Rahela Tasnim lay on a bed in an upscale hospital in Dhaka, the capital of Bangladesh. She was about to give birth. Her husband, Jahed, stood by.
“This is first baby in my family,” he said. “I’m quite happy”
Rahela was excited too, but she was nervous. Her baby was to be delivered surgically.
Rahela’s doctor told her that she could deliver her baby vaginally, but she decided to have a Caesarean section because she is a professional woman who wanted control over the timing of her child’s birth. That way she could plan her maternity leave and her return to work.
A large number of women worldwide are making the same choice.
In the United States, Caesarean sections have long been common, but rates are now rising fast in many less wealthy nations, including in Asia. The C-section rate in Thailand has reached 34 percent. In Vietnam, it is 36 percent. And in China, nearly half of all births are by C-section.
In Bangladesh, many women who choose C-sections say they do so for convenience and to avoid the pain of childbirth. It is primarily the middle and upper classes that opt for C-sections, but the rate is also rising among the poor.
“That is a complete change,” said Sister Gillian Rose, who runs Bollobhpur Hospital in West Bangladesh.Rose sees the growing rate of C-sections as a troubling trend. She said one of the reasons more women are having Caesareans is that private doctors at private clinics are telling women they need the surgery when they do not.
“Private clinics are just springing up like the plague with no government regulation, and the doctors basically are getting rich quick,” said Rose.
And while doctors may be profiting, some women may be suffering.
“In settings where surgery is not safe, what we have been seeing is increased risk of hysterectomy and other severe complications,” said João Paulo Souza, an obstetrician for the World Health Organization who has studied the ballooning number of C-sections in developing countries.
Dr. Shams El Arifeen, a senior health researcher in Dhaka, said there is another downside to the booming rate of C-sections in poor countries like Bangladesh. These countries have a limited capacity to provide safe surgical births, so when women undergo unnecessary C-sections, “those who actually need [them] are… being pushed out of that system,” he said.
El Arifeen said in Bangladesh the problem is not the overall rate of C-sections, which stands at 12 percent and falls within WHO recommendations. The problem, he said, is that many women who have C-sections do not need them, and many who do need them go without.