The Impact of Community Pressure on Cesarean Deliveries in Bangladesh: Insights from National Surveys

Cesarean deliveries are vital in the fight against maternal and child mortality. Yet, a concerning trend is emerging: unnecessary cesarean sections are skyrocketing worldwide, including in Bangladesh, where rates surged from just 2.9% in 1999 to an alarming 45% in 2022—51% for first-time mothers. This study sheds light on the striking prevalence and key determinants of cesarean deliveries in Bangladesh’s public and private healthcare facilities, highlighting an urgent need for deeper understanding and action. We utilized data from the Bangladesh Demographic and Health Surveys (BDHS) for the years 2011, 2014, 2017-18, and 2022. Chi-square tests were conducted to assess the bivariate relationships between cesarean sections and various background variables. To evaluate the net effect of each independent variable while controlling for other covariates, we employed binary logistic regression models. Alongside common socio-economic factors, sufficient antenatal care (ANC), delivery location (public vs. private), and community characteristics—such as literacy and cesarean prevalence—were significantly linked to cesarean deliveries. Women in high-prevalence communities were 11.68 times more likely to have a C-section for their last birth compared to those in low-prevalence areas. Additionally, those delivering in private facilities were 8.16 times more likely to have a C-section than those in public facilities. These findings indicate that the rising cesarean rates in Bangladesh may be influenced by both individual and provider-level factors, with community pressure being a significant contributor. Recommended policy strategies include enhanced monitoring, especially in private hospitals, and awareness campaigns highlighting the negative impacts of unnecessary cesarean deliveries in Bangladesh.