Child mortality rises, C-section delivery too 

Infographics: TBS

The mortality rate for children under five years has increased in the country while the overall death rate rose for the fourth time in a row, according to the Bangladesh Sample Vital Statistics 2023 published by the Bangladesh Bureau of Statistics (BBS) today.

Last year, 33 out of every 1,000 children under the age of five died, compared to 31 in 2022.

The death rate for newborns and children under one year of age also rose. Twenty out of every 1,000 newborns under one month died in 2023, up from 16 in 2022. Moreover, 27 out of every 1,000 children under one year of age died in 2023, an increase from 24 in 2022.

The child mortality rate for those under five increased in both urban and rural areas.

BBS also found the Caesarean section (C-section) delivery rate has increased by 9% in a year. In 2023, the C-section delivery rate was 50.7%, which was 41.4% a year ago.

Ahmed Ehsanur Rahman, associate scientist at the Maternal and Child Health Division of icddr,b, told TBS that there are three main causes of neonatal mortality in the country: low birth weight and premature birth, respiratory distress after birth, and infection and pneumonia.

"The majority of neonatal deaths in the country are due to premature birth and low birth weight. To address this, we have opened 'kangaroo mother care' centres in hospitals. However, these centres are not easily utilised," he said.

A newborn should be admitted to a kangaroo mother care centre for four to five days, during which time the mother is trained and then sent home to practise the care, Ehsanur said. There are 300-400 kangaroo mother care centres across the country, but only a few of them provide good quality care, he said, adding that newborns are not brought to the rest of the centres.

The icddr,b scientist said that it is terrible news that despite the increase in facility births, the number of deaths due to respiratory distress after birth is not decreasing.

"This means that even though a baby is born in a hospital, there is a shortage of skilled manpower and equipment needed to save the baby after birth. Therefore, we should now focus on improving the quality of the services that are available," he said.

The icddr,b scientist said that the data from the recent BBS survey reflects the true reality. Previously, the child mortality rate was not properly calculated, he added.

"In order to achieve the SDG target of reducing neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births by 2030, we need to significantly increase investment in child mortality prevention. Otherwise, we will not be able to achieve the SDGs," Ehsanur said.

Births by C-section increases

The natural childbirth rate has significantly decreased, as per the BBS finding.  

In 2023, the natural childbirth rate was 49.3%, compared to 58.6% a year earlier. In urban areas, 59.1% of births occurred through caesarean delivery in 2023, compared to 53% the previous year.

However, the hospital birth rate has increased. In 2023, 32.77% of births occurred at home, compared to 42.31% in 2022.

Commenting on the issue, Ferdousi Begum, former president, Obstetrical and Gynaecological Society of Bangladesh, told TBS that caesarean delivery is increasing due to lack of counselling of patients regarding normal delivery.

"C-section has become a tendency. Patients are afraid there will be problems in normal delivery. We do not have any counselling here. None of our hospitals have the post of councillor.

"Many people don't want to bear the pain [of normal delivery]. They have to be given epidural anaesthesia, but we don't have that facility here in hospitals."

She also said, "Pregnancy is an unpredictable condition. Suddenly, the condition of the mother and child can become worse. Most of our hospitals do not have the equipment needed to start treatment quickly if a patient's condition deteriorates.

"Besides, a patient requires one nurse and one midwife but we don't have a nurse and a midwife here for every 100 people. Shortage of manpower remains high," said the doctor.

The World Health Organization (WHO) always recommends that a country should accept a maximum of 10%-15% of C-section births, but anything higher is alarming.

In Bangladesh, the unnecessary higher Caesarean deliveries are causing physical harm to mothers and financial losses to families, WHO said.

Life expectancy declines

The mortality rate in Bangladesh rose once again for the fourth time in a row.

In 2023, the crude death rate was 6.1 in every 1,000, up from 5.8 in 2022. With the crude death rate seeing an increase of 0.3 in every 1,000 in a year, life expectancy has dropped as well.

The life expectancy was 72.3 years in 2023 compared to 72.4 years in 2022.

The rate in men is higher than in women, which is 6.8 in every 1,000 and 5.5 in every 1,000.

Maternal mortality has decreased. In 2023, the maternal mortality rate was 136 per lakh, compared to 153 in the previous year.

The rate in villages is higher (6.4 in every 1,000) than in cities (5.2 in every 1,000).

Heart attack killed 1.02 in every 1,000 in Bangladesh in 2023, making it the biggest killer once again, same as last year.

The nine other diseases that killed Bangladeshis the most were strokes, respiratory diseases, liver cancer, asthma, common fever, high blood pressure, pneumonia, cardiovascular diseases, and diabetes.