A mother carries her baby during a village gathering in Habiganj in this March 2015 file photo. Bangladesh has seen a 51 percent rise in C-section deliveries, putting the lives of mothers and babies at risk, experts say. (Photo by Stephan Uttom/ucanews.com)
On June 25, a prominent lawyer filed a petition in Bangladesh’s Supreme Court seeking a strict order to ban unnecessary caesarean sections (C-sections) for delivering babies at hospitals and clinics.
Citing newspaper reports, barrister Syed Sayedul Haque told the top court that 77 percent of C-sections were unnecessary and in 95 percent of cases hospitals and clinics compelled expectant mothers to go through C-sections for financial benefits.
“If we cannot stop unnecessary C-sections, it will turn into a serious crisis,” Haque said.
The move came after British charity Save the Children published a study on June 23 that found Bangladesh saw a 51 percent increase in C-section deliveries from 2016 to 2018.
About 77 percent of all C-sections — or an estimated 860,000 procedures in 2018 — were medically unnecessary, up from 570,000 in 2016, the report said.
The charity said Bangladesh had an increase in C-sections from 4 percent in 2004 to 31 percent in 2016. Some 83 percent of C-section deliveries took place in private facilities.
The study showed that in 2018 Bangladeshi parents paid US$483 million in out-of-pocket expenses for C-sections that were medically unnecessary or US$612 per case.
During this period, about 300,000 women who desperately needed a C-section were unable to pay for or access one, it found.
Medical charities have been vocal about the increase in C-sections over the years.
Observing Safe Motherhood Day on May 28, Health Minister Dr. Zahed Malek warned against medically unnecessary operations. “Doctors and women should avoid C-sections unless there is a complication during the delivery,” he said.
According to the World Health Organization, the recommended ratio for C-sections is 10-15 percent per country, and they should only be conducted in cases of saving lives where mothers face serious health complications.
Maternal mortality versus C-section
Until the 1990s, a high rate of maternal mortality was a curse for Bangladesh. However, thanks to the expansion and improvement of medical services with support from national and international aid groups, the maternal mortality rate decreased from 574 deaths per 100,000 live births to 194 deaths in 2010, according to Health Ministry statistics.
The current rate is 196 deaths per 100,000 live births, whereas U.N. Sustainable Development Goals mandate the rate should be 70 deaths by 2030.
Health experts believe the boom in C-sections has not contributed to reducing the maternal mortality rate but has instead put the lives of mothers and babies at needless risk.
“If we look at the maternal mortality scenario, the rate remains almost the same over a decade, so the increase in C-sections has done nothing to improve the situation. Most of the C-sections are medically unnecessary and the situation continues due to the appalling health regulatory system in Bangladesh,” Dr. Ishtiaq Mannan, deputy country director of Save the Children, told ucanews.com.
Many doctors exploit wealthy women who are afraid of enduring pain during childbirth, said Mannan, an expert on maternal and newborn health.
While C-sections are expensive, they expose mothers and babies to various health hazards, increasing the likelihood of infection, excessive bleeding, organ damage and blood clots as well as ensuring a significantly longer recovery time for the mother, he explained.
“The irony is that wealthy and urban women who do not need C-section line up for it, while poor and rural women who face complications and need it cannot afford it,” Mannan added.
A behavioral change
Besides the money-making intentions of doctors, a behavioral change in Bangladeshi women has contributed to the C-section boom, according to Sister Mary Olympia, a Catholic nun and doctor.
“Our women are more educated today, but they hesitate to take up anything that involves physical labor, so their patience and endurance have slumped. In order to avoid labor pain, many opt for C-sections even if there are no complications, and once a mother has a C-section, she must go for the same for her next childbirth,” said Sister Olympia from the Associates of Mary Queen of Apostles congregation.
Many public and private hospitals have made C-sections a “commercial enterprise” by exploiting hesitation and fear among expectant mothers, said Sister Olympia, who is based at St. Mary’s Mother and Child Care Hospital in Gazipur district near capital Dhaka.
“A mother will face lifelong risks after having a C-section delivery, but private hospitals and clinics don’t warn her but compel her anyway. To stop this unethical practice, a strong regulation is required as well as awareness among people,” the nun added.
Misconceptions among mothers also increase unnecessary C-sections, said Dr. Sayeba Aktar, former head of the gynecology department at Dhaka Medical College and Hospital.
“Many women think if they have a C-section their babies will be brilliant because there will be no pressure on their head during birth. This is a wrong idea. We have seen babies suffer from respiratory problems and asthma. Sometimes babies are delivered before time, so their growth is hampered and they remain immature,” Aktar told ucanews.com.
The government has noticed the alarming rise in C-sections and a national action plan to regulate the medical sector is underway, said Dr. Shamsul Haque, line director of maternal and child health at the state-run Directorate General of Health.
“We have been carrying out various campaigns to discourage people from unnecessary C-sections. We are also working with medical charities to formulate a plan to curb this malpractice. We plan to take action against medical facilities that compel people to have C-sections for money,” Haque told ucanews.com.
Mannan of Save the Children believes cutting the proliferation of C-sections is a question of ethics.
“A doctor needs to have a strong ethical standard so that he or she does not put the lives of mothers and babies at risk by recommending C-sections for making money when a normal delivery would suffice,” he said.