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Unnecessary C-section deliveries must be stopped

30 September 2022

The rate of cesarean deliveries has increased almost eight-fold in Bangladesh. In 2004, the rate stood at four percent. However, a recent analysis revealed that the rate was found to be 33 per cent in 2017-18.
The World Health Organisation's recommendations suggest the rate should not cross 15 per cent of the total birth deliveries. Bangladesh exceeds the standards set by its neighbours as well, in this regard. The rate of caesarean delivery was found to be 22 per cent in India (2019-2021), 22 per cent in Pakistan (2017-2018), 16 per cent in Nepal (2016) and 17 per cent in Myanmar (2015-16).
Although C-sections are a regular occurrence among Bangladeshi urban mothers (12 per cent in 2004 and 44 per cent in 2017-18), rural mothers have also been increasingly availing this service.
In 2004, only two percent of rural women gave birth through C-sections, which jumped to 29 per cent in 2017-18. The annual increase of the rate stood at 21 per cent with rural mothers, while for urban mothers, it stood at 10 per cent. The percentage is higher in private and NGO-based facilities, at 83.70 and 43.90 per cent respectively, compared to public facilities.
Women reported malpresentation, failure to progress in labour, convenience, avoiding labour pain, pre-eclampsia, prolapsed cord, diabetes and a few other factors, for which they choose to go for the caesarian section. The overall out-of-pocket cost for C-section delivery was found to be Tk 20,000 in Bangladesh.
Mothers with obesity were almost three times more likely to have a C-section than those women of normal weight. On the other hand, mothers who had optimal antenatal care visits (four and above) were 6.91 times more likely to avail of C-section deliveries, than mothers who had none.
In addition, mothers with stronger educational backgrounds were 2.87 times more likely to have C-section deliveries, compared to mothers with no formal education. Mothers from a higher-income background were also found to be more likely to avail of C-section services compared to those belonging to lower-income groups.
Experts should come up, doctors must be brought under an accountability system, and a social movement is a must to popularise normal delivery.

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