Climate change's devastating toll: Salinity's impact on coastal women's health in Bangladesh

"It started with frequent lower abdominal belly pain, fever, urinal pain, cough, etc. Sometimes, there was blood in my urine if I did heavy work as a day labourer at a grocery shop or fish farm at that time. I used to take medicine from a non-professional local doctor because there are no proper treatment facilities here, and I couldn't afford it. My condition was getting worse, and I had to have my uterus removed later."

Rahima (38) from Gabura Union under Shyamnagar Upazila (Satkhira, Bangladesh) explained how she lost her uterus one and a half years earlier. She lives with two small children and does home-based tailoring for a living now. Her husband left them and settled another family somewhere else four or five years ago.

Like Rahima, many girls and women from coastal regions suffer from various diseases of the reproductive organs due to the harsh consequences of climate change, specifically salinity. With fresh water increasingly scarce, women and girls must wash their menstrual cloths and other sanitary items in water that is often dirty, salty or both, with serious consequences for their health. Some even resort to buying birth-control pills they can ill afford to stop their periods, especially during the dry seasons.

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Note: Salinity is the concentration of salt, mainly sodium chloride, in water or soil. It is measured in parts per thousand (ppt) or parts per million (ppm). Salinity levels can affect the suitability of water for drinking, agriculture, and aquatic life, making it a critical factor in environmental and agricultural management.

Geographical location makes Bangladesh one of the world’s most disaster-prone countries. According to German Watch's Global Climate Index, Bangladesh is the 7th country most affected by climate change, with related economic losses of 12 billion USD in the last 40 years. The people of the coastal areas of Bangladesh are facing more disasters linked to salinity, floods, cyclones, river erosion and thunderstorms than those in other countries.

Bangladesh’s coastal area is a considerable part of the country. About 29 per cent of the population live in the coastal areas (Ahmad, 2019). The entire southern region of our country lies just 2 metres above sea level.

Before diving into the current reality and sufferings, some geographical context helps understand the issue's importance. Almost all of the country’s 19 coastal districts are affected by moderate to severe salinity, which has increased in the last five years due to the impact of different cyclones over a small area (Kabir et al., 2016). Satkhira district was one of the more severely saline-affected regions. It is bounded by the Jashore district to the north, the Bay of Bengal to the south, the Khulna district to the east, and 24 Parganas district of India to the west. The district is divided into seven upazilas (sub-districts), of which Shyamnagar Upazila is adjacent to the Sundarbans. Three unions in this upazila (Gabura, Burigoalini and Padmapukur) were the most affected by salinity after cyclones Sidr (2007) and Aila (2009) (Rezoyana et al., 2023).

As these unions are in one of Bangladesh's most climate change-stressed and vulnerable areas, people (especially women) face multi-dimensional impacts. Critical shortages of drinking and fresh water as well as food and livelihood insecurity are the most significant, and are both connected to many other problems.

The crisis of fresh water is illustrated by a quotation from the conclusion of a study titled Water Quality of Different Sources at Buri Goalini and Gabura Unions of Shyamnagar Upazila, Bangladesh, published in June 2019: "Most of the Electrical Conductivity (EC) values of the samples exceeded the WHO prescribed standard values. It can be concluded that the water sources of Gabura were more affected by EC and salinity as compared to Buri Goalini Union. The EC and salinity were much higher in pond water of Gabura and deep tubewell water of both the Unions. They were not suitable for drinking purposes." (Shaibur et al., 2019).

The local Kholpetua river has overflowed many times since this research, and the situation worsens daily as well as spreading to other areas. And you don't have to be an expert to know that many critical diseases are waterborne.

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Note: According to the World Health Organization (WHO), Electrical Conductivity (EC) is a measure of a solution's ability to conduct electrical current. It is related to the concentration of dissolved salts, including ions like sodium and chloride. High EC levels in drinking water can indicate elevated salinity or contamination, impacting water quality and its suitability for consumption.

The main crisis in these coastal unions is safe drinking water. Local housewife Anjali Mondal (44) said:

"We get drinking water by preserving rainwater during the monsoon, but it's only for four to five months. We used to face serious crises during winter and summer. A few NGOs provide drinking water for 60 poisha [0.60 BDT, equivalent to around half a USD cent] per litre. Still, we have to go very far to collect water and carrying 10-15 litres of water from that far is very painful."

Water tanks are available but expensive, with a 20,000-litre tank costing around 14,000 BDT. "Usually, people from marginal income can't afford this kind of rainwater-preserving set up, so many people used to drink directly or indirectly from the unsafe pond water. That's why many diseases are increasing," she added.

In the nearby unions of Padmapukur, Burigoalini and Kaikhali, the salinity of the pond water is slightly lower (Rezoyana et al., 2023). There is one freshwater pond left, named Drishtinandan Pukur (Eye-pleasing Pond), but that is also at risk of salinity.

"The river [which is saline] is very close [50 to 60 m] to the Drishtinandan Pukur,” said Omar Faruk, Assistant Teacher at 173 Number Sora Government Primary School, Gabura. “There is a dam to protect this union from flood, but it is too fragile to fight against cyclones. Every year, this dam breaks due to cyclones and river erosion, then villagers repair it on their own initiative as the necessary support from the authority is insufficient."

The people from these coastal areas are suffering from a shortage of safe drinking water and fresh water for household work, bathing, cooking, and cleaning, so they are forced to use saline water.

"We even get salty water from the deep tube well at Gabura,” added Hafizur Rahman, another Assistant Teacher from the same school. “If you bathe in the saline water from the river daily, it is good in a way because it's cleaned by the tide every day. But suppose you do this from a closed saline water body. In that case, it is more harmful to the health because many people use the same water source daily and very easily spread diseases."

Local people say they used to plant different types of vegetables and fruit trees around the homestead. Now, vegetables and fruit trees will not grow due to increased salinity. They are affected by various types of fungi, including leaf rot. That's why many people cut plastic bags and cultivate vegetables in them.

This has been happening for a long time in the area. People suffer from many chronic diseases related to skin, stomach, blood pressure, menstrual health, reproductive system, appendix, etc. Women and girls suffer the most since they use the salty water the most for household tasks and maintaining menstrual hygiene.

Many patients, like Rahima mentioned above, are sufferers of uterine and urinary infections, and various skin diseases.

"My entire family are affected by these types of diseases,” said Khadija, 25. “I had stomach ache and urinal pain before finding uterus infection. I took treatment and am now feeling better. However, my sister Mahfuja, 26, still treats her urinal and uterus infection-related diseases. My other sister had to suffer during her caesarean section. My mother suffers from an ulcer, and my brother has a skin allergy and used to have rash while working with salty water."

"In the case of women, various diseases are occurring related to the uterus due to salt,” said Doctor G M Tariqul Islam, resident medical officer with the Shyamnagar Upazila Health Complex. "For example, urinary tract infections and Leucorrhoea [vaginal infection] are increasing. Due to these, pelvic inflammatory disease, irregular periods and infertility are occurring more."

"Most of the women over 40 who come for the treatment have had hysterectomies [surgical removal of the uterus]. If uterus is removed before a certain age, it creates various hormonal problems later, including osteoporosis, sleeping problems, irritable mood and various mental problems which also creates problems in the patient’s family and social life."

Khadija lives with her parents, and the place is surrounded mostly by shrimp farms, which use fully saline water. She has a 10-year-old boy and has been left by her husband. Marginal women like Khadija mostly work on the shrimp farms, as one of the only remaining livelihoods available. Things were very different 15 or 20 years ago, when most of the land was used for paddy cultivation using fresh water. This provided better livelihoods and had much less impact on health. Now, at least 70 per cent of agricultural land on the south coast is affected by different degrees of soil and water salinity (Ziaul & Zaber, 2013) due to climate change and human activities like shrimp cultivation, which directly allows saline water to the locality. The poverty and the impoverished conditions are compounded by the saltwater intrusion.    

"You will get patients like us in almost every house at Gabura,” Mahfuja added. “They don't have that much understanding as well as any option to use anything other than salty water."

Many were also shocked when it was reported in national media that the girls of Kaikhali Union were taking birth control pills from their mothers, sisters or female friends to stop their periods and avoid the hygiene problems.

Even affording three meals a day is a challenge for the ordinary people of these coastal areas. It is difficult for girls and women there to think of spend 100 to 150 BDT every month on sanitary pads. So they use old clothes during the period. Naturally, those clothes cannot be washed in the bathing pond. They wash the used clothes in the nearby dirty and salty water and use them again, leading to the various problems of the uterus. Many of them resorted to sukhi pills (free birth control pills distributed by the government’s Family Planning Department) that were close at hand to stop menstruation during the winter, when clean fresh water is scarcest. Many non-governmental organizations working on family planning distribute birth control pills to married women mostly for free.

Experts say taking birth control pills without a doctor's advice can cause serious harm. The user can suffer from irregular periods, brain and physical damage and permanent infertility.   

Papia Ray, a senior teacher from Kaikhali S R High School, said: "As we know, talking about periods and menstrual health is a very sensitive topic to discuss and taboo in the socio-cultural context in Bangladesh, especially in the village areas. I know about [some girls] using pills to stop periods during winter and summer when people face the worst fresh water crises."

"As a teacher, I try to make our female students as aware as possible. Also, some initiatives are taken regarding the proper sanitary napkins and use of safe water during periods by a few organizations. Now, the use of pills is less than before, I think. Still, as salinity is notably increasing daily, people need more support," she added.

Another crucial fact pointed out by a local climate activist from Gabua Union, Md Ashikur Rahman, is how salinity influences child marriage and separation. "Due to the continuous use of saline water, girls started suffering from permanent skin diseases after the age of 18 to 20,” he said. Their skin has darkened due to salinity. Mostly, no one agrees to marry a girl with skin diseases and a dark tone in the village context. So, parents expect their daughter to be married between the age from 10 to 15; otherwise, it will be a burden later them, they think."

"The irony is they started facing those skin diseases mostly after their twenties, their husbands leave them and marry another adolescent girl. And they return to their parents with two to three kids and more liabilities. So, at any cost, we have to protect our coastal areas from salinity impact before everything goes out of control," he said.

As Doctor Islam explained, due to the density of salinity many people, especially women, are suffering from hypertension (high blood pressure), which causes cardiovascular diseases and heart stroke. High salt levels also causes iron deficiency, and lead to poor digestion and malnutrition. Rates of vitamin B12 deficiency have also increased, contributing to a rise in anaemia in these regions. Pregnant patients who come for treatment often suffer from iron deficiency, which has long-term effects on the babies.

These women — many others along with Rahima, Khadija, and Mahfuja — are examples of bravery and tenacity in the face of overwhelming obstacles, bringing attention to the critical need for support, freshwater solutions, and sustainable development in these vulnerable coastal areas. They receive hope and believe there will be a solution when they meet someone like this essay writer who is documenting their sufferings through images and notes. They sincerely request, "Please, write this" and "Please, don't forget to note that,” etc. Their testimonies are a call to action as well as a powerful reminder that the fight against salinity is not only a necessity but a testament to the strength of the human spirit in the face of adversity.

Voicing the collective plea of her sisters along the coast, Khadija’s words resonate:

“We are drowning in a hardship of salinity. What has happened to us we had to suffer but at least our children should get a good environment.”

Check out the photo series part two: Climate's cruel toll: The agonizing quest for coastal food and livelihood security