Caesareans saw massive boom in two years, costing patients $483m annually while the most vulnerable mothers are losing out
Bangladesh is facing a massive boom in the number of unnecessary C-sections between 2016 and 2018, the number of caesarean deliveries increased by 51%, new figures released by Save the Children show.
The country saw an estimated 860,000 medically unnecessary caesarean operations last year, while up to 300,000 women who really needed a C-section were unable to afford or access it.
The findings highlight the extent of Bangladesh’s burgeoning C-section problem, where the country’s wealthy are turning to C-sections in record numbers, even though any unnecessary operation places both mother and baby at needless risk.
Key findings of the analysis
In 2018, Bangladeshi parents paid around $483 million in out-of-pocket expenses for C-sections that were medically unnecessary. That comes to an average cost of $612 per case.
Around 77% of all C-section operations—or an estimated 860,000 procedures in 2018—were medically unnecessary, up from 570,000 in 2016.
At the same time, up to 300,000 women who desperately need a C-section every year are unable to get one.
In a dozen years between 2004 and 2016, the C-section rate in Bangladesh increased from 4% to 31%.
Save the Children has called for better regulation of the health care sector, more oversight on medical doctors who carry out the procedure, and greater funding for vital maternal health services.
Dr Ishtiaq Mannan, deputy country director of Save the Children in Bangladesh and an expert on newborn and maternal health, said: “This surge in popularity has created a situation where we have more and more affluent mothers lining up for unnecessary C-sections, under the belief that it’ll be more comfortable or because they have been misled by their doctor, while poorer women who desperately need the operation can’t access it. It is simply astonishing.”
About 80% of all births in private hospitals in Bangladesh are now C-sections, the report claims. This is in part due to poor regulation of the medical sector and some unscrupulous practitioners, for whom doing C-sections is a profitable business.
Dr Mannan further said: “Doctors and medical facilities are financially incentivized to deliver babies surgically rather than naturally, and they face few repercussions for providing misleading or incorrect advice.
“Unnecessary C-sections put mothers and babies at needless risk, increasing the likelihood of infection, excessive bleeding, organ damage and blood clots, as well as a significantly longer recovery time for the mother. It also takes away the benefits of a natural birth, which enables newborns to receive a dose of good bacteria that’s believed to boost their immune system when they travel through the birth canal, and enables a mother and her baby to have physical contact earlier, and breastfeeding to begin sooner.”
One of the biggest challenges is addressing a major shortage of accredited midwives, who not only support natural childbirth when viable, but also help reduce the burden faced by busy doctors. Across the country, there are just 2,500 midwives, barely a 10th of the 22,000 recommended by a recent health sector review.
Save the Children is supporting a midwife training program in partnership with the UN Population Fund to help address the shortage.
Dr Mannan continued: “It’s important that all women, regardless of their income, location or status in society, have access to the right information and services, so they can make informed decisions about how they choose to give birth. Increasing the number of midwives in Bangladesh is a big part of this. And if a C-section is medically required, all women must be able to have one, not just those who can afford it.”
According to international recommendations, caesarian sections are medically indicated in only 10% to 15% of deliveries.
Many other countries have experienced caesarean booms, too, including Thailand, Sri Lanka and the United States.
Where Bangladesh differs is that the C-section boom has not corresponded to a matching reduction in maternal deaths, as expected.
Criticism of the rising trend is not new in Bangladesh. But gynecologists and obstetricians have consistently denied any unnecessary use of the procedure.