1m infants born through unnecessary surgery

The number of surgeries performed to deliver infants in the country has risen alarmingly as around 45 infants per every 100 are delivered through surgery.

In total, 1.6 million (16 lakh) infants are born in this manner every year in the country. Of these, over 1 million (10 lakh) infants are being born through unnecessary surgery.

These figures concerning unnecessary surgeries were revealed in the Bangladesh Demography and Health Survey (2022). The survey also said that nationally, the TFR or total fertility rate has remained static for the last decade or so.

The government has been unable to bring it down. In fact, in certain divisions the TFR is going up. However, advancements made in the health sector have also appeared in the survey. Infant mortality rate has dropped and more deliveries are taking place in hospital.

The primary findings of the report were released on Tuesday at an event organised by the National Institute for Population Research and Training (NIPORT) at a hotel in the capital. Lending support to the initiative were USAID and the international Centre for Diarrhoeal Diseases (icddr,b).

The demography and health survey has been carried out in Bangladesh since 1993. The survey is carried out every three to four years. The facts and figures in this survey are considered the most reliable in the health sector. Government policymakers, UN agencies, local and foreign researchers, scientists and journalists use these statistics from this survey with due importance.

This latest survey comprises information of 30,018 households in the villages and towns of all divisions of the country. The information was collected from 27 June to 12 December 2022. This is the first time that the data was collected in a totally digitalised system.

At the start of Tuesday's event, NIPORT director (research), Mohammad Ahsanul Alam, said this survey is carried out to know and to understand the country's social and demographic character, the state of women and children's health, and the extent of the essential services' reach.

According to the World Health Organisation (WHO), for every 100 pregnancies, 10 to 15 mothers may experience certain complications. There is then fear of delivery complications. In such cases, surgeries are performed to save the lives of the mother and child. This is a life saving measure. If the rate of surgeries is over 15 per cent, then it is considered unnecessary.

Public health and maternal health experts for the last two decades have been saying that the number of unnecessary surgeries for the delivery of infants has been on the rise.

The presentation stated that every year around 3.6 million (36 lakh) infants are born. Of this, 45 per cent or just over 1.6 million (16 lakh) are delivered through surgery. And of this, 30 per cent or 1.08 million infants are delivered through unnecessary surgery.

The larger chunk of these unnecessary surgeries is done in private clinics and hospitals. In fact, 84 per cent of the child birth surgeries are done in private institutions. In government hospitals, this is 14 per cent. The remaining 2 per cent of these surgeries are conducted in certain NGO-run health centres.

While presenting this part of the survey, icddr,b scientist Ahmed Ehsanur Rahman said, "I was shocked, stunned, upon learning the huge number of surgeries performed for childbirth. This is not justified in any way. We must bring a halt to this."

Mothers often face postnatal physical complications after surgery and at times, infection sets in. Also, such procedures are costly.

Public health specialist Abu Jamil Faisal was present at Tuesday's event. Speaking to Prothom Alo after the programme, he said that now Covid couldn't be blamed any longer. The fact must be faced that the government's programme isn't working and there is a lack of monitoring. Unless this is rectified, the state of unrequired surgeries will just worsen.

Bangladesh is a populous country. Population was at one time considered the No 1 problem of the country. Bangladesh achieved success in the population sector basically by bringing the total fertility rate or TFR down. Immediately after independence, the TFR was 6. That means, women between the ages of 15 and 49 gave birth to six children on average. Various initiatives were adopted and the TFR rate began to decrease. The fall in TFR won Bangladesh international acclaim.

The latest demography and health survey states that over the past one decade, the TFR has been static at 2.3. That means, a reproductively able woman gives birth to over 2 children on average.

In the 20011 survey, the TRFF was 2.3. It was the same in the later three surveys.

In some cases, though, the TFR has been increasing instead of decreasing. The latest survey showed an increase in TFR in a number of divisions including Barishal, Chattogram, Khulna, Mymensingh and Rangpur divisions. The TFR in Dhaka was 2.2 before and remains the same. It has gone down in Rajshahi and Sylhet. The highest TFR in the country is in Mymensingh, at 2.7. That means in this district, a mother on average gives birth to over 3 children. The TFR in Khulna was 1.9. Such TFR is normally seen in European countries. But now the TFR in Khulna has increased to 2.2, according to the latest survey.

The survey states that the rate of children with stunted growth has dropped. It said that 24 per cent of children under five years old were shorter than they should be at their age. Compared to the past three surveys, the rate of children with stunted growth has decreased. In 2011 and 2014 the rate of stunted growth children was 41 and 36 per cent. In the 2017-16 survey, this was 31 per cent.

In the case of child nutrition, the rate of underweight children is not decreasing. Presently the rate of underweight children under the age of five is 22 per cent. In 2017-18 it was 22 per cent too.

The rate of wasted children is on the rise. In 2017-18 this was 8 per cent. That has now increased to 11 per cent. This is an indication of a fall in the state of nutrition.

A child's nutrition depends on its being breastfed and also given the required infant food. While presenting the part on child nutrition, knowledge management and communication expert of Carolina University, Sushmita Khan, said the number of breastfed infants under the age of six months is falling. Four years ago, 65 per cent of the infants were solely breastfed up till six months. The latest survey showed this had fallen to 55 per cent. She said it was reported in the survey that 49 per cent of children of 6 to 23 months had eaten unhealthy food on the day before the survey.

The rate of infant mortality has dropped in the country. According to the survey, 31 infants out of every 1000 births were dying before reaching five years of age. Four years ago this was 43. Previously 27 newborns out of 1000 died within 28 days of being born. That is now 20. Government officials highlight this as significant progress.

Four years ago, 51 per cent of childbirth took place in some health centre or the other. That is now 65 per cent. And 70 per cent child deliveries are being done by trained health workers. Four years ago this was 54 per cent.

The survey also contained data pertaining to blood pressure and diabetes, but that was not presented at the Tuesday event. The other information of the survey was presented by USAID team lead (family health) Umme Salma Jahan and icddr,b assistant scientist M Moinuddin Haider. The programme was presided over by NIPORT director general Md Shafiqul Islam.