Is Bangladesh too posh to push?

Tuesday 30 January 2018

Written byTahrim Ariba Chowdhury

The current scenario

A surgical operation for delivering a child by cutting through the wall of the abdomen of pregnant mothers with severe delivery complications is called Cesarean Section (CS). It is a lifesaving intervention. However nowadays, the decision to undertake a CS operation is taken nonchalantly and happens quite frequently in labour rooms in Bangladesh. The CS rate has surged to 31% from 21% in Bangladesh causing unbearably high out of pocket expenses. Over 1 million C-section occurs in Bangladesh out of which 750,000 are at private facilities. Even with this rising facility delivery, Bangladesh's maternal mortality hasn't declined in the last 6 years (BMMS, 2016).

The reason behind

As previously reported in August 2017, at least six out of every 10 caesarean births in Bangladesh are medically unnecessary, or more than 570,000 per year. The out-of-pocket cost of unnecessary C-sections to patients is estimated at US$315 million per year, or US$552 per operation. Having an unnecessary C-section puts mothers and babies at needless risks, increasing the likelihood of infections, excessive bleeding and etc. Natural births on the other hand enable mothers and babies to have physical contact sooner with breastfeeding beginning earlier. Lack of regulation and implementation of programs with challengeable qualities are not able to create the accountability. Hence despite of rising numbers of facility delivery mothers in Bangladesh are still dying. C-sections are 8 times more profitable over natural births and much shorter in procedure- regardless of whether it's needed.

What is Save the Children doing?

Save the Children is working to turn the tide to improve access to quality healthcare in Bangladesh while reducing the number of unnecessary C-sections. We are running a midwife training program in partnership with UN Population Fund to address the shortage. We've also turned to public campaigning, teaming up with like-minded organizations to launch a ‘Stop Unnecessary Cesarean Section’ initiative. Working with a number of stakeholders including doctors, researchers, rights activists, representatives of donor agencies and media, Save the Children is creating a collaborative platform to raise voice, build awareness and influence policy advocacy on this issue. We are also trying to strengthen the health system through advocacy and promotional activities and change policies from the root level. This movement has given us some positive results at the policy level. However, there's still a long way to go before the right balance can be struck. It is time to wrestle back control and better protect what is arguably the most important moment in a person's life.

First time parents in Bangladesh

Tanjim Haque and his wife Naila- a young enthusiastic couple, went for regular doctor’s checkups during their pregnancy. The test reports were positive, the baby was in good shape and everything was good to go for a normal child delivery.  Unfortunately what the delivery lacked was confidence and support from the doctor- which is the most essential support required.  There were a series of unhelpful and demotivating factors that came from the doctor during the pregnancy period.

The doctor (keeping anonymous) discouraged the young couple to have a normal delivery suggesting the intolerable level of pain of giving birth lasting more than 6-8 hours. Soon before the due delivery date, the doctor declared his unavailability at the time of delivery had the baby been born through normal delivery. “The doctor said that if the baby was not a C-Section born then he won’t be available at delivery time and his assistant would undertake the delivery. This left us very startled since we were consulting with this doctor from day one and could not gather enough confidence to undergo the normal delivery by someone who was a complete stranger to us! If we were at least told about this earlier, we would have transitioned onto a new doctor,” says, Tanjim.

The couple repeatedly requested the doctor to spare some time for normal delivery to which they did not receive any positive answer. Never did the doctor utter the word “Cesarean Section”, however he did not encourage them to have a normal child delivery either, which left the couple utterly confused. Nervous and uncomfortable, given the complexity of the situation, the young couple decided to undergo a C-Section delivery in 39 weeks of pregnancy. Tanjim and his wife had a full term baby and there were no such complications before and after the delivery process. It was reported that his wife suffered from severe back pain for almost 9 months after her C section. However, both of them realize the unnecessity of the surgery and have become very skeptical towards health care provision in Bangladesh as a whole.

** Disclaimer: The actual names and photos have not been used for privacy concern.