2 out of every 5 babies are born thru C-section, situation alarming: BBS

Infographic: TBS

Two out of every five babies are currently born through C-section in Bangladesh, according to Bangladesh Bureau of Statistics (BBS) data.

In 2022, 41.37% of babies in the country were born via caesarean delivery, which is a way higher than the recommended range of 10-15% by the World Health Organization (WHO).

According to Bangladesh Sample Vital Statistics 2022 of BBS, Khulna division has the highest rate of caesarean delivery, with 57.85% of babies born through C-section. The rate of caesarean delivery is the lowest in Sylhet division, where 26.17% of babies are born through it.

The BBS data shows infant mortality rate in the country has increased along with the rise in caesarean deliveries. However, the maternal mortality rate in the country has decreased compared to before.

Vaginal birth is the most ideal and most frequently recommended birth method in most circumstances, whereas C-sections are meant to be reserved for situations when a natural delivery is not possible or if the health of the mother or the child is in danger, said the BBS report.

According to the BBS data, the tendency of C-sections is observed as an alarming situation in city corporation areas than in rural areas. In city corporation areas, about three out of five births (58.21%) are given through C-Section while 51% are in municipal areas and other urban areas and the lowest in rural areas (38.46%).

Experts say the C-section delivery rate is alarmingly higher in Bangladesh as it is practised unnecessarily in the majority cases.

Experts advise that the number of midwives and the antenatal care rate should be increased, and the policies of Directorate General of Health Services (DGHS) should be implemented in order to reduce unnecessary caesarean deliveries.

Ishtiaq Mannan, a public health specialist working for an international organisation, who has been working to raise awareness about caesarean delivery for a long time, told The Business Standard that C-section is a life-saving procedure, and it is necessary in case it saves a mother's life. In general, 15% of mothers require C-section delivery, he said.

"The rate of normal delivery in private hospitals is negligible. The job of the DGHS is to control quality, it is a huge crime to perform a C-section on someone who does not need it because unnecessary caesarean on a person's body can lead to many complications and financial losses," he said.

Although the DGHS policies to prevent unnecessary caesarean delivery includes the creation of midwives, there is no implementation in reality, said Ishtiaq Mannan.

85% of C-section cases occur at private health facilities

BBS data shows private health facilities are the most responsible with an 84.86% share of C-section deliveries in their total cases.

Dr Ferdousi Begum, immediate past president of the Obstetrical and Gynaecological Society of Bangladesh (OGSB), told TBS, "If you want to have a normal delivery in a private institution, you need a confident team. It is not possible for a gynaecologist to sit with a patient for 10 hours. Trained manpower (junior doctors, midwives and nurses) are needed to take care of the mother and baby for a long time."

Additionally, ultrasound machines and a proper labour room are also needed, she said.

"Most private clinics do not have a labour room or a team. The health authorities should play a role so that each clinic has a labour room and a team," Dr Ferdousi Begum said.

Infant mortality rate rises

According to the BBS data, at present, among children under the age of five, 31 out of every one thousand are dying within a span of five years. In the years 2019, 2020, and 2022, the death rate was 28 per thousand.

The highest under-five mortality rate attributed to pneumonia, claiming close to 29.63% of all deaths. Other prominent causes are respiratory disease (7.54%), jaundice (2.87%) and fever (8.38%).

Drowning is highly prevalent in rural areas claiming about 7.25% of deaths. Respiratory disease and malnutrition also are two major causes of deaths among the under-5 children. Heart attack and heart disease account for 2.83% of the total deaths.

The infant mortality rate in the country has also increased. In 2022, 24 infants died per 1,000 live births in the country, which was 22 in 2021.

As per the WHO definition, a birth is considered to be still birth if a baby is born with no signs of life at or after 28 weeks' gestation. In 2022, the overall stillbirth rate in Bangladesh was 9.5% per 1,000 live births showing an increase in a time span of one year since 2021.

Stillbirths occur with the highest frequency (15.8 per 1,000 live births) in Rajshahi division followed by Mymensingh division (13.9 per 1,000 live births). The prevalence of stillbirths is the lowest (6.5 per 1,000 live births) in Dhaka division.

According to the survey results of 2022, the women in rural areas were less likely than the women in urban areas to have stillbirths: 10.1 versus 6.9. These findings are in sharp contrast with the 2021 survey findings when the rural women were more likely to have still birth compared to their urban counterparts

Maternal mortality rate declines

The overall maternal mortality rate was estimated to be 153 deaths per 1,00,000 live births which is lower than the 2021 estimate of 168.

Overall 34.34% of women aged 15-49 years and who gave birth during 2022 were visited at least four times by skilled health personnel as per international standards for antenatal care services. Antenatal care-seeking coverage is observed to be the highest in city corporation areas (65.71%) followed by municipal and other urban areas (48.79%). The rate is significantly lower than the national average among mothers in rural areas (28.90%).

The mother's educational background is negatively correlated with the likelihood of a C-section because women with higher educational backgrounds are more likely to give birth through C-sections, said the BBS.