Determinants and Geographical Distribution of Caesarean Delivery at First Birth in Bangladesh: Evidence from the 2019 Bangladesh Multiple Indicator Cluster Survey

Abstract Background The prevalence of Caesarean section (CS) has increased substantially worldwide, including in Bangladesh. Evidence suggests that women undergoing CS at first birth are more likely to have repeat Caesarean deliveries in subsequent pregnancies, contributing to the continued rise in overall CS rates. This study aimed to identify the determinants of CS at first birth and examine its district-level geographical distribution in Bangladesh. Methods This study analyzed data from 3,180 women included in the 2019 Bangladesh Multiple Indicator Cluster Survey (MICS). The outcome variable was the mode of delivery at first birth. Explanatory variables at the individual, household, and community levels were considered. Bivariate analyses were performed to assess associations between CS and the explanatory variables, followed by multilevel logistic regression to identify factors independently associated with CS at first birth. Results Overall, 44.66% of first births were delivered by CS. Women aged 30 years or older, those who received four or more antenatal care visits, those delivering larger-than-average infants, and those giving birth in private health facilities had significantly higher odds of CS at first birth. Geographical analysis revealed marked district-level variation, with the highest prevalence concentrated in the Dhaka and Khulna divisions. Conclusions Nearly one in two first births in Bangladesh are delivered by CS, with substantial geographical disparities across districts. Advanced maternal age, delivery in private health facilities, frequent antenatal care utilization, and larger birth size were significant determinants of CS at first birth. These findings underscore the need for evidence-based clinical guidelines, strengthened monitoring of CS practices, and targeted interventions to reduce unnecessary Caesarean deliveries while ensuring equitable access to medically indicated obstetric care.