Summary
A medRxiv preprint analysing surveys of 26,539 recent mothers found that Bangladesh’s caesarean rate rose from 19.5% in 2012–13 to 52.0% in 2025. The researchers attributed most of the increase, in accounting terms, to more births taking place in facilities.
Bangladesh’s caesarean rate rose from 19.5% of births in 2012–13 to 52.0% in 2025, according to a medRxiv preprint analysing data from 26,539 recent mothers. The researchers’ accounting analysis attributed most of the 32.5-percentage-point rise to more births taking place in health facilities, where caesareans were already common.
The repeated cross-sectional study used Multiple Indicator Cluster Surveys from 2012–13, 2019 and 2025. It also examined caesarean use among facility births across 2,720 clusters in 2025, alongside modelled travel times.
Most of the increase followed a shift to facility births
In a decomposition of the change over time, the increase in facility births accounted for 82.8% of the rise in the national caesarean rate. A shift towards private facilities accounted for another 12.6%. A separate, one-step version of the analysis grouped the effects of place of birth together; those effects accounted for 94.7% of the rise.
These figures describe how the overall rate changed as birth settings and sector mix changed. They are not estimates of how many individual caesareans were caused by moving into facilities. The study found that caesareans were much more common in private facilities than in public ones: the private-sector rate increased from 79.1% to 86.1% between 2012–13 and 2025, while the public-sector rate fell from 38.7% to 33.5%.
Private-sector rates and local patterns
The high private-sector rate appeared across household wealth groups: in 2025 it was between 85% and 87% in each group. Among first births in private facilities, the rate in 2025 was 4.8 percentage points higher than the researchers’ model based on 2012–13 data predicted. First births are useful for examining changes in caesarean use because they rarely follow a previous caesarean.
The researchers also found geographic clustering in caesarean use among facility births. The private-sector share of births in nearby clusters accounted for much of this pattern, rather than household factors alone. Longer modelled travel time was associated with fewer caesareans, mainly because fewer births occurred in facilities. Within the private sector, travel time was not associated with caesarean use: the prevalence ratio was 0.99 per additional 10 minutes of travel time (95% CI 0.97 to 1.01).
The preprint’s survey-based analysis cannot determine how many caesareans were medically needed. Its findings point to birth setting and the private-sector share as major contributors to the national increase in accounting terms, but do not establish the clinical reasons for individual procedures. The authors conclude that, if the 2025 mix of birth settings and sector-specific rates persists, further growth in facility births would continue to raise the national rate.