Right to safe motherhood
Oli Md. Abdullah Chowdhury
Growing trend among a section of doctors to earn money adopting any means has been discussed widely among different social tiers for a long period of time. Bangladesh Maternal Mortality Health Survey 2010 though appreciated an overall improvement in maternal health condition, also revealed a sharp increase in caesarean section deliveries. Many of the readers might be attracted to the news published in The Prothom Alo (April 19, 2011) revealing almost five-fold increase in caesarean deliveries in the last decade. Were all those caesarean sections necessary?
Progress in reducing maternal mortality
Bangladesh has made commendable progress in reducing maternal mortality. The survey has reported a decline of 40% in the maternal mortality by 2001 and 2010. Therefore, Bangladesh is progressing well towards achieving the MDG 5 related to maternal mortality. There are several factors contributed in reducing maternal mortality rate. They include behavioural change in seeking health care and reduction in fertility.
Health care is a basic necessity
Health has been mentioned as basic necessity in the constitution of Bangladesh. As stated in Article 15(a) of the constitution, it is the fundamental responsibility of the state to secure the basic necessities of life, including food, clothing, shelter, education and medical care. The successive governments have committed resources to improve health condition in the country. However, efforts made by different non-government agencies and private facilities have significantly contributed in improving maternal health condition and reducing maternal mortality.
Private facilities contributed to the two-thirds of deliveries occurred through caesarean sections. Many of those private facilities consider financial benefit ahead of the best interest of the patients. There are also reported incidents when poor patients had been trapped in the cycle of money-lenders having illicit ties with private facilities. They had no other option but to borrow money from money-lenders in order to carry out cesarean section.
Conveyance of the doctor and patience
The report further indicates that many women who needed a caesarean section could not avail it. Researchers found around 19 percent caesarean sections among women who reported no complications, had undergone through caesarean section presumably for the convenience of the women or the provider.
Hastiness on the part of obstetricians
Obstetricians do not want to wait for cervical dilatation that takes even four to six hours or more. Due to clinical impatience, doctors tend to conduct caesareans in the absence of medical reasons. Some faculties have expressed their concern because caesarean sections had been so common even in training institutes that fresh graduates were unable to learn normal deliveries.
Demand Side Financing
The practice is widespread not only in private hospitals, monetary incentives in selected government hospitals have also contributed towards increasing number of caesarean sections. A project, namely Demand Side Financing (DSF) implemented by the government provides extra incentives for doctors and health workers involved with cesarean sections in government facilities. Although the project aims to promote safe birth, medical professionals took this opportunity to earn an extra sum of money.
Caesarean sections have its impact on children also. A woman who has a caesarean usually has less early contact with her baby and is more likely to have initial negative feelings about her baby. Best interest of the child needs to be taken into consideration while making a decision of caesarean section. High rate of caesarean section in the country is alarming and there must be an accountability mechanism to check this growing trend.
The writer is human rights worker.