A judicial hurrah! HC endorses Health Ministry's caesarean control policy
In a cinematic moment etched in memory from the Bollywood movie "3 Idiots," one can recall the gripping natural childbirth orchestrated by engineering students for the college principal's elder daughter amidst a city submerged in floods. One cannot help but speculate that if circumstances had been different, would the principal have chosen a caesarean operation?
Today, as the spotlight turns to the High Court's endorsement of the caesarean control policy, we stand at the crossroads of redefining childbirth practices with safety and choice at the forefront of the debate.
The caesarean section, often abbreviated as C-section, is a surgical procedure designed to bring a baby into the world safely. This technique, involving a precise incision in the mother's abdomen, emerged as a lifeline in pregnancies where risks loomed for both mother and child.
The World Health Organisation (WHO) recommends that caesarean sections should account for only 10% to 15% of total deliveries in a country. Surprisingly, a 2022 report from the Bangladesh Health and Demographic Survey (BDHS) shows that the rate stood at 45% in the two years preceding the survey. This surpasses the WHO's recognised benchmark by an astonishing threefold.
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More startlingly, data from Save the Children Bangladesh showed a whopping 77% of C-sections in 2018. And roughly 860,000 procedures were found to be medically unnecessary. In private and NGO-affiliated facilities, the figures stand significantly higher at 83.70% and 43.90%, respectively, compared to public institutions.
While C-sections can be life-saving, they are not without risks. Mothers may face infections, fever, abnormal bleeding, muscular pain, organ damage and headaches. There is also a risk of anaesthesia, future pregnancy complications and even potential infertility.
It also deprives newborns of the natural birth benefits – like a boost of beneficial bacteria for the baby's immune system during their journey through the birth canal and earlier physical contact with the mother, fostering quicker breastfeeding initiation.
The concerning trend persisted for years, with authorities failing to take effective action. It was not until 2019 that a writ petition (No. 7117/2019) was filed by the Bangladesh Legal Aid and Services Trust (BLAST), urging the High Court to intervene. The plea sought directives to stop private hospitals and clinics from engaging in unwarranted C-sections on expectant mothers.
The High Court then issued a rule upon the Secretary of Health and Family Welfare Ministry, Director General of Health Services and President of the Bangladesh Medical and Dental Council to show cause as to why their failure to address this matter should not be declared to be without any lawful authority and of no legal effect.
The Hon'ble Court, in a decisive move, further issued an interim order mandating the respondents to form a committee of pertinent stakeholders within a month and formulate guidelines to deter medically unnecessary C-sections, with a six-month deadline for submission to the court.
The Health Ministry's proposed policy under the title "Bangladesh National Guidelines and Technical Standards and Operating Procedure for Promotion of Normal Vaginal Delivery (NVD), Prevention of Unnecessary Cesarean Section, Creating Awareness about Necessity and Justification of Cesarean Section" tackles multiple key issues, outlining a strategic approach in short, medium and long-term periods.
Long-term efforts emphasise the critical need to review and amend existing legal frameworks. Additional strategies encompass normal vaginal delivery education in undergraduate curricula, enhancement of skills among medical practitioners for normal delivery, facility readiness, awareness building and the implementation of routine counselling sessions to elevate ethical standards for healthcare practitioners.
The policy also underscores adherence to internationally recognised criteria for conducting caesarean sections. Additionally, it mandates obtaining complete patient consent for elective caesareans, emphasising that incomplete or misleading information will hold no legal weight and will be considered an offence.
On 12 October 2023, a distinguished double bench consisting of Honorable Justices Naima Haider and Kazi Zeenat Haque of the High Court Division officially endorsed the Ministry of Health's policy to curb unnecessary caesarean operations. This constitutionally binding verdict elevates the policy to a formal judgment, per Article 111 of the Bangladesh Constitution.
Furthermore, it mandates swift policy dissemination at all levels within the next six months. This groundbreaking decision reaffirms women's right to sexual and reproductive health protection. The government is expected to emphasise maternal well-being, especially in efforts to diminish unnecessary C-sections in Bangladesh.
Shilajit Kumar Roy is an LL.B. 4th year student in law discipline at Khulna University .
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.
