Caesarean section use and inequalities in Bangladesh in regional context: comparisons with West Bengal and Nepal.

BACKGROUND

Caesarean section (CS) can be life-saving when medically indicated, but its rapid increase raises concerns about overuse and unequal access.

OBJECTIVE

To characterise CS prevalence, facility patterns, socioeconomic inequality, and associated factors in Bangladesh, and descriptively compare these patterns with Nepal and West Bengal, India.

METHODS

We analysed cross-sectional data from the 2022 Bangladesh and Nepal Demographic and Health Surveys and the West Bengal sample of India's National Family Health Survey-5 (2019-2021). Analyses included each woman's most recent live birth in the preceding 5 years. We estimated weighted prevalence, concentration indices, and adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) using survey-weighted modified Poisson regression.

RESULTS

CS prevalence was highest in Bangladesh (44.6%), followed by West Bengal (34.8%) and Nepal (19.3%). Among facility births, the proportions delivered by CS were 69.3%, 37.4%, and 23.9%, respectively. Private for-profit facility delivery showed the strongest association with CS use in Bangladesh (APR 5.86; 95% CI 5.26-6.54), West Bengal (APR 3.02), and Nepal (APR 2.65). CS use was concentrated among wealthier women, with concentration indices of 0.20, 0.24, and 0.35, respectively. In Bangladesh, CS use was also associated with urban residence and more antenatal care visits; maternal age showed stronger associations in West Bengal and Nepal.

CONCLUSIONS

Bangladesh had higher CS use than West Bengal and Nepal, alongside high private-facility CS rates and substantial wealth-related inequality. Policies should strengthen monitoring and clinical audit to identify and review potentially unnecessary CS while ensuring timely access to medically indicated CS for disadvantaged women.