An estimated 1.7 million women in Bangladesh underwent unnecessary caesarean sections (CS) in 2025, exposing mothers and newborns to avoidable health risks, financial hardship and long-term complications, experts said at a national dissemination event in Dhaka on Wednesday.
The findings were presented at a program titled “Reducing Unnecessary Caesarean Sections in Bangladesh”, organized by Ashulia Women and Children Hospital (AWCH) at the Centre on Integrated Rural Development for Asia and the Pacific (Cirdap).
Health Services Division Secretary Md Saidur Rahman attended as chief guest, while Directorate General of Health Services (DGHS) Director General Prof Md Abu Jafor was present as special guest.
Weak regulation, profit incentives blamed
Speakers said the surge in unnecessary CS is being driven mainly by weak regulation of private health facilities, poor adherence to evidence-based labour protocols and widespread fear of normal childbirth.
Data presented showed that more than 70% of private maternity facilities operate with minimal oversight, often lacking adequate staff, emergency backup and standard labour room infrastructure. Many function largely as surgery-focused centres, where financial incentives outweigh patient safety.
Normal vaginal delivery, experts said, is frequently portrayed as dangerous or excessively painful, leading to premature surgical intervention even when there is no clinical indication.
Science tells a different story
Medical experts cited World Health Organization (WHO) guidance, noting that prolonged latent labour alone is not an indication for caesarean section if both mother and baby remain clinically stable.
They also said around 70% of neonatal brain injuries occur before labour begins, while fewer than 10% happen purely during labour. Normal childbirth supports immune development through maternal microbiome transfer, reducing long-term metabolic and immune risks.
Evidence that change is possible
AWCH data showed its CS rate ranged from 62% to 72% between 2008 and 2016. After introducing evidence-based measures—such as antenatal counselling, Robson classification, strengthened labour monitoring, consultant audits and vaginal birth after caesarean (VBAC)—the rate fell from 52% to 42%, a 20% relative reduction.
A Gates Foundation–funded scale-up across eight facilities in 2022–23 produced mixed results, with experts stressing that training alone is not enough without strong clinical governance, leadership accountability and midwife-led care.
Government acknowledges gaps
Health Services Division Secretary Md Saidur Rahman acknowledged shortcomings in implementation.
“The work that should have been done by us could not be accomplished, but this hospital has shown that it can be done,” he said, stressing the need for better monitoring, licensed facilities, proper labour rooms and reliable CS data.
Prof Md Abu Jafor said the issue threatens Bangladesh’s goal of universal health coverage by 2030, noting that CS rates are highest in urban areas and private hospitals.
Data showed facility-based CS rates rose from 30% in 1999 to 69% in 2022, with experts warning they could reach 90% by 2030 without urgent reform.
Speakers urged stricter regulation, stronger enforcement of national guidelines and sustained investment in midwifery care to curb the growing crisis.
