Rise in C-section alarming

At a discussion on the primary result of the Bangladesh Demographic and Health Survey 2022, health officials stated that childhood stunting had come down markedly over the last five years. The survey is done every five years with the support of USAID and International Centre for Diarrhoeal Diseases, Bangladesh (icddr,b) and its findings are shared by the National Institute of Population Research and Training (NIPORT). While it is heartening to learn that stunting in children under the age of five has come down from 31 per cent to 24 per cent in 2022, caesarean births have increased to 45 per cent in 2022, up from 34 per cent in 2017.

This phenomenal rise in unnecessary caesarean births has been made possible primarily due to the unhealthy profit-making tendency in the country's health sector. Again, the general apathy showed by health authorities to continually monitor and enforce transparency and accountability among health establishments is equally responsible for this dismal situation. Health professionals generally agree that because most healthcare facilities in the country that deal with child birth have formed unholy alliances in the form of syndicates, patients find themselves unable to do anything but submit to this malpractice.

While national media do cover the issue in the major urban centres, things are less than favourable for pregnant mothers in the rural areas. When doctors have carte blanche to decide that a c-section is necessary and that too must be done at a private clinic, patients have little choice but to comply. It is normal for patients to place their trust in healthcare professionals when it comes to giving child birth, but it appears that the ethical code that is supposed to be the cornerstone of medical practice in this country has been thrown out the window for the purposes of windfall profits - even when there is 'no complicacy' in pregnancy.

It is not simply a question of making money off patients, there are serious health hazards involved in c-section delivery. When healthy mothers who have no need for caesarean births go through the procedure, many face complications. Though cost varies from centre to centre one might have to spend Tk 60,000 or more on C-section. Thus, one can only wonder how many thousands of crores of Taka are being made at the cost of patients' health (not to mention out-of-pocket experience). According to some estimates, there were around 860,000 unnecessary operations of this kind done in 2018, while up to 300,000 women who need a C-section are unable to afford or access it. "In 2018 alone, 77 per cent of all C-section operations were medically unnecessary" according to one gynaecologist's calculations.

The fact is that healthcare has now moved largely out of the public sphere and into private sector. It is businessmen who now own private medical hospitals and these are treated primarily as profit-making ventures with little in way of imparting quality healthcare services for the benefit of the public. Profit is the only 'mantra' on the table, and as stated before, in the absence of serious monitoring either by government or by Bangladesh Medical & Dental Council (BMDC), matters have been allowed to deteriorate to this state. The BMDC states that it "is a statutory body with the responsibility of establishing and maintaining high standards of medical education and recognition of medical qualifications in Bangladesh. It registers doctors to practice in Bangladesh, in order to protect and promote the health and safety of the public by ensuring proper standards in the practice of medicine." The question is, what exactly is the body doing to tackle the malpractice that has now reached epidemic proportions?