More than half of the babies born in Bangladesh now arrive through caesarean section.
But how many of those operations are truly necessary?
According to the Multiple Indicator Cluster Survey (MICS) 2025, conducted by the Bangladesh Bureau of Statistics (BBS) and UNICEF, 51.8% of deliveries in the country now take place through the caesarean method, nearly three times the rate of 12 years ago. The World Health Organization (WHO) says caesarean sections should not be performed without medical necessity, and that a rate of 10% to 15% at the population level is the most appropriate.
The question has become a point of sharp disagreement. Health and Family Welfare Minister Sardar Md Sakhawat Husain says the trend of unnecessary operations has increased at an alarming rate, and alleges that some private clinics and broker networks frighten families into them.
Doctors say they try for normal delivery, that a caesarean is sometimes medically essential, and that some mothers themselves ask for one.
Experts say each pregnancy must be judged on its own circumstances, and that ensuring hospitals are accountable is now a major challenge.
'Have you come for an operation?'
Two days before the last Eid-ul-Azha, at around 7:45am, Fahmid Ahmed (pseudonym) was admitted to a private hospital in the capital with his pregnant wife. Throughout the pregnancy they had been under the care of a doctor at that hospital. Both the mother and the unborn child were in good physical condition, and the couple were mentally prepared for childbirth through the normal process.
Immediately after admission, they were asked, “Have you come for an operation?” The couple were surprised and said they had come for a normal delivery.
A new experience then began. Every now and then, the hospital’s assistant doctors would come to the pregnant mother and say, “Normal delivery is very painful”, “It is very difficult”, and “There will be a lot of complications”. At one point her husband protested: “Why are you saying such things? Where you should be giving encouragement, you are doing the opposite by frightening her.”
As the necessary medical tests continued, the assistant doctors said the unborn child had moved towards the upper part of the abdomen and would have to be delivered through an operation.
The couple still did not give up hope. They contacted the doctor who had treated them throughout the pregnancy and discussed the matter, but that brought no solution. Finally, at around 10:30pm, the woman gave birth through an operation.
From the beginning, the doctor had said he would make every possible effort for a normal delivery. The couple’s experience was different.
Their experience is one part of the overall picture of childbirth among women in the country. Every day, many women like her have to give birth through operations.
Rate far above WHO guidance, with wide gaps by wealth
The caesarean rate in the country was 19.1% in 2012-13. In 2019, it increased to 36%. In 2025, it reached 51.8%.
The rate varies according to urban and rural areas and economic status. It is 56% in urban areas and 50% in rural areas. Among women from the wealthiest families, 68% give birth through caesarean sections. The rate is 57% in the fourth wealthiest group, 52% in the middle group and 34% among the poorest families.
According to the WHO, caesarean sections should not be performed without medical necessity. Although caesarean rates are increasing worldwide, this has not increased health benefits; rather, the risks for mothers and children have increased. The organisation says a caesarean rate of 10% to 15% at the population level is the most appropriate.
Why the rate is rising
Dr Kishwar Sultana, professor of the Department of Gynaecology and Obstetrics at Holy Family Red Crescent Medical College and Hospital, told Dhaka Tribune there are multiple reasons behind the increase.
First, she said, it needs to be examined whether the rate is increasing more in the private or public sector. Some private-sector hospitals are still not being brought fully under monitoring, and some centres are operated for commercial purposes. However, this cannot be said about all institutions. In some cases, there may be a lack of proper supervision.
Another reason is that mothers who previously had a caesarean section also have to undergo caesarean sections for subsequent childbirths. Some mothers also think that they will have two children, so there is no need to go through the pain of normal delivery. This is called maternal choice.
Pointing out that some matters on the doctors’ side also need to be considered, she said the safety of mother and child is important to doctors. There is no guarantee that both will be fine simply because a normal delivery takes place, and the lengthy process of normal delivery also needs to be considered. Even then, doctors try for normal delivery, but many times patients’ families do not want to accept this. Whenever any problem occurs, the blame is placed on the doctor. No doctor wants anything bad to happen to their patient. However, there is no scope to deny that medical negligence has occurred in some cases, but it is also not right to hold all doctors responsible.
She said repeat caesarean sections are also a major reason. If a mother has a caesarean section once, a caesarean is also performed for her subsequent childbirth. Even for the delivery of a third or fourth child, a caesarean has to be performed. If someone has had two caesarean sections before and is pregnant again, it is assumed that she will have to undergo a caesarean for the third time as well. This is how the number is increasing.
When a C-section is necessary, and when normal delivery is possible
Professor Sultana said that if a woman comes to a doctor and wants a normal delivery, it is her right. If everything is fine during pregnancy, she is advised accordingly, and they wait until the scheduled date. If labour pains do not begin even after that, it is possible to wait and observe for another two to four days, or even up to seven days, while the baby’s heartbeat is monitored.
However, caution is needed from the beginning in some pregnancies. If the mother’s blood pressure rises significantly, the condition of the unborn child deteriorates, the baby’s heartbeat becomes abnormal or the baby passes stool inside the womb, delivery has to be performed on an emergency basis. If the mother starts bleeding, quick measures also need to be taken. caesarean sections have to be performed in these cases. Hospitals with maternity services generally have arrangements for emergency caesarean sections 24 hours a day.
Professor Farhana Dewan, former president of the Obstetrical and Gynaecological Society of Bangladesh (OGSB), also told Dhaka Tribune that doctors try for normal delivery. It is not that caesarean sections are performed intentionally, she said, and many times patients also want them. However, there are many reasons why caesarean deliveries are more common than normal deliveries.
She said caesarean sections are sometimes necessary for medical reasons, for example if there has been a previous caesarean section, if the baby’s position is not correct, if the amniotic fluid decreases, if the baby’s movements decrease or if the mother has a tumour in her uterus. In such cases, a caesarean is performed through prior planning, which is called an elective caesarean. Even after labour pains begin, an emergency caesarean may be necessary for various reasons. These are the indications for caesarean sections, or medical reasons. If everything is normal, doctors try for normal delivery.
Decisions are sometimes taken considering the safety of the baby as well, she said. Doctors become concerned if the baby cannot be monitored properly or if there is a risk that the baby’s condition may deteriorate. Sometimes, if a caesarean is performed late, the baby may develop breathing difficulties, and there may even be a risk of death.
Shortage of neonatal care facilities
In an ideal situation, Professor Dewan said, every hospital should have a neonatal intensive care unit (NICU), making it possible to provide medical support to newborns when necessary. However, the number of NICU facilities in the country is inadequate compared to the number of deliveries. Many people are unable to receive this service because they do not have the financial means, and beds are often unavailable in government hospitals as well.
In some risky situations, she said, the decision to perform a caesarean is made through prior planning. In other cases, an emergency caesarean has to be performed. For example, if a patient starts bleeding, it is an immediate emergency. Such caesarean sections cannot be performed just anywhere; they have to be performed at a multidisciplinary centre where the necessary facilities and various specialist doctors are available.
Rise in ‘maternal request’
Another issue being seen more frequently is maternal request, meaning the mother herself wants a caesarean section. She directly says she will not be able to tolerate the pain of normal delivery and therefore wants a caesarean. This is not seen only in Bangladesh; it is also observed in different countries around the world.
Professor Dewan said mothers are kept under observation throughout pregnancy to determine whether they are prepared for normal delivery. Through regular check-ups, as the scheduled delivery date approaches, it is examined whether the mother has diabetes, high blood pressure or any other physical problem and whether the baby’s position is correct. If everything is fine, normal delivery can be attempted. However, if the mother’s age is very high or she has any other physical problem, additional caution needs to be taken when making the decision.
One C-section does not prevent future normal births
Professor Dewan said that even if the first child is born through a caesarean section, the second can be delivered through normal delivery. It is necessary, however, to know why the first child was not delivered through normal delivery and why a caesarean had to be performed. Doctors ask every patient about this. If there were reasons such as prolonged labour pains or the cervix not opening even after the scheduled date had passed, normal delivery can be attempted for the second child.
If the mother’s pelvis, or the passage through which the baby is born, is small, there is no possibility of normal delivery. Along with hearing the patient’s previous history, doctors try to understand why a caesarean was performed the first time by examining previous medical documents. If there is a recurring reason that will require a caesarean for subsequent childbirth as well, then it has to be performed. But if a caesarean had to be performed for a temporary reason, such as the baby’s heartbeat decreasing, the water breaking or the umbilical cord coming out first, normal delivery can be attempted for the second child.
Health minister: Unnecessary operations at ‘alarming’ rate
At a workshop organised by the Bangladesh Midwifery Society (BMS) on July 6, Health and Family Welfare Minister Sardar Md Sakhawat Husain emphasised the importance of reducing the trend of unnecessary caesarean operations. He said delivery rooms must be established compulsorily at all private clinics and hospitals by July 11, otherwise the licences of the concerned institutions would be cancelled.
The minister said the trend had increased at an alarming rate. At present, he said, a section of people in the country has become excessively profit-oriented, with their main goal being to earn money rather than the welfare of people or the interests of the country. This has also had a negative impact on the healthcare sector.
He said that at one time, most children in the country were born through normal delivery, and there was a long tradition of safe childbirth in rural areas with the assistance of experienced traditional birth attendants. Although healthcare has improved now, the trend of unnecessary caesarean sections for commercial purposes has increased.
Initially, after regular medical examinations, in many cases broker networks and some medical centres frighten family members by warning them of various complications. They create fears such as, “If an operation is not performed, the mother or the child will not survive”, and force families to make the decision to undergo a caesarean section. Naturally, families fall into this trap because they do not want to take risks with the lives of the mother and child.
The minister also alleged that some private clinics and broker networks were encouraging pregnant women to undergo caesarean sections by frightening and intimidating them. He said the government would take strict measures to protect the nation from this situation. At the same time, 100,000 new personnel would be recruited in the health sector, of whom 80,000 would be women, most of them midwifery workers.
Accountability the key challenge
Overall, medical necessity, maternal choice, repeat caesarean sections, commercial tendencies among hospitals and limitations in healthcare facilities have emerged as factors behind the increase in the caesarean rate. According to experts, decisions must be made by considering the circumstances of each pregnancy. Creating opportunities for normal delivery by avoiding caesarean sections without medical necessity, and ensuring accountability among hospitals in this regard, are now major challenges.