reduction, she said.

A Gates Foundation-funded scale-up of the model across eight facilities during 2022–23 produced mixed results, with only one facility achieving a reduction of 25% or more.

"Training alone is not enough. Leadership accountability, effective governance, midwife-led models and infrastructure readiness are essential," she said.

WHO guidelines often ignored

Speaking at the event, Professor Khurshid Talukder, research director at AWCH, said prolonged latent labour alone is not an indication for caesarean section when both mother and baby are stable – a position endorsed by the World Health Organization (WHO).

"Labour requires time. Around 70% of neonatal brain injuries occur before labour, while fewer than 10% are purely intrapartum," he said.

He added that normal birth supports immune development through the transfer of the maternal microbiome, reducing long-term metabolic and immune risks.

Call for stronger regulation

Dr Moinul Ahsan, director (clinics) at the Directorate General of Health Services (DGHS), said senior gynaecologists must take the lead in reducing unnecessary caesarean deliveries.

"Private hospitals must have functional labour rooms. No private hospital will be licensed without a labour room," he said.

Addressing the event as chief guest, Health Secretary Saidur Rahman said preventing unnecessary caesarean sections requires responsible follow-up of mothers and infants from the start of pregnancy.

"Manpower shortages cannot be an excuse. We must increase community engagement and ensure every pregnant woman is brought under regular monitoring," he said.

He stressed the need for reliable, integrated data on both caesarean and normal deliveries from public and private facilities to support effective policymaking.

The health secretary warned that many clinics lack adequate arrangements for normal delivery, paediatric care and anaesthesia support, posing serious risks to mothers and newborns.

While acknowledging the need to simplify hospital licensing procedures, he said minimum standards for labour rooms and maternal care must be strictly enforced.

The event also revealed that more than 70% of private maternity centres operate with little or no effective oversight. Many lack essential manpower, emergency services and standard labour rooms, allowing profit-driven, surgery-based childbirth to become increasingly common — exposing mothers and newborns to unnecessary health risks and severe financial strain.