Monitoring of clinical conditions may curb soaring C-section deliveries in Bangladesh

An icddr,b study on over 2500 childbirths under its Matlab Health and Demographic Surveillance (HDSS) area found that around 35% of these deliveries were caesarean section (C-section).

WHO recommends that C-section rate should remain between 5-15%. Photo: Shehzad Noorani / icddr,b

The World Health Organization (WHO) recommends that across the population all-cause C-section rates should remain between 5 and 15 percent to best decrease the high maternal mortality ratio (MMR).

However, in Bangladesh, the C-section rate has increased to 23% in 2014 from 4% in 2004, according to Bangladesh Demographic and Health Survey (BDHS) 2014.

Moreover the study found that only 1.4% of the 35% C-section deliveries were conducted for absolute maternal indications (AMI) – clinical conditions in which mothers are unlikely to survive without C-section.

“This means that causes of the rest of the C-sections are a matter of inquiry,” opines Dr Iqbal Anwar, senior scientist at icddr,b and senior author of the study published in PLOS One.

“Over 80% of these C-sections were conducted in for-profit private facilities that raises concern about profiteering tendencies of private healthcare providers. However, the role of patients’ preferences could not be ruled out for this epidemic of C-sections,” adds Dr Anwar.


What were the major reasons for C-section in these women?

Major indications of C-sections were previous history of C-section 24.1%, fetal distress 21%, prolonged and obstructed labour 16%, disorder of amniotic fluid 14% and post-dated pregnancy 13%, according to the study.

“Reasons for caesarean births as reported in the patients’ record file need to be supported by appropriate clinical conditions, suggests Dr Tahmina Begum, principal author of the study and research investigator, universal health coverage at icddr,b.


C-section deliveries need monitoring. Photo: Shumon Ahmed / icddr,b

Dr Tahmina explains that many such documented indications such as prolonged- or obstructed-labour did not enclose labour monitoring tool data on labour duration (partograph). “Without such vital information, it is difficult to validate indications – as to whether the C-sections were undertaken for real cause or not,” she adds.

Dr Anwar recommends monitoring of the indications both at the public and private sector healthcare facilities.

“All district-level healthcare facilities including for profit private clinic and hospitals must report to the civil surgeons about their monthly performances including indications of C-section,” he observes.