Prevalence, Geographic Variation, and Factors Associated with Caesarean Section Delivery in Bangladesh: A Multilevel Analysis of MICS 2025

In many parts of the world, the way a baby is born has shifted dramatically over the last few decades. While childbirth was once almost exclusively a natural process, it is now increasingly common for babies to be delivered through surgery, known as a Caesarean section. This medical procedure involves making an incision in the mother's abdomen and uterus to remove the baby. For decades, health experts have debated the right balance. While the surgery is life-saving when a mother or baby faces a genuine medical emergency, using it too often without a clear medical reason can introduce unnecessary risks and costs. The question of how often this surgery should happen is not just a medical one; it is deeply tied to where a person lives, how much money they have, and what kind of care they receive. Understanding these patterns is crucial because a rate that is too low can mean women are dying from complications that could have been prevented, while a rate that is too high suggests that resources are being used for procedures that might not be needed.

A recent study focused on Bangladesh, a country where the use of Caesarean sections has risen sharply in recent years. Researchers wanted to understand exactly how common this surgery has become and what factors are driving it. They looked at data from a massive national survey conducted in 2025, which gathered information from thousands of women across the country. By examining the records of 6,675 women who had recently given birth, the team could see not just the overall numbers, but also how the situation varied from one region to another and how it differed based on a woman's age, wealth, and the care she received during her pregnancy.

The findings reveal a startling reality: in Bangladesh, Caesarean sections have become the norm rather than the exception. The study found that nearly seven out of every ten women, or about 73 percent, gave birth via surgery. This is a significant jump from previous years, indicating a rapid transformation in how babies are delivered across the nation. However, this high rate is not spread evenly. There are deep divides depending on where a woman lives. In the Khulna division, the rate was the highest, with more than eight out of ten women undergoing the surgery. In contrast, the Chattogram division had the lowest rate, though it was still high at nearly 60 percent. Even within the same country, the likelihood of a surgical birth varies wildly based on geography.

Beyond location, the study uncovered that a woman's personal circumstances play a major role. Women from the wealthiest households were more likely to have a Caesarean section than those from the poorest families. Similarly, older mothers, specifically those between 35 and 49 years old, were more likely to undergo the surgery compared to younger women. Interestingly, the number of children a woman had already given birth to mattered as well; mothers who had three or more children were less likely to have a Caesarean section than first-time mothers. Perhaps the most striking factor was the amount of prenatal care a woman received. Women who visited their doctors frequently during pregnancy were much more likely to end up with a surgical delivery. Those who attended eight or more check-ups were significantly more likely to have a Caesarean section than those who visited fewer times.

The researchers also looked at where the birth took place. The difference between public and private hospitals was stark. In private facilities, the vast majority of births were by Caesarean section, whereas in public hospitals, the rate was much lower. This suggests that the type of healthcare facility a woman chooses, or is able to access, heavily influences the outcome. Contrary to findings in some other countries where city dwellers often have higher rates, the data for Bangladesh showed that women living in rural areas were actually slightly more likely to have a Caesarean section than their urban counterparts.

These patterns point to a complex mix of influences. The high rates among wealthy women and those with frequent doctor visits suggest that access to care and perhaps a preference for the perceived safety or convenience of surgery are driving the numbers up. The fact that the rates are so high in some regions but lower in others indicates that local healthcare systems and practices vary greatly. The study does not claim to know the exact medical reasons for every surgery, as the survey data did not include detailed medical records for each birth. However, the strong link between high numbers of prenatal visits and surgical delivery suggests that the more a woman interacts with the medical system, the more likely she is to be steered toward a Caesarean section, whether by her own choice or a doctor's recommendation.

Ultimately, this research highlights that while Caesarean sections are a vital tool for saving lives, their use in Bangladesh has reached levels that warrant careful attention. The fact that nearly 73 percent of births are surgical, with some regions exceeding 80 percent, is far above the range that health organizations consider optimal for a population. The study concludes that there is a need to monitor these practices closely and ensure that surgeries are performed only when medically necessary. By understanding who is getting these surgeries and where, health officials can work toward a system where every woman receives the right kind of care for her specific situation, balancing the need for medical intervention with the goal of avoiding unnecessary procedures.