The cesarean epidemic in Bangladesh: Associated factors and maternal health risks

The global rise in cesarean section (CS) deliveries has raised concerns, particularly when performed without medical indications. This study aimed to estimate the prevalence of CS deliveries in both public and private healthcare facilities in Bangladesh and to explore reported non-medical correlates of CS delivery and self-reported postoperative maternal complications.

A population-based cross-sectional study was conducted between January and December 2023 across urban and rural areas of three major administrative divisions in Bangladesh. Participants were selected from a community-based multistage sampling approach based on birth registration records, and face-to-face interviews were conducted with 4,614 mothers who had given birth during the study period. Data on delivery mode, self-reported medical indications, patient preferences, healthcare provider behavior, and post-cesarean outcomes were collected and analyzed descriptively.

Among all births, 61.51% were delivered via CS, with a markedly higher rate observed in private healthcare facilities (81.45%) than in public hospitals. Approximately 21.57% of respondents reported that CS delivery was performed due to previously identified medical indications, based on maternal report and available institutional information (where feasible). A considerable proportion (38.93%) of women who underwent CS births reported postoperative complications, including postoperative pain (23.02%), postpartum hemorrhage (10.85%), surgical site infections (3.63%), and venous thromboembolism (1.43%).

The findings reveal an alarmingly high rate of CS deliveries in Bangladesh, particularly within private healthcare settings, with many participants reporting limited or unclear medical explanations for CS delivery. The high frequency of self-reported postoperative complications suggests important maternal health concerns. Strengthening monitoring of CS practices, improving patient-provider communication, and enhancing public awareness may help optimize CS utilization and maternal healthcare outcomes in Bangladesh.