Study report
1.7m children born through unnecessary surgery last year
Around 1.7 million children were born through unnecessary surgical procedures in the country last year. Estimates suggest that such surgeries are causing financial losses of more than Tk 50 billion (5,000 crores) annually. A lack of professional integrity and weak government oversight have led to an alarming rise in surgical deliveries during childbirth in the country.
These figures came up in a study on reducing unnecessary surgical deliveries. The findings of the study were published at an event, titled “Reducing Unnecessary Caesarean Section in Bangladesh”. The event was organised by Ashulia Women and Children’s Hospital (AWCH).
The programme identified major problems behind unnecessary surgical procedures and put forward a number of recommendations to reduce the practice.
At the event, health services secretary Md Saidur Rahman said there is widespread negligence in maternal and child healthcare. Surgical deliveries during childbirth are excessively high in the country, putting mothers at risk. The reality, he said, is that normal delivery has almost disappeared in Bangladesh.
The research findings were presented at the event by professor Anjuman Ara, a physician at Ashulia Women and Children’s Hospital.
She said that globally, one in five children is born through surgical delivery, or about 21 per cent. In Bangladesh, the rate is far higher. Here, nearly one in every two children is born through surgery, or about 45 to 52 per cent.
Pointing out that private hospitals have pushed the situation to an alarming level, where around eight to nine (85 to 90 per cent) out of every 10 children are delivered through surgery, professor Anjuman Ara said that about 3.5 million children were born in the country last year, of whom around 1.68 million were delivered through unnecessary surgical procedures.
Referring to a 2018 study, Anjuman Ara said unnecessary surgical deliveries are causing financial losses of more than Tk 50 billion a year. More than 70 per cent of the country’s private maternity care facilities operate without adequate oversight.
She further said that many institutions lack sufficient staff, emergency medical support or standard labour rooms. As a result, surgical delivery is being chosen as an easy solution by prioritising financial gain.
Documents shared by the organisers at the event show that in 1999, 30 per cent of hospital births were conducted through surgery. The rate rose to 51 per cent in 2007 and reached 69 per cent in 2022. Experts fear that without urgent intervention, 90 per cent of hospital births could take place through surgical procedures by 2030.
Professor Anjuman Ara said that about 3.5 million children were born in the country last year, of whom around 1.68 million were delivered through unnecessary surgical procedures
Professor Ferdousi Begum, head of the obstetrics and gynaecology department at Ashulia Women and Children’s Hospital, said that by deliberately portraying natural childbirth as risky and painful, expectant mothers develop irrational fears.
She added that in 1990, mothers used to die from not having surgery, whereas now they are dying due to excessive surgical interventions.
Nobody wants to give the time
Professor Khurshid Talukdar, physician and research director of the Pediatrics Department at Ashulia Women and Children’s Hospital, said that natural childbirth takes time, but most patients and physicians are unwilling to give the necessary time for this natural physiological process.
He debunked a common misconception, explaining that many believe natural childbirth can damage the baby’s brain. However, due to inadequate prenatal care, nearly 70 per cent of brain damage in newborns occurs before birth, while problems during delivery account for less than 10 per cent.
Speakers at the event further said that between 2008 and 2016, the rate of cesarean births at Ashulia Women and Children’s Hospital ranged from 62 to 72 percent. Afterwards, the hospital introduced prenatal counselling, the Robson classification, labour monitoring, consultant audits, and the practice of vaginal birth after cesarean (VBAC). As a result, the cesarean birth rate at the hospital was reduced to 42 per cent. However, even though this model was expanded to eight institutions in 2022–23 with support from the Gates Foundation, the expected success was not achieved.
Highlighting the importance of natural delivery, Khurshid Talukdar said this process is crucial for the child’s immunity and long-term health. Natural birth is the main way beneficial microbes or the mother’s microbiome are transferred to the child’s body, and it also allows immediate ‘skin-to-skin’ contact between mother and baby. Children born via cesarean section are deprived of these fundamental rights.
Speakers at the event further said that between 2008 and 2016, the rate of cesarean births at Ashulia Women and Children’s Hospital ranged from 62 to 72 per cent.
Afterwards, the hospital introduced prenatal counselling, the Robson classification, labour monitoring, consultant audits, and the practice of vaginal birth after cesarean (VBAC).
As a result, the cesarean birth rate at the hospital was reduced to 42 per cent. However, even though this model was expanded to eight institutions in 2022–23 with support from the Gates Foundation, the expected success was not achieved.
Also present at the event was director general of the Directorate General of Health Services, professor Md Abu Jafor. The event was chaired by Dabir Uddin Ahmed, physician and chief executive officer of Ashulia Women and Children’s Hospital.