Weak regulation and profit-driven practices fuel the rise, experts say, pointing out that evidence-based interventions show potential to curb the trend. Experts urge urgent reforms in maternal healthcare.
An estimated 1.7 million women in Bangladesh underwent unnecessary caesarean sections (C-sections) in 2025, exposing mothers and newborns to avoidable medical risks, financial strain, and long-term health complications, experts revealed at a national dissemination event in Dhaka. The alarming figure underscores a deepening crisis in maternal healthcare, driven by weak regulation, profit-oriented private healthcare practices, and growing fear of natural childbirth.
The findings were presented at a programme titled “Reducing Unnecessary Caesarean Sections in Bangladesh,” organised by Ashulia Women and Children Hospital (AWCH) and attended by senior officials from the Health Services Division and the Directorate General of Health Services (DGHS). Speakers warned that unless urgent reforms are implemented, the country’s C-section rate could rise further, undermining public health goals and the pursuit of universal health coverage.
A Growing Epidemic in Childbirth Practices
Data presented at the event revealed that facility-based C-section rates in Bangladesh have risen sharply over the past decades – from 30 per cent in 1999 to 69 per cent in 2022. Experts cautioned that without decisive policy action, the rate could reach as high as 90 per cent by 2030.
The surge in surgical deliveries is attributed primarily to weak oversight of private maternity facilities, poor adherence to evidence-based labour protocols, and the perception that normal vaginal delivery is risky or excessively painful. More than 70 per cent of private maternity facilities operate with minimal regulatory oversight, often lacking adequate staffing, emergency backup systems, and standard labour-room infrastructure. Many function largely as surgery-oriented centres where financial incentives outweigh patient safety considerations.
Medical experts highlighted that normal childbirth is frequently misrepresented as dangerous, prompting premature surgical intervention even when there is no clinical indication. According to World Health Organization (WHO) guidance, prolonged latent labour alone does not justify a C-section if both mother and baby remain clinically stable.
Health Risks and Long-Term Consequences
Unnecessary C-sections pose significant health risks for both mothers and infants. Research indicates that surgical deliveries without medical indication are associated with higher rates of maternal complications such as infections, haemorrhage, and intensive care admission compared to vaginal births.
Experts also noted that normal vaginal delivery plays a crucial role in immune development through the transfer of maternal microbiota, potentially reducing long-term metabolic and immune risks in children. In contrast, avoidable surgical births may deprive newborns of these benefits while increasing healthcare costs and recovery time for mothers.
Beyond clinical risks, the economic burden of unnecessary C-sections is substantial. Families often incur high out-of-pocket expenses, especially in private hospitals where surgical deliveries are significantly costlier than vaginal births. The rising dependence on surgical childbirth also strains the healthcare system and widens inequities in maternal care access.
Evidence that Change is Possible
Despite the bleak outlook, experts at the event highlighted examples showing that unnecessary C-sections can be reduced through targeted interventions. AWCH data showed that its C-section rate, which ranged from 62 per cent to 72 per cent between 2008 and 2016, dropped to 42 per cent after the introduction of evidence-based measures such as antenatal counselling, strengthened labour monitoring, consultant audits, and promotion of vaginal birth after caesarean (VBAC).
A Gates Foundation–funded initiative across eight facilities in 2022–23 yielded mixed results, demonstrating that training alone is insufficient without strong clinical governance, leadership accountability, and midwife-led care models.
Scientific research also supports the effectiveness of comprehensive maternal health interventions. Studies suggest that improved antenatal care, health education, and diagnostic services can significantly reduce unnecessary C-sections, while broader stakeholder engagement – including policymakers, healthcare providers, and families – is essential to sustainable reform.
Government Acknowledges Gaps
Senior government officials acknowledged shortcomings in the implementation of national guidelines on childbirth practices. Health Services Division Secretary Md Saidur Rahman admitted that regulatory efforts have been inadequate and emphasised the need for better monitoring, licensed facilities, reliable data, and properly equipped labour rooms.
DGHS Director General Prof Md Abu Jafor warned that the rising C-section rate threatens Bangladesh’s ambition to achieve universal health coverage by 2030. He noted that surgical deliveries are disproportionately concentrated in urban areas and private hospitals, highlighting persistent disparities in healthcare governance.
Experts at the event called for stricter regulation of private healthcare providers, stronger enforcement of national clinical guidelines, and sustained investment in midwifery care. They also stressed the need for public awareness campaigns to counter misconceptions about natural childbirth and empower women to make informed decisions about delivery methods.
A Broader Global Challenge
The crisis in Bangladesh reflects a broader global trend of rising C-section rates, often driven by commercialisation of healthcare, demographic changes, and social attitudes toward childbirth. Studies across countries have shown that C-section rates frequently exceed WHO recommendations, with private healthcare systems often exhibiting the highest proportions of surgical deliveries.
However, public health experts caution that while C-sections remain a life-saving intervention when medically necessary, their overuse undermines maternal and neonatal health outcomes. Addressing the problem requires systemic reforms, stronger accountability mechanisms, and a shift toward patient-centred, evidence-based maternity care.
Image: Save the Children
