Unnecessary caesarean sections have reached peak because of the unhealthy profit-making trend in the country's health sector and an apparent inaction of health authorities to establish transparency and accountability in the process.
Gynaecologists say that the money-minting attitude of private hospitals or healthcare facilities and some syndicates are working behind the massive boom in the number of medically unnecessary C-sections. Such unnecessary major medical operations place mother and baby at a needless risk, the warned.
Nupur, 31, living in Munshiganj district in the central region of the country, gave birth to a baby girl last year. Despite 'no complicacy' in her pregnancy she had to go through a C-section at a local clinic.
"I was taken to a caesarean operation room while my delivery pain started at midnight at home. Despite it was meant for a normal delivery, the on-duty health professional took me for C-sections. They (clinic authorities) created panic among my family members saying normal delivery could be fatal," she said.
"It cost nearly Tk 60,000 to complete all the medical procedures. On the other hand, I face regular pain at my backbone where the anesthesia was injected and I no longer can lift things as I did during my previous health condition," Nupur added.
People in Bangladesh bear as much as 68 per cent of healthcare expenses out-of-pocket while the country's total health expenditure is 2.34 per cent of GDP.
Rickshaw-puller Moinul Islam told the FE that he came from Kurigram district in the country's northern region. He was collecting money in Dhaka roads for her wife as she needed a C-section. His wife was admitted to Dhaka Medical College & Hospital (DMCH) and she was going to have a twin baby as the local clinics in Kurigram didn't take any risk for normal or C-section.
Save the Children said between 2016 and 2018 the number of C-sections increased by 51 per cent.
In 2018, Bangladeshi parents paid $483 million in out-of-pocket expenses for C-sections that were medically unnecessary.
The country saw an estimated 0.86 million (860,000) of these unnecessary operations in 2018, while up to 0.3 million (300,000) women who need a C-section are unable to afford or access it. In 2018, 77 per cent of all C-section operations were medically unnecessary.
Noted gynaecologist Prof Dr Samina Chowdhury told the FE that the unnecessary caesarean sections have increased at an alarming rate that is worrying as it has certain adverse health effects.
This is a major operation and it can cause uncontrolled bleeding and long-term health effects like damage to women's reproductive organs, urination system and affecting bladder which can be fatal.
"Businessmen are now owners of the private hospitals in the country and they consider health institutions as a money-making platform which we see taking the lifesaving method to an unnecessary level," she lamented.
A syndicate has been developed and their only duty is to perform the C-section at private hospitals and clinics, said Prof Samina, also an activist to stop the unnecessary operations.
So many private clinics don't have basic arrangements for normal delivery or labour rooms but they have caesarean section facilities, meaning that they accept clients only for C-sections, she pointed out.
"We have appealed to the government to inspect those private health facilities and take necessary actions," she informed.
Meanwhile, corporate hospitals set monthly targets for doctors to meet. Health professionals' employment at those hospitals remain vulnerable if they fail to meet the target, she alleged. Such unethical pressure has taken the situation from bad to worse, added Prof Samina, also former president of Obstetrical and Gynaecological Society of Bangladesh (OGSB).
Dr Md Mahamudur Rahman, director of the government's Maternal and Child Healthcare Services, told the FE that 85 per cent of the C-section in Bangladesh is carried out by the private healthcare providers.
The government's health facilities, including at Upazila level community health clinics, emphasises on normal delivery until there is any complex situation that demands C-section.
"We have to change our mindset first," he said.
"We see C-sections in the EU, other western countries only happen when it is required and they have a higher rate of normal delivery," he noted, adding "Doctors, nurses and clients are involved in the bad practice of unnecessary C-section in Bangladesh."
A pregnant mother needs sufficient time to ensure a normal delivery but we don't have the arrangement, said both Samina Chowdhury and Mahmudur Rahman.
"We need to increase the number of midwives to support doctors and ensure safe motherhood," they suggested.
The current doctor-patient ratio in Bangladesh is only 5.26 per 10,000 population, second lowest in South Asia, according to the World Health Organization.
Both the physicians stressed the need to sensitise people about risk of unnecessary caesarian operation. Many clients think that a caesarean section is safe and painless, they noted, adding so, awareness building is necessary to put an end to unnecessary C-sections.
The health experts also suggested reintroduction of the use of the vacuum and forceps method to help mothers give normal birth. And, many private hospitals introduced painless normal delivery which can be helpful.
Director General of Directorate General of Health Services Dr ABM Khurshid Alam told the FE the DGHS has a protocol with the OGSB to monitor unnecessary C-section in private hospitals and clinics across the country.
"DGHS line director for Hospital and OGSB jointly monitoring the situation to check unnecessary C-sections in the country and running awareness campaigns among stakeholders and clients so that only unnecessary operations can be stopped," said Dr Alam.
