The Impact of High C-Section Rates on Bangladesh's Progress Towards SDG 3.1

Bangladesh has substantially reduced maternal mortality amid rapid growth in C-section use, yet Sustainable Development Goal (SDG) 3.1 remains unmet. The objective of this ecological secondary data analysis was to explore national co-trends, district inequalities, and the consequences for meeting the aim of fewer than 70 maternal deaths per 100,000 live births by 2030. The data covered the seven rounds of the Bangladesh Demographic and Health Surveys (1999/2000-2022) as well as annual estimates of maternal mortality ratio (MMR) at WHO/United Nations level (2000-2023) and survey-weighted estimates of C-section rates for all 64 districts in 2022. Analyses included average annual reduction rates, 2030 continuation scenarios, district variation and uncertainty, and matched-year correlation. National C-section use rose from 2.8% to 44.0% and facility delivery from 8.7% to 63.5%, while MMR declined from 522.7 to 115.1. The long-term trend 2030 MMR was 72.6 and the recent trend 2030 MMR was 69.9. District estimates of the C-section ranged from 10.0% to 77.0% of the total population, with 48 districts having estimates higher than 30%, 26 higher than 50%, and five higher than 70% of the total, with 25 districts having reliability limitations. The association between the use of cesarean section and MMR was strongly negatively correlation (r = -0.922), but the opposite temporal trends do not allow for causal inferences. Satisfactory provision of C-sections, improved essential obstetric services, district responsive interventions, and condition-specific monitoring are all critical for achieving SDG 3.1.