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Cesarean Section is a life-saving intervention: Let’s prevent it’s misuse

Cesarean Section is a life-saving intervention: Let’s prevent it’s misuse. Outline of presentation. Problem Statement Situation analysis Why the increasing trend C-section Progress made so far Ask and way forward. Problem. Delivery is a physiological process.

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Cesarean Section is a life-saving intervention: Let’s prevent it’s misuse

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  1. Cesarean Section is a life-saving intervention: Let’s prevent it’s misuse

  2. Outline of presentation • Problem Statement • Situation analysis • Why the increasing trend C-section • Progress made so far • Ask and way forward

  3. Problem

  4. Delivery is a physiological process • Normal delivery is a physiological process • Some deliveries need selected intervention • Only 10-15% requires Cesarean Section delivery

  5. Where are we now? National trends in caesarean section, 2004–2014 1.9 percentage point increase per year! Bangladesh Demographic and Health Surveys

  6. Quality of care: c-section Overall 23% deliveries are by c-section By socio-economic quintiles By facility types Bangladesh Demographic and Health Surveys, 2014

  7. Situation analysis

  8. High CS – High MMR Expected CS – Low MMR • Unnecessary CS is predominant • Those who need, do not have timely access to CS. • CS is done only to women who are in absolute need. • Everyone has timely access to CS. • Bangladesh: • CS 23% - MMR 176 • Nepal: • CS 20% - MMR 258 • Netherlands: • CS 14% - MMR 7 • Sweden: • CS 18% - MMR 4 High CS – Low MMR Low CS – High MMR • Women who are in absolute need get CS. • In addition, unnecessary CS is done. • Poor health systems with very limited access. • Even those who need, do not have timely access to CS. • Sri Lanka: • CS 35% - MMR 30 • USA: • CS 33% - MMR 14 • Sub-Saharan Africa: • CS <6% - MMR 500+

  9. C-Section vs. maternal mortality 100 32 15 10 % caesarean section rate, log scale 3.2 1 0.3 1000 1 3.2 320 10 100 32 mmr (per 100,000), log scale

  10. Current Situation of Bangladesh • More than 570,000 CS—were medically unnecessary. • Up to 284,160 women, mainly from poorer communities, are in need of a C-section but are unable to access one. • In 2016 Bangladeshi parents paid a combined $315 million in out-of-pocket expenses for C-sections that were medically unnecessary. That’s an average cost of $552 per case, including wage loss. Live saving CS Unnecessary CS: 70% Need live saving CS, Can’t have it 15% Facility Delivery 37% Home delivery 63% CS: 60% Bangladesh Demographic and Health Surveys, 2014

  11. Why is C-Section increasing in Bangladesh

  12. The conflict…. Economic interest Clinical Standard Ethics Skills Regulation Information Client Choice

  13. Progress made so far

  14. Policy attention: • Honorable Minister of Health and Family Welfare has gone on record to mention the rising trend of C-Section in Bangladesh and its’ alarming repercussions on mothers and children in many discussions, forums, meetings. • The Program Implementation (PIP) (2017) has integrated C-Section under one of the rising challenges of attaining good Maternal and Neonatal Health. the PIP mentions the rising popularity of C-Sections in Private facilities while the quality if questionable. • BDHS policy brief (2014) quotes…. “Intervene judiciously to limit the rapid increase in caesarian sections (CS)”…..indicating rise in C-Sections in the last three years being well above recommended range.

  15. Research: • icddr,b pursuing a research work with BRAC University Public Health students • Matlab study (both private and public) [Tahminaet al yet to be published] found CS for Absolute Maternal Indication was only about 1.4% • Sylhet Study (all private) [Tahmina et al yet to be published] 82% by CS, maximum was up to ALL (100%) • Matlab maternal and foetal complication during labour study F Huda (2012) [published]

  16. Recommendation from stakeholders consultations • Awareness building on harms of unnecessary CS and, promotion of NVDs • Health systems strengthening • Strengthening regulatory framework: • Review existing law, rules and procedures to propose modifications. • Develop a plan to ensure enforcement of existing laws, related to licensing and renewal. This should be aligned with Standard Operating Procedure (SOP). • Develop, maintain and update a database of qualified Obstetricians and make it accessible to public • Mandatory establishment of midwifery led NVD care at all private hospitals/clinics. This should be a pre-requisite to allowing CS and periodically monitored to ensure compliance • Enhance competencies and skill of NVD among the providers. • Enhance and expedite introduction of midwife led delivery care • Modify program strategies: Equal incentive for NVD and CS in DSF facilities, Expedite strengthening of UH&FWC, Establish functional 24/7 CEmOC in district and selected UHCs, Create a special monitoring cell at the DGHS to ensure 24/7 services, Establish functional referral system • Ensure facility readiness and promote standard practice: Strict adherence to labor room protocol and SOP for all maternal care, mandatory use of Partograph

  17. Ask and next steps

  18. Ask for each of you • Volunteer if you feel passionate • Pick up your role • Become a champion – take initiative • Stay connected

  19. Website and Social Media • Website: www.stopuncs.org • Facebook page: stopuncs • Email: stop.uncs@gmail.com

  20. Thank you

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