The rising rates of cesarean section (CS) deliveries in Bangladesh

According to pooled data from the Bangladesh Demographic and Health Survey (BDHS) for 2003-04 to 2017-18, the overall CS (cesarean birth) rate rose from about 3.99 % in 2003-04 to 33.22 % in 2017-18.
More recent analyses suggest CS rates of around 45% in 2022.
Institutional births (i.e., births in health facilities) have increased; among these births, the share that was CS is very high. For example, one source noted that in recent years, hospital births by CS accounted for ~66% of hospital births.
There is strong inequality: higher rates of CS in urban areas, among wealthier women, in private health facilities, and among women with more education.

Medical vs non-medical factors

While CS is life-saving when medically indicated (e.g., fetal distress, placenta problems), many studies suggest that in Bangladesh a large portion of CS deliveries may be non-medically indicated.
For example: In one study of urban Bangladesh, 52.37% of urban mothers delivered by CS in 2022, which is far above what would be expected purely from medical need.

Socioeconomic & facility-level factors

Delivery in private health facilities is strongly associated with higher CS rates. One meta-analysis found that women who delivered in private facilities were 8.16 times more likely to have a CS compared with those in public facilities.
Community norms matter: Women in communities with higher CS prevalence are more likely to opt for CS themselves.
Wealth, education, urban residence: Women from wealthier households, with higher education, and living in urban areas have higher rates of CS.
Antenatal care (ANC) visits: More ANC visits correlate with higher likelihood of CS. Possibly because more contact with health system → more interventions.
Maternal characteristics: Older maternal age, higher body-mass index (BMI / obesity), first child, etc. are also associated with CS.

Cultural, institutional & convenience-driven factors

Some families and women perceive CS as more convenient (scheduled, avoids labour pain) or as safer, especially in private hospitals. One opinion piece says the rise seems driven more by convenience and economic factors rather than increases in medical necessity.
Private hospitals may have financial incentives favouring CS, scheduling convenience for doctors, as suggested in comments in some reports.

The World Health Organization (WHO) has historically estimated that CS rates above ~10-15% may not further reduce maternal and neonatal mortality and might instead expose women and babies to unnecessary risks.
When CS is not medically needed, it can increase risks: for the mother (surgical complications, longer recovery, future pregnancy risks) and for the baby (early term births, respiratory issues, etc).
High CS rates place financial strains on households and health systems. A study noted huge costs associated with CS in Bangladesh when unnecessary.
Overuse may crowd out resources for needed care, and lead to normalising surgical births when vaginal births may still be safe and preferred in many cases.
The trend may also reflect broader equity issues: in poorer communities, low access to needed CS remains, while in wealthier communities, overuse occurs.

Strengthen monitoring of CS rates by facility (public & private), set policy targets and reporting.
Educate women and families about indications for CS, risks vs benefits, and promote informed consent.
Encourage support for safe vaginal birth where appropriate (including labour support, midwifery care).
Develop guidelines/regulations for private sector hospital practices to reduce non-medically indicated CS.
Promote community-based awareness: shifting norms that “CS is always safer” and creating space for vaginal birth preferences.
Focus on maternal health system strengthening: ensure quality labour and delivery care in all settings so that women are not opting for CS due to fear of labour or perception of poor facility care.

Consider Gentle Massage for Joint Pain Relief