A SHARP increase in Caesarean sections in public hospitals in the Rajshahi division is a warning that Bangladesh鈥檚 maternal healthcare system is drifting towards a dangerous over-medicalisation of childbirth. A study published in Nature shows that nearly 41 per cent of births in government facilities in the region now occur through C-section, almost three times the World Health Organisation鈥檚 recommended threshold. In May, another study published in the international medical journal BMJ Open, based on a survey of new mothers in nine upazilas of Rajshahi, found that 34.4 per cent of deliveries were performed via C-section. Research identifies predictable causes such as a shortage of skilled staff for round-the-clock obstetric care, fear of complications and a growing inclination among physicians to choose surgical delivery for convenience. But the data also reveal deeper inequities, with poorer women in Rajshahi, unlike national patterns, more likely to face unnecessary surgery, reflecting limited health literacy and weak accountability within facilities meant to protect them. Such systemic drift has costs, including prolonged recovery, financial strain and heightened long-term health risks for mothers.
What is especially troubling is that public hospitals, long considered safe alternatives to profit-driven private clinics, are now mirroring the very trends they were expected to counter. The progressive increase in the rate of Caesarean section, which should be reserved for high-risk pregnancies or medical emergencies, has been a public health concern. The overall rate of C-section was only around 4 per cent and the rate in rural areas was only 2 per cent in 2004 while the overall rate is now over 51 per cent, according to the Bangladesh Institute of Development Studies. The study finds that from 2004 to 2018, C-section cases increased far more sharply in rural areas than in urban areas. A 2018 study by the World Health Organisation and UNICEF said that about 77 per cent of the Caesarean sections that took place in Bangladesh that year were unnecessary and that about 95 per cent of the income of private hospitals and clinics had come from Caesarean sections. In October 2023, the High Court asked the government to take steps to make it mandatory for all public and private hospitals and clinics to follow the guideline on the prevention of unnecessary Caesarean sections, but the government failed to comply with directive.
Unless the government enforces strict monitoring of child delivery decisions, invests in midwifery and rebuilds trust in normal childbirth, the country risks undermining its progress towards reducing maternal and neonatal mortality. The government should, therefore, ensure that all health facilities follow standard protocols on child deliveries and take actions against any non-compliant physician or facility.
