Prevalence and correlates of cesarean section delivery and physician attendance during cesarean section in Bangladesh: evidence from nationally representative data 2017-18.

backgroundCesarean section (CS) rates in Bangladesh have increased dramatically from 3% in 2000 to 33% in 2017–18, substantially exceeding the recommended 10–15% range in global maternal health literature. While CS can be lifesaving when medically indicated, concerns exist regarding both overutilization and the qualifications of providers performing these surgical procedures. As CS is a major surgical procedure legally restricted to Bachelor of Medicine and Bachelor of Surgery (MBBS)-qualified physicians under Bangladeshi law, examining physician attendance distinct from the broader category of medically trained providers is critical for evaluating obstetric care quality and regulatory compliance. Therefore, this study aimed to identify the prevalence of CS delivery and physician-attended CS for women and its associated factors in Bangladesh.

methodsData from the Bangladesh Demographic and Health Survey (BDHS) 2017–18 were analyzed for 3,650 women aged 15–49 years who delivered at health facilities within three years preceding the survey. ‘Physician attendance’ was identified using the BDHS question on delivery attendants. Respondents who reported ‘doctor’ (MBBS or higher qualification) as a delivery attendant were classified as having physician attendance. This is distinct from the broader BDHS category of ‘medically trained providers,’ which includes doctors, nurses, midwives, and other trained personnel. Binary logistic regression, guided by Andersen’s Behavioral Model, examined factors associated with (a) CS delivery and (b) Physician-attended CS. All analyses incorporated sampling weights to account for the complex survey design.

resultsThe prevalence of CS delivery was 33% (n = 1,741). Among CS deliveries, 24.3% (n = 423) had physician attendance. Factors significantly associated with CS delivery included geographic division, maternal age, antenatal care by physicians, birth order, education level (women and husbands), and wealth index. Similarly, regional location, maternal age, education, and wealth were significantly associated with physician-attended CS. Media exposure was associated with lower odds of CS delivery, but showed no significant association with physician-attended CS.

conclusionsThis cross-sectional analysis identified significant sociodemographic gradients in both CS utilization and physician-attended CS. The findings suggest the need for improved facility reporting systems to distinguish medically indicated CS, strengthened regulatory oversight of private facilities, equitable deployment of qualified obstetric physicians in underserved regions, and evidence-based antenatal counseling on delivery options. Longitudinal research with clinical data is needed to establish causal pathways and inform targeted interventions.