Urgent need to address increasing caesarean section rates in lower-middle-income countries like Bangladesh

Abstract

Cesarean section (CS) delivery has substantially increased globally over the past few decades (1). The prevalence of CS worldwide has increased from about 16 million in 2000 to 29.7 million in 2020 (2). Data from 2010 to 2018 covering 154 countries and a total of 94.5% of world live births show that 21.1% of women have given birth by CS (3). This escalating trend has been observed in all regions, particularly low- and middle-income countries from Eastern and Southern Asia and Northern Africa, indicating a sharp increase of 44.9% and 31.5%, respectively, and the trend has emerged as a critical global health concern (3). The prevalence of CS increased by 27% in Bangladesh during the past decade (i.e., 18% in 2011 to 45% in 2022) (4), which is a much higher figure compared to neighboring countries such as India (14%), Pakistan (14%), and Nepal (4%) (5). According to the World Health Organization (WHO) (6), CS rates between 10% and 15% are considered an acceptable standard. This means that CS rates in Bangladesh are threefold higher than WHO’s acceptable standard, which is alarming for maternal health, newborns, families, and the healthcare system. More specifically, the CS rate in Bangladesh is higher among mothers who live in urban areas (36.9%) than among mothers who live in rural areas (17.9%) (7). Regarding divisional levels, the rate of CS delivery is the highest in Khulna (35.2%), followed by Dhaka (32.9%), Rajshahi (28%), Chattogram (20.1%), Barishal (19.90%), Rangpur (19.50%), and Sylhet (13.30%) (7). The present opinion article aims to explore the primary reasons for the dramatic increase in CS delivery in Bangladesh and proposes evidence-based recommendations for reducing the rate of unnecessary CS.