C-sections greatest burden among childbirth expenses

Families may be spending the highest amount from their pockets for caesarian section deliveries among different child delivery-related expenses, suggests a recent icddr,b analysis.

C-section deliveries fork out an average USD 250 out-of-pocket (OOP) expenditure while a normal delivery burden on the pocket is only around USD 60 when childbirth takes place in healthcare facilities.

Over 85% families heavily rely on their family fund for c-section delivery spending. Photo: GMB Akash / icddr,b

This year World Health Day theme Universal Health Coverage (UHC) calls for greater access to quality health services without financial hardship, and reiterates that about 100 million people are pushed into extreme poverty each year because of OOP spending on health.

As indicated by the icddr,b study, cases of such lopsided OOP cost for c-section deliveries may be rising because C-section rate has gone as high as 31 percent of all deliveries in Bangladesh in recent years.

This rate is well over WHO standards at 10 to 15 percent and icddr,b researchers have earlier urged to implement effective national monitoring on c-section deliveries.

“No surprise that the wealthiest people spent around USD 280 on c-section, but the poorest people spend no less than USD 200 which is a huge burden on their pocket,” observes Dr Abdur Razzaque Sarkar, icddr,b associate scientist and principal author of the study published in The International Journal of Health Planning and Management.

Increasing rates of spending more from pockets on child deliveries, especially by the less wealthy people, is a grim indication because Bangladesh aspires to achieve UHC in order to make health systems equitable and quality healthcare available for people from all economic strata.


Data on over 4500 delivery cases was analysed, based on Bangladesh Demographic and Health Survey (BDHS) 2014 data coupled with a cross-sectional survey on child delivery-related expenditure.

“We have also found that mothers aged between 35 and 49 were spending significantly more and interestingly, moms with higher education and who received recommended antenatal services were also among those spending more on c-section, more frequently in urban Bangladesh,” comments Dr Sarkar.

“Over 85 percent families heavily rely on their family fund (including income and savings) to cope with this extra burden which has a huge impacts on the livelihood of these households,” he adds.

In order to minimise child delivery-associated cost, the study suggests introducing social health insurance - an initiative in line with the core objective of the Healthcare Financing Strategy of Bangladesh that aspires to achieve UHC by 2032.

icddr,b researchers have already highlighted that disadvantaged groups spend relatively more OOP and are in greater need of health insurance. These new findings on child delivery strengthen the case to make UHC a feasible way to lessen OOP burden in Bangladesh.

Muhamamd Zahir Hassan Nabil