Is there a connection between C-section and maternal death?

Bangladesh’s remarkable decrease in maternal mortality rate has been stalled since the year 2010. Whereas the number of health facilities to the support mothers has nearly doubled up in the last eight years, the number of maternal deaths has almost remained unchanged. Why is that so?

According to a government survey by NIPORT the estimated maternal mortality rate was 196 per 100,000 live births in 2016, which is nearly at the same ratio till today. The study noted that while the rate of female deaths due to maternal causes dropped significantly from 20% in 2001 to 14% in 2010, it still stood at 13% in 2016. indicating a worrying stalling trend. NIPORT identified haemorrhage and eclampsia as the two most common causes of maternal deaths, accounting for 55 percent of all maternal deaths. Such a high rate of maternal deaths from these two conditions is unacceptable, because both excessive bleeding and convulsions can be treated with two simple injections. Although these two medical treatments should be provided by the authorities, most of the government healthcare centres have no supply of these two vital injections, betraying the fact that maternal health remains neglected. An analysis of the causes of maternal deaths in 2010 and 2016 suggest that over 80% of deaths were preventable. Sadly, Bangladesh is in the paradox where expanded facility deliveries, especially the surge in the perceived ‘safe’ cesarean deliveries, have not lead to a reduction in maternal mortality. The problem lies in the quality and access of the services provided.

The improved health facility system in Bangladesh gave rise to a boom in Cesarean-sections. Between 20014 and 2016 the rate of C-sections went up from 4 to 31%, which is way above the recommended 10-15% range of the World Health Organisation (WHO). According to a report of Save the Children Bangladesh many of these performed C-sections are unnecessary. Only during the last two years 51% of the C-sections were medically deemed as unnecessary. These cesarean deliveries are mostly performed in private hospitals. Last year alone this amounted in Bangladesh to a total of 860.000 unnecessary C-sections , costing around $483 million out-of-pocket expenses. At the same time, up to 300,000 women in Bangladesh who desperately need a C-section every year are unable to get one.

Looking back at the time when maternal deaths reduced shockingly, then only a quarter of births were delivered in hospitals, while just nearly a third of the deliveries were administered by skilled health workers.Though many would not agree to this, unscrupulous clinic owners and doctors encourage C-sections for their own business interests, which ultimately adds to the patients misery. While many perceive a C-section delivery as safe, women undergoing caesarean surgeries are more likely to have an infection, excessive bleeding, prolonged postpartum pain, and a significantly longer recovery. Natural births, on the other hand, enable mothers and babies to have physical contact sooner with breastfeeding beginning earlier.

In the developed countries, unnecessary C-sections are discouraged and the same is expected from the healthcare services in Bangladesh too. To take a step forward to control C-sections, recently the Bangladesh Legal Aid and Services Trust filed a writ, with the High Court, seeking its directives to stop unnecessary caesarean operations from being performed. Responding to that, the High Court has ordered the government authorities to form a committee within a month to formulate guidelines to prevent unnecessary C-sections at all hospitals, and clinics. The court ordered that the committee will have to submit the guidelines within six months. This substantive and definitive action can help us to achieve the healthcare target of SDG by 2030.

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