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’s almost six times that. Source: Eduardo Lopez / Shutterstock
Women work as day labourers in a potato field in Rangpur, Bangladesh. Source: Shutterstock/Mohammad Saiful Islam
IN THE waiting rooms of Dhaka’s private hospitals, women with swollen bellies trawl through gossip magazines and bask under blissful air-conditioning. When the time comes, four out of five will eventually give birth surgically rather than naturally.
These mothers, from the wealthiest echelon of society, are a major factor behind the rapid growth of the C-section industry in Bangladesh.
The word “rapid” is no exaggeration either. In 2004, just four percent of babies were born via a C-section in Bangladesh. Ten years later, it had surged to 23 percent. Many experts believe it is beyond 30 percent today.
Wealthy mothers are choosing to have caesarean births in record numbers, and often when there is no medical reason. Some don’t want to experience the pain of childbirth. Others are following the dubious or misleading advice of doctors.
In fact, new findings released by Save the Children today reveal at least six out of every 10 caesarean births in Bangladesh are medically unnecessary, or more than 570,000 per year.
The out-of-pocket cost of unnecessary C-sections to patients is estimated at US$315 million per year, or US$552 per operation, according to the analysis.
Having a C-section when there is no medical reason puts mothers and babies at needless risk, increasing the likelihood of infections, excessive bleeding, organ damage and blood clots as well as increasing the recovery time for mothers.
Natural births on the other hand, enable mothers and babies to have physical contact sooner, with breastfeeding beginning earlier. When babies travel through their mother’s birth canal, they also receive a measure of good bacteria which is believed to boost their immune system.
Many other countries have experienced caesarean 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’s almost six times that.
This means while wealthy mums enjoy the luxury of medical choice, most mothers at the other bookend of Bangladeshi society, known as the “ultra poor”, cannot afford or even access specialist care if something goes wrong.
The few who do 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.
This disparity of opportunity is stark, but there are other elements at play here too. One major concern in Bangladesh is the poor regulation of the medical sector, leaving doctors almost entirely unaccountable for their actions.
As a result, more and more doctors are recommending C-sections over natural births, which are about eight times more profitable and a much shorter procedure, regardless of whether it’s needed.
There are also issues with newly qualified doctors not having the skills or confidence to deliver babies naturally and instead opting for surgery. Poor quality control mechanisms within Bangladesh’s medical sector fuel these problems.
Underlying all this is a major shortage of accredited midwives, who not only support natural child birth but help reduce the burden faced by busy doctors. Across the country, there are just 2,500 midwives, barely a tenth of the 22,000 recommended by a recent health sector review.
Save the Children is among those working to turn the tide and improve access for all to quality healthcare in Bangladesh while reducing the number of unnecessary C-sections. Part of that work includes running a midwife training programme in partnership with the UN Population Fund to help address the shortage. We’ve also turned to public campaigning, teaming up with the International Centre for Diarrheal Disease Research in Bangladesh and other like-minded organisations to launch, “Stop Unnecessary Cesarean Section”.
The campaign urges the government to introduce policy and regulatory frameworks to ensure mothers are fully informed of key information before they choose to have – or not have – a caesarean operation. We’re also calling for improved record keeping, reporting and monitoring of caesarians, along with better ethical standards and more accessible public information. It is a multi-pronged approach to a complex and often political issue that has for too long been hampered by poor regulations, vested interests and financially driven agendas.
Now it’s time to wrestle back control and better protect what is arguably the most important moment in a person’s life.
** Dr Ishtiaq Mannan is Save the Children’s deputy country director in Bangladesh, a qualified public health physician and an expert in newborn, maternal health and health systems.
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