Level, trend, and determinants of cesarean births in Bangladesh

Cesarean delivery plays a significant role in reducing maternal and child death. However, unjustified cesarean section is on the rise worldwide including in Bangladesh. Cesarean section rates are increasing in Bangladesh; it increased from 2.9% in 1999 to 33.2% in 2017 which is much higher for first births. This study aims to describe the prevalence and determinants of births by cesarean section in private and public health facilities in Bangladesh. Data from the Bangladesh Demographic and Health Surveys (BDHS) is used in this study for the period 2011, 2014, and 2017-18. Traditionally caesarian section increases with a pattern of adequate antenatal care and we also discovered the same. Among all institutional deliveries over the observation period, the mother’s age at birth, birth order of index child, wealth index, adequate antenatal care (ANC) visit, parental education, and place of delivery (public/private) were found to have significant association over this period. In multivariate analysis place of delivery, number of ANC visits, birth order of index child, and wealth quintile were found to be significant determinants of caesarian births in Bangladesh. Our findings suggest that increased cesarean section rates in Bangladesh may be driven by both individual-level and provider-level factors. Close monitoring is required to avoid unnecessary caesarian deliveries in Bangladesh.