STOP Lets Unnecessary Cesarean Section stopuncs Problem Delivery

STOP Let’s Unnecessary Cesarean Section #stopuncs

Problem

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

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

Quality of care: c-section 50 Overall 23% deliveries are by c-section 27 10 7 18 2014 By socio-economic quintiles 80 38 Public sector 28 Private sector By facility types NGO

32 10 15 3. 2 1 0. 3 % caesarean section rate, log scale 100 C-Section vs. maternal mortality 1 3. 2 10 100 32 mmr (per 100, 000), log scale 320 1000

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

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

Progress made so far

Electronic and Print Media § Television Coverage: o RTV: Current Scenario of C Section Delivery in Bangladesh o Independent TV: Investigation on C Section Bangladesh o Ekattor TV: Talk Show § Press Articles: o BDNEWS 24. COM: Feature o ক ল র কণঠ : বনধ হ ক অপরয় জন য় স জ র য় ন o Bangla Tribune: স জ র য় ন ড ল ভ র এভ ব ব ড় উদব গজনক : সব সথয পরত মনতর o The Daily Jugantar: ভয় দ খ য় স জ র য় ন অপ র শন o The Daily Star: The curious case of the C-section অপ র শন য ওয়

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.

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]

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

Ask and next steps

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

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

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

Thank you