Study suggests effective monitoring to cut CS deliveries

A new study has revealed that Caesarean section has seen an 8-fold rise in Bangladesh since 2004 as private healthcare providers have been leading the worrying shift from normal delivery on business grounds.
"It was about 2.0am I was taken to the delivery room of a private hospital dedicated for mothers and children. On-duty doctor came and started shouting at the nurses that why I had been taken to the labor room instead of the operation theater that was ready for C-section," narrated a mother who participated at the study sharing event.
The doctor was unhappy as normal delivery requires more time and effort while C-section needs less effort with offering handsome money, participants of the event observed.
The overall prevalence of C-section among Bangladeshi mothers was found to be 3.99 per cent in 2004 which jumped to 33.22 per cent in 2017-18; almost 8-fold, although the World Health Organisation (WHO) recommends that C-section rate should not exceed 15 per cent of total birth delivery.
The findings were disclosed at a study-sharing event organised by the Bangladesh Institute of Development Studies (BIDS). Dr. Md Abdur Razzaque Sarker, Research Fellow, BIDS, presented the research findings.
Dr. Binayak Sen, the Director General of BIDS, chaired the event titled "Massive Boom of C-section Delivery in Bangladesh: A Household Level Analysis (2004-2018)".
The study observed that the C-section delivery was higher in private facilities-it was 46.2 per cent in 2014 and 52 per cent in 2017-18 - than public facilities (12 per cent in 2014 and 10.6 per cent in 2017-18).
Dr. Abdur Razzaque Sarker observed that there is no monitoring system functioning in the healthcare system in Bangladesh. We don't have any data to know if the previous cases of C-section were necessary and on what ground.
"We don't even have scientific study to know if there are any health and mental effects of C-section on mother and child," he added. Dr. Binayak Sen said, "It is shown that the private healthcare facilities are leading the C-section and we need to know exact information that was medically necessary to be conducted on business ground."
Prof Dr. Abdus Sattar mentioned the malpresentation of patient's cases by worrying pregnant mothers and her families to move for C-section.
The study found that in 2004, the prevalence of C-section delivery was only 2 per cent at rural level where the rate jumped to 29 per cent in 2017-18. The annual percentage change of C-section delivery was 10 per cent among urban mothers while it was 21 per cent for rural mothers.
Although the C-section was high among urban mothers (12 per cent in 2004 and 44 per cent in 2017-18), the rural mothers also utilised C-section services alarmingly.
A total of 27,328 married women aged 15 to 49 years who had a live birth in the two years preceding the survey were included for this study. The overall out-of-pocket cost for C-section delivery was about BDT 20,000 in Bangladesh.
The average out-of-pocket cost of CS delivery was higher in private facilities (BDT 21,506) than public facilities (BDT 13,622) while about BDT 16,860 was needed for those who received CS services from NGO facilities in Bangladesh.
Participants emphasised on changing the whole healthcare system, food habits and patients' mental attitude towards normal delivery. It is high time for the proper authorities to implement effective national monitoring measures to put restrictions on the rising number of CS deliveries, the study suggested.

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