Trends, District-Level Variations, and Socioeconomic Disparities in Cesarean Section Delivery and its Association with Neonatal Mortality in Bangladesh

BackgroundCesarean section (CS) rates have risen dramatically worldwide, with a majority of the countries exceeding the World Health Organizations (WHO) preferred rate of 10-15%. However, disparities exist, with evidence suggesting that socioeconomic disadvantage and geographic location play significant roles. Despite this, comprehensive estimates, especially in Bangladesh, remain scarce. This study aims to determine trends, district-level variations, and socioeconomic disparities in CS rates in Bangladesh. MethodsData from six rounds of Bangladesh Demographic and Health Surveys were analyzed. The considered outcome variables were the occurrence of CS delivery in relation to the mode of delivery and delivery place. Neonatal mortality was also assessed as another outcome variable. Explanatory variables included districts, wealth quintiles, and socio-demographic characteristics. Descriptive statistics were used to provide an over-the-year trend and variation in CS delivery in Bangladesh. Multilevel mixed-effects binary logistic regressions were used to explore predictors of CS delivery and the association between CS and neonatal mortality. ResultsBetween 1999/2000 and 2017/18, hospital births in Bangladesh increased by 42%, primarily driven by a substantial rise in CS delivery, from 30% to 66%. Private healthcare facilities played a significant role, contributing 80% of the countrys total CS delivery in 2017/18, a substantial increase from 45.5% in 1999/2000. In contrast, CS delivery rates in government healthcare facilities decreased from 49.7% to 15.5% during the same period. Deficient use of CS was reported by women in border and hilly districts, as well as those in the poorest wealth quintile. A clear link between a CS delivery and neonatal mortality was not found. ConclusionThe uneven distribution of CS delivery across districts and socioeconomic groups underscores the need for a more nuanced approach to childbirth. While government efforts to curb unnecessary use of CS have fallen short, this study suggests a one-size-fits-all strategy could worsen disparities. Instead, the focus should shift from mere accessibility to ensuring justified and appropriate utilization, with public healthcare facilities playing a key role in offering safe alternatives.