Home ›› 30 Sep 2022 ›› Front
Deena (not her real name) was planning to deliver her baby normally at the Anwar Khan Modern Medical College Hospital in Dhaka, but the healthcare professionals working there convinced her to undergo a C-Section operation citing childbirth complications.
A caesarean section, or C-Section for short, is an operation to deliver one or multiple babies through a cut made in the mother’s abdomen and womb. The procedure – though touted as safe and convenient – is far more expensive, and can trigger lasting health complications.
After convincing Deena for a C-Section, the hospital tried to charge her Tk 1 lakh – which included doctor’s fee – for three days of stay. The healthcare facility later dropped the fees to Tk 80,000. Deena paid them over Tk 1 lakh, as she had to stay there for two additional days.
“It is difficult to provide a breakdown on why the bill went so high, as the hospital charged us for a lot of different things. The doctor charged me Tk 35,000 for the operation alone. The costs should be around Tk 15,000, as I had no major complications,” Deena told The Business Post.
The number of C-Sections being performed in Bangladesh has skyrocketed in recent years, industry insiders say, adding that many private hospitals and soon-to-be-mothers now prefer C-Section to normal delivery, believing it to be the more convenient and less painful method.
According to a survey conducted by Bangladesh Institute of Development Studies (BIDS) between 2004 and 2018, overall prevalence of CS among Bangladeshi mothers show an alarmingly upward trend, rising from 3.99 per cent in 2004, to 33.22 per cent in 2018.
The report is titled Massive boom of Cesarean delivery (C-Section) in Bangladesh: A household level analysis (2004-2018)
Private hospitals and clinics are taking advantage of this boom by charging whatever they deem fair for C-Section operations and post-operative care, as there is no government set rate in such facilities.
While government or donor-run medical facilities charge zero or around Tk 5,000 for this service, costs of a CS operation at a private hospital or clinic can go as high as Tk 2.55 lakh, with baby care costing new mothers an additional Tk 20,000.
An analysis of costs and services provided by the public and private healthcare facilities show that there is little difference between the treatments they provide, despite several private hospitals claiming they charge more because they provide better healthcare services.
Clinics operating under the Surjer Hashi Network (SHN) – which offers health and family planning services primarily to the poor and the ultra-poor people – can provide all the facilities found at an expensive private clinic, but at a fraction of the costs.
C-Section delivery at any Surjer Hashi Clinic costs around Tk 11,000 to Tk 14,000, while normal delivery costs around Tk 3,000. Pointing out that private hospitals and clinics are charging exorbitantly, experts urged the government to fix the maximum rates for maternity services.
Commenting on the matter, National Committee on Health Rights Movement Chairman Dr Rashid-E-Mahbub said, “Safe birth must be affordable for all. A lack of wealth should not be a barrier to get proper maternity services.
“The government needs to act fast to put a stop to the unethical practice of private hospitals exorbitantly overcharging the soon-to-be mothers.”
Private hospitals charge whatever they wish
The Business Post conducted spot visits to nearly 20 private hospitals and clinics in Dhaka to collect detailed information about the current costs of childbirth. Small clinics charge around Tk 40,000 to Tk 50,000, and sometimes more for C-Section deliveries.
For the same service, mid-level clinics and hospitals are charging Tk 50,000 to Tk 85,000, which can go up to Tk 120,000 if there are complications.
In the capital, among the mid-level hospitals, only Ad-Din Women’s Medical College Hospital is charging a relatively lower amount for C-Section deliveries. This hospital has no package system, but their detailed service list shows that the operation fee is Tk1,500.
If a patient stays in a single cabin, the total cost will be around Tk 20,000.
Meanwhile, some private hospitals in the city are charging from TK 80,000 to Tk 280,000 for the same operation. The costs may climb up to Tk 400,000 if there are health complications.
An official of the Lab-Aid Hospital in Dhanmondi says they charge large amounts of money because they are providing top services. The official added that a person needs to be prepared to spend around Tk 120,000 for any C-Section operation in the hospital.
“A patient will get an accurate estimation of costs for her stay and operation after she visits a doctor at this hospital,” the official said on condition of anonymity.
BRB Specialized Hospital has seven packages, and they charge between Tk 69,000 to Tk 158,000. Evercare Hospital Dhaka has five packages and charges Tk 145,000 to Tk 255,000, Square Hospital has eight packages under two categories and charges Tk 111,000 to Tk 238,300, and United Hospital charges Tk 115,000 to Tk 250,000 under three packages.
Why are C-Sections going up?
A BIDS household level survey shows that Bangladesh has the highest percentage of C-Sections compared to its neighbours India, Pakistan, Nepal, and Myanmar.
C-Sections accounted for 33 per cent of Bangladesh’s childbirths in 2017-18, which was 22 per cent for India in 2019-21, 22 per cent for Pakistan in 2017-18, 16 per cent for Nepal in 16 per cent, and 17 per cent for Myanmar in 2015-16.
Dr Shamima Haider Moon, a consultant at the Impulse Hospital, said, “The healthcare professionals at government hospitals are doing very well, but a good number of patients still prefer private hospitals.
“This is because we are providing better healthcare services. Most of the patients coming here for deliveries are opting into C-Section operations to avoid pain. The costs are higher compared to public hospitals because healthcare professionals here are using more expensive equipment.
“From gloves, to medical devices, the equipment used by private hospitals is more costly. So the rates go up. Besides, the women now are less willing to endure the pain of normal childbirth, so they prefer C-Section.”
Dr Azizul Azim, program manager (MNCH) under Directorate general of Health Services (DGHS) said, “We encourage soon-to-be mothers to opt for the normal delivery method at government hospitals.”
When asked about much higher costs of childbirth at private hospitals, Azim said, “Public hospitals are our only concern.”
What are the risks of C-Section?
Deputy Director of Mohammadpur Fertility Services and Training Centre (MFSTC) Dr Maksuda Begum said, “We always encourage mothers to have normal deliveries in our facility, as C-Sections can trigger many long term health complications.
“The risks include infection of the uterus, post cesarean infection in abdomen, and blood clots.”
A Swedish study published in 2021 found that Caesarean section is associated with an increased risk for bowel obstruction, incisional hernia, and abdominal pain. More than one section delivery added significantly to the risk for these complications.
A C-section also increases the risk of the uterus tearing along the scar line who attempt a vaginal delivery in a later pregnancy, said member Secretary of Obstetrical and Gynaecological Society of Bangladesh’s (OGSB) Scientific Sub-Committee Assistant Prof Dr Runa Akhter Dola.
Painless normal delivery an expensive alternative
Dr Shamima Haider, one of the team members of Impulse Hospital’s Painless Normal Delivery Team, said, “In 60% of the cases, C-Section can be avoided by opting into painless (epidural) normal delivery.
“In this procedure, a health care professional injects a local anesthesia into the space around the spinal nerves in the patient’s lower back. This anesthesia usually blocks the pain from labour contractions and during the birth very effectively.”
Many private hospitals in the country have already started the procedure, but government hospitals are yet to start it due to not having the required facilities, she said.
In Impulse hospital, a patient would need to spend at least Tk 50,000 for a two-day stay and painless normal delivery, while BRB hospital is charging Tk 52,000 to Tk 93,000 under seven packages for a single day stay.
Square Hospital is charging Tk 60,300 to Tk 91,300 for painless normal delivery.
