Too posh to push?
A surgical operation for delivering a child by cutting through the wall of the abdomen of pregnant mothers is called a cesarean section (c-section). It is a lifesaving intervention for mothers with severe delivery complications.
However, nowadays, the decision to undertake a c-section operation is taken non-chalantly and happens quite frequently in labour rooms in Bangladesh. The c-section rate has surged from 23% to 31% in Bangladesh, causing unbearably high out-of-pocket expenses.
Over 1 million c-sections occur in Bangladesh, out of which, 750,000 are at private facilities. Even with this rising number of deliveries taking place in health facilities, Bangladesh’s maternal mortality has not declined in the last six years.
Many other countries have experienced cesarean booms too, including Thailand, Sri Lanka, and the United States. Where Bangladesh differs is that its boom has not corresponded with a matching reduction in maternal deaths as it should.
Given its number of c-sections, Bangladesh’s maternal mortality rate should be about 30 deaths per 100,000 live births. However, in reality it is more than six times that.
The few women who do require c-sections are often forced to borrow money from friends and relatives or sell household possessions to cover the costs, leaving them in crippling debt that not only takes years to repay, but can compromise their children’s education, health care, and nutritional intake.
The reasons behind the boom
At least six out of every 10 cesarean births in Bangladesh -- more than 570,000 per year -- are medically unnecessary. The out-of-pocket cost of unnecessary c-sections to patients is estimated at $315 million per year, or $552 per operation.
Having an unnecessary c-section puts mothers and babies at needless risk, increasing the likelihood of infections, excessive bleeding, and other complications. Natural births, on the other hand, enable mothers and babies to have physical contact sooner, with breastfeeding beginning earlier.
But c-sections are eight times more profitable for the health provider than natural births, and much shorter in procedure -- regardless of whether they are needed.
Lack of regulation and questionable quality of service mean there is no accountability for the health care professionals.
Hence, despite the rising numbers of facility deliveries, mothers in Bangladesh are still dying.
Turning the tide
A “Stop Unnecessary Cesarean Section” campaign has been launched recently. This initiative is turning towards public campaigning, while teaming up with like-minded organizations.
Together, they are working to turn the tide to improve access to quality health care in Bangladesh while reducing the number of unnecessary c-sections. Working with a number of stakeholders, including doctors, researchers, rights activists, representatives of donor agencies, and media, this initiative is creating a collaborative platform to raise voices, build awareness, influence policy.
The initiative is also trying to strengthen the health system through advocacy and promotional activities, and change policies from the root level. This movement has given us some positive results at the policy level.
However, there is still a long way to go before the right balance can be struck. It is time to wrestle back control and better protect what is arguably the most important moment in a person’s life.
Tahrim Chaudhury works at Advocacy and Communication, Health, Nutrition, HIV & Aids, Save the Children.