Caesarean section in Bangladesh, 2012-13 to 2025: facility birth, the private sector and small-area geography
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Background
In Bangladesh, caesarean section rose from one in five births in 2012-13 to one in two in 2025. We asked how much of this rise came from more facility births, a move to private facilities, and changing rates within sectors.
Methods
This repeated cross-sectional study used Multiple Indicator Cluster Surveys from 2012-13, 2019 and 2025 (26,539 recent mothers). A Kitagawa decomposition split the rise into parts. For 2025, we mapped caesarean use among facility births in 2,720 clusters and examined modelled travel time.
Results
The caesarean rate rose from 19.5% (95% CI 18.1 to 20.9) to 52.0% (50.7 to 53.2). More facility births made up 82.8% (78.9 to 87.7) of this 32.5 point rise and the move to private facilities 12.6% (10.1 to 15.0). In a one-step version, place of birth made up 94.7% (90.7 to 98.9). The private caesarean rate rose from 79.1% to 86.1%, while the public rate fell from 38.7% to 33.5%. Among private first births, which rarely follow a previous caesarean, the 2025 rate was 4.8 points (0.3 to 10.2) above the 2012-13 model’s prediction. The 2025 private rate was 85% to 87% in every wealth group. Longer travel time was linked with fewer caesareans, mainly through fewer facility births. Among private-sector births, travel time was not linked with caesarean (prevalence ratio 0.99 per 10 minutes, 0.97 to 1.01). Caesarean use among facility births clustered geographically; the private share of births in nearby clusters, not household factors, accounted for much of this.
Conclusions
In accounting terms, most of the rise came from births moving into facilities, mostly private ones, where caesarean was already common. The data cannot show how many caesareans were needed. If 2025 sector mix and rates persist, more facility births would keep raising the national rate.
