Unpacking Caesarean in Rural Bangladesh: Who, What, When and Where

Background: Bangladesh has experienced an alarming increase in birth through caesarean. In this article, we unpack women’s interpretation on why they underwent caesarean, with whom they locate the proposition of the caesarean and when the decision was made in rural Bangladesh. Methods: : We conducted a cross-sectional household survey of 2,299 women in Kushtia district. Of these, 1,233 who gave birth through caesarean completed a supplementary questionnaire. Descriptive statistics were used to report caesarean rates which were disaggregated by sociodemographic characteristics and contact with the health services. We analysed women’s reported reasons for having caesarean, when the decision was taken and who proposed the intervention. Findings: Over half (54%) of women gave birth through caesarean. The proportion of caesareans was significantly higher among women with higher educational attainment, higher socioeconomic status, and increased antenatal care during pregnancy, particularly if this care was sought in private facilities (p<0.05). Women reported that health service providers primarily proposed the caesarean (73%), followed by family members (21%) and finally, the woman herself (6%). Regarding the reasons for caesarean, 34% of women reported non-medical reasons (convenience and avoidance of labour pain), and 66% mentioned medical reasons. Over half of the women reported that the decision to undergo a caesarean was taken on the day of birth. Conclusion: Women in rural Bangladesh often report avoidable reasons for caesarean. Better regulation of caesarean services in both public and private health services, as well as improved counselling of women regarding caesarean indications and its consequences, is recommended.