OBJECTIVES

Caesarean section (CS) has been on the rise in Bangladesh. In Bangladesh, this rate has increased from about 3% in 2000 to about 24% in 2014. This study examines the association of socio-demographic, healthcare and spatial characteristics of mothers with CS, using data from latest Bangladesh Demographic and Health Survey (BDHS).

METHODS

The study is based on data from 2014 BDHS. BDHS is a nationally representative survey which is conducted periodically and 2014 is the latest of the BDHS conducted. Data collected from 4,627 mothers who gave birth in health care institutions in three years preceding the survey was used.

RESULTS

Average age of the mothers was 24.6 years. Convenience and labor pain avoidance were two main reasons mentioned by the mothers for elective CS. Older mothers (25-29 years) had higher odds of delivery by CS [OR= 2.29;CI=1.55-3.38] than adolescent mothers (15-19 years). Chance of CS decreases with higher birth order, e.g., second birth order [OR=0.58;CI=0.43-0.78], and third order or higher [OR=0.42;CI=0.29-0.63] in comparison to the first birth. Mothers who lived in urban areas had higher odds of CS delivery [OR=1.91;CI=1.15-3.16] than mothers who lived in rural areas. Mothers who received higher number of ANC visits had higher chance of CS, e.g., 1-2 visits [OR=2.31;CI=1.44-3.70], and 3 or more [OR=3.47;CI=2.18-5.52]. Mothers who had delivery in private facilities had higher chances of CS done [OR=47.73;CI=34.24-66.54]. If the delivery is conducted in an urban private facility the odds of it being a CS are 50 times higher than a normal delivery.

CONCLUSIONS

Bangladesh health system urgently needs policy guideline with monitoring of clinical indications of CS deliveries to avoid unnecessary CS. Strict adherence to this guideline, along with changing popular perception of unsafe nature of the CS can achieve increased institutional normal delivery in future.