1. Let’s STOP Unnecessary Cesarean Section
#stopuncs

2. Problem

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

4. Complications of Cesarean Section
Clinical
post-surgery infection or fever
too much blood loss
injury to organs
emergency hysterectomy
blood clot
reaction to medication or anesthesia
emotional difficulties
scar tissue and difficulty with future deliveries
harm to the baby
Socio economic – Cost, wage loss, pressure on family support

5. Quality of care: c-section
Overall 23% deliveries are by
c-section
By socio-economic quintiles
This slide shows proportion of c-section conducted by place of delivery. 40% in public sector, 73% in private sector and 28 percent in NGO facilities. The issue is, possibly we have a quality of care issue here. And, if not addressed immediately this may grow bigger.
By facility types

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

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

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

9. Progress made so far

10. Electronic and Print Media
Television Coverage:
RTV: Current Scenario of C Section Delivery in Bangladesh
Independent TV: Investigation on C Section Bangladesh
Ekattor TV: Talk Show
Press Articles:
BDNEWS24.COM: Feature
কালের কণ্ঠ: বন্ধ হোক অপ্রয়োজনীয় সিজারিয়ান অপারেশন
Bangla Tribune: সিজারিয়ান ডেলিভারি এভাবে বেড়ে যাওয়া উদ্বেগজনক: স্বাস্থ্য প্রতিমন্ত্রী
The Daily Jugantar: ভয় দেখিয়ে সিজারিয়ান অপারেশন
The Daily Star: The curious case of the C-section

11. 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.

12. Research:
icddr,b pursuing a research work with BRAC University Public Health students
Matlab study (both private and public) [Tahmina et 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]

13. Website and Social Media
Website:
Facebook page: stopuncs

14. Ask and next steps

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

16. Next steps Summary of consultation – plan of action Keep you posted
Initiate dialogue to implement the plan of action

17. At the end of the campaign -
CS related policy and regulatory frameworks will be formulated, specified/clarified and modified.
Mechanisms and structures will be in place and functioning to enforce CS related policy/regulatory requirements
Systems (CS related) like record keeping, reporting, monitoring and QA will be strengthened
Professional standards, ethics and support systems will be defined, widely known and promoted
Citizen/consumer/patient rights will be defined, widely known and promoted
Benefits of NVD and harmful consequences of unnecessary CS will be widely known and promoted

18. Thank you