By Md. Zillur Rahaman

In the country, the number of obstetricians giving birth by cesarean is increasing at an abnormal rate. It has been alleged that a certain section of doctors or medical related persons are performing cesarean deliveries on pregnant mothers unnecessarily in order to earn extra money. In fact, an expectant mother and her relatives have to depend on a large extent on the immediate decisions of the doctors and nurses on duty. In many cases in remote areas proper examination is not done before cesarean delivery and unnecessary cesarean is pushed only for the greed of money. Many expectant mothers die prematurely in the clutches of unnecessary cesarean. And many surviving mothers and their babies are at serious health risk, which they have to suffer for the rest of their lives.

Recently, Bangladesh Bureau of Statistics (BBS) published a data of Bangladesh Sample Vital Statistics (SVRS 2023) 2023, it is said that 50.7 percent of children are born by surgery in the country. This rate is 9.3 percent higher than last year i.e. 2022. Last year, the surgical birth rate was 41.4 percent. According to public health experts, up to 15 percent of deliveries may require surgery. But surgery is more than 50 percent, i.e. 35 percent unnecessary surgery. Experts say that most of the surgeries are being performed without any necessity, which is very risky and harmful for the post-natal health protection of mother and child. The health department of the government is not able to reduce unnecessary surgeries in childbirth in the country.

Meanwhile, the guidance of the World Health Organization is that 15 percent of children may be born by cesarean in a country due to various reasons. But as per 2017-18 calculations, it is about 32.22 percent in Bangladesh and it was only 3.99 percent in 2003-2004. Apart from this, the rate of caesarean delivery in rural areas was only 1.97 percent at that time, which has risen to 29.18 percent in 2017-18, which is a major drawback to safe motherhood and an alarming picture for maternal and child health.

In fact, if complications arise during child birth, delivery mothers are provided with an alternative to normal delivery through cesarean. In the language of medical science, this is called a cesarean section (abbreviated C-section). It is said that the Roman Emperor Julius Caesar was born through an abortion, hence the name. However, there is disagreement among medical professionals as to how true this is. Some complications during delivery can threaten the life of mother and newborn. Caesarean section is then essential but it also causes some problems for mother and child. Therefore, special importance should be given to avoid cesarean unless absolutely necessary. But in our country the health risks of mother and child are not considered at all. The number of child births through unnecessary cesarean procedures is increasing at an abnormal rate only due to the greed of money and business mentality. As a result both mother and child are suffering.

Studies have shown that babies born naturally are smarter and more intelligent than babies born by caesarean section. If the rate of unnecessary caesarean births continues to rise, a situation will emerge in the near future when caesarean births will constitute a large portion of the population. Babies born through them are also more likely to be born by operation. In many cases, the head size of these children may be slightly larger. Then, in the end, the human species on earth may go to such a state, where human immunity will be a little weak, intelligence will be a little behind. It is not impossible for such problems to occur outside of the normal process.

Experts say that cesarean has now become a big business in most of the private hospitals and clinics in the country. This trend cannot be stopped in any way, rather private hospitals and clinics are becoming more reckless day by day. When a delivery mother is found, everyone from a class of doctors in private hospitals-clinics use various pretexts to make the patient mentally scared about normal delivery. In many cases, there is even fear of harming the mother or the newborn if the cesarean is not done. Desperately, the mother and her relatives agree to the hospital for the sake of a safe motherhood and a healthy child. And when the delivery method is agreed to through cesarean, the money-making negotiations begin. Allegations have been made that the doctors involved in cesarean get more money than normal delivery.

Hospital or clinic authorities are also busy with it. Because more time is required in hospital, more medicines are required, more expenses are collected starting from surgery and in some cases, various types of bacterial attacks occur after the operation. This increases the business of the hospital and if the delivery is normal, the patient can go home in a day or two. But after the cesarean, the patient has to stay for about a week. It is possible to collect more money in the name of hospital cabin or bed rent and various service charges. Expert doctors say that the trend of cesarean is increasing at an alarming rate in private hospitals and clinics now in government and various NGO hospitals and clinics.

In 2018 an article by researchers from six institutions including the International Centre for Diarrhoea Disease Research, Bangladesh (ICDDRB), the World Bank, an average obstetric cesarean costs Tk 22,850 in Bangladesh. Previous expenditure is considered current expenditure as no more national accounts are available. According to the latest Demographic and Health Survey, 3.63 lakh children were born in 2022 and of these, 45 percent or 16.90 lakh children were born by surgery. Among them, 10.72 lakh were born by unnecessary cesareans.

These babies would have been born naturally if not for unnecessary cesarean. Some natural births are at home, some in hospital. Previous researchers have found that normal delivery costs an average of Tk. 3,565. Due to unnecessary cesarean instead of normal delivery, each delivery incurred an additional cost of Tk 18,520. In 2022, the additional cost of childbirth was Tk. 1,986 crores. With this money, it is possible to run the cost of 14,208 community clinics for 3 years, as the government allocates Tk. 600 crore annually for community clinics.

Experts say, in practice, more than 15 to 20 percent of cesareans are unnecessary. But now the trend of cesarean is increasing outside Dhaka. They blame the business mentality of private hospitals and clinics as the reason. There is also a perception among mothers and families that caesarean section is safe but unnecessary cesarean increases the mother's risk of death and various physical complications. Actually it is not just a surgery, the patient has to be unconscious. As a result, his risk increases. Once the weapon has been manipulated, the next one has to be manipulated. Sometimes the uterus has to be removed. The birth sac also ruptures. Sometimes there is so much bleeding that the mother can no longer be saved.

Apart from the business mentality of hospitals and clinics behind the increase in cesarean, it has now become a fad for many. They feel that caesarean section is better for the mother's body and other things than natural delivery. This is a serious misconception and must be dispelled. To reduce cesarean, everyone should be made aware and this awareness should be created among patients and doctors. Safe motherhood is not limited to childbirth. This includes everything from the mother's pregnancy to delivery and post-natal care. The health and nutrition of the newborn depends on ensuring the health and nutrition of the mother, that is why the government and all the medical concerned should take effective steps to prevent it along with awareness.

The writer is a, Banker and Columnist