Women's lives in dire condition in coastal region

The COP30 climate summit is underway in the Brazilian city of Belém. For Bangladesh, the most urgent need to face the impacts of climate change is financial compensation. At the same time, global greenhouse-gas emissions, which are responsible for rising temperatures, must be curbed. Yet global leaders still have not reached an agreement on these two issues.

However, the global climate crisis was created by the development of wealthy nations through the burning of fossil fuels. Its impacts are falling heavily on Bangladesh’s people, especially women, whose lives are becoming increasingly unbearable. From deaths caused by disasters, to freshwater shortages, health complications, and domestic violence – women are facing a wide range of hardships. Children are becoming victims of these crises as well.

In coastal areas, when it begins to rain, women’s eyes light up with joy—not for enjoyment, but because they rush to collect rainwater or fresh water in plastic tanks, large clay pots, locally known as motkas, or various sizes of plastic bottles. Providing drinking water for the family throughout the year is primarily a woman’s responsibility.

In 2021, the Department of Public Health Engineering installed a black plastic rainwater-harvesting tank in the yard of Rusiya Begum, a resident of Kanainagar village in Chandpai Union of Mongla upazila in Bagerhat. She filled a jug from the tap attached to the tank and showed it. But who will drink this water now? So that it doesn’t go to waste, she drank it herself. Smiling, she said, “You can’t let sweet water go to waste.”

Beside Rusiya Begum’s tank is another black tank. She explained that it was bought by her daughter-in-law’s father after disputes arose over water. But for a large 14-member household, the amount of water is still not enough. It takes nearly half an hour to fetch water from the pond. So she has to store rainwater in various containers inside and outside the house.

More than a year ago, Rusiya Begum had to undergo a hysterectomy. One of her sons took a loan from BRAC to pay Tk 70,000 for the operation. But she also has to endure scolding because of the high cost. Her husband, Rafiqul Islam, used to work at a ship dock. His leg has become paralysed due to an accident.

It is not only Rusiya Begum – women in the coastal areas of Bagerhat and Khulna suffer from numerous illnesses. Between 27 and 29 September this year, these correspondents visited the region. The affected women said they hardly have time to deal with their health problems. Most of their day is spent on domestic work and ensuring the supply of drinking and cooking water.

After cyclone Sidr in 2007 and cyclone Aila in 2009, the southern coastal districts of Bagerhat, Satkhira, and Khulna began experiencing severe shortages of safe and potable water. Additionally, iron, arsenic, and fluoride are also found in water sources in these areas.

A study published last year by the Bangladesh Meteorological Department, titled “Changing Climate of Bangladesh: Trends and changes detected in weather observations from 1980 to 2023 in Bangladesh,” stated that the duration of rainfall may decrease in the future, with heavy rainfall occurring over shorter periods. Based on her experience, Rusiya Begum feels that rainfall patterns are no longer the same, and the water in the area is becoming increasingly saline.

According to the World Health Organization (WHO), adults should consume five grams of salt per day. But in coastal saline regions, a person ingests an average of 16 grams of salt daily through two litres of drinking water. When potable water is available at home, women often do not drink it themselves – they reserve it for their husbands and children. For cooking, washing menstrual cloths, and almost every household task, women must rely on saline water.

Jayanta Mallik, Executive Engineer at the Department of Public Health Engineering, Bagerhat office, told Prothom Alo that the tolerable level of salt in water is 1,000 milligrams per litre. But many upazilas in Bagerhat are showing levels as high as 3,000 milligrams per litre. Due to excessive salinity, deep tube wells have become ineffective in parts of Mongla, Sharankhola, Morrelganj, Kachua, Chitalmari, and Rampal.

According to the report “Bangladesh Sample Vital Statistics 2023”, published by the Bangladesh Bureau of Statistics (BBS) in June last year, 13.96 per cent of households in the Khulna division spend more than 30 minutes collecting safe drinking water from outside sources. Salinity can be a major obstacle in accessing water from improved sources. Among all divisions in the country, the Khulna division has the highest neonatal mortality rate (21.79 per thousand). Khulna also ranks second in the statistics for areas with a high rate of child marriage.

Amarendra Nath Biswas, chief scientific officer of the Salinity Management and Research Centre of the Soil Resource Development Institute in Batiaghata, Khulna, told Prothom Alo that the ideal level of salinity for salt-tolerant crops is 3 dS/m, and for other crops it is 1 dS/m. But in April–May, the salinity level in water rises to 35 dS/m. If this water is used for irrigation, crops die. Yet this very water is what women must use for their daily activities, which is creating various health risks.

A study published last year by the World Bank, titled “An Unsustainable Life: The Impact of Heat on Health and the Economy of Bangladesh,” analysed the country’s temperature and humidity data from 1976 to 2023. Information from more than 16,000 people was collected in two phases. Citing another study, the World Bank stated that coastal women living in temperatures between 28°C and 32°C face a 25 per cent higher risk of miscarriage. Such data and research findings indicate that women’s health risks are linked to climate change.

Among the many health problems faced by women in Bangladesh’s coastal regions due to climate change, uterine complications are one of the most prominent. Several women in Mongla upazila shared their experiences.

Ruth Sarkar from South Kanaimar said that her uterus had almost protruded. Later, doctors removed it three years ago. One of her sisters also has uterine problems, but due to lack of money, she has not been able to undergo surgery.

Rima Akhter, from Kanainagar, was married when she was 12-and-a-half-year-old. Now 30, she has a 13-year-old child. Three years ago, a cyst was detected in her uterus. Although she underwent surgery, her uterus did not have to be removed. Rima described suffering from breathing difficulties and various other complications.

The house of Kusum Haldar of Ward No. 1 in Chandpai Union is almost submerged in water. When asked whether she has any uterine problems, she felt embarrassed. But later she said, “They cut out my uterus in 2008.”

Forty-five-year-old Shankari Roy from Haldibunia had to fetch water even when she lived at her father’s house. After her marriage in 2002, she has had to continue the same work. Two years ago, a BRAC water tank was installed at her home. Her mother-in-law is 75 years old, and her only daughter, Oiti Roy, is visually impaired and a second-year college student.

Shankari Roy said her uterus had prolapsed many years ago. She cannot lift heavy objects. Even so, she has to fetch water and carry out other household chores. After carrying a 10-liter pitcher of water, she becomes breathless. She said storms and cyclones are constant in the coastal region. The struggle becomes much harder when there are elderly or disabled family members. Then it feels like a fight for survival, with very little time left to think about her own health.

However, noting that various NGOs and government projects have increased awareness about health, Shankari said that despite the difficulties, she tries to buy sanitary pads for her daughter during her menstrual period.

Mohammad Shahin, Upazila Health and Family Planning Officer of the Mongla Upazila Health Complex, said that based on practical experience, women’s health problems in coastal areas are linked to saline water. VIA tests are being conducted at the hospital for women aged 30 to 49 who may have uterine problems.

Mohammad Shahin said that from 2020 to September 2025, a total of 95 women were identified through the VIA test as being at risk of cervical cancer. There is no gynecology consultant available at the upazila level, so women must travel to Khulna and other locations for uterine surgeries. Women come here with various complications related to hormonal issues—such as hot flashes that feel like fire coming out of the ears and head, dizziness, insomnia, mental trauma, and sexual health problems.

These correspondents spoke to Rabeya Begum in Kanainagar of Mongla. One of her daughters is 12 years old. Another child died in her womb this June. Rabeya said she had high blood pressure. Her fever rose to 105 degrees. She began having convulsions. When she was taken to a clinic in Khulna, doctors informed her that the baby had died three days earlier. Even before conceiving this child, Rabeya had been experiencing various uterine complications.

A study conducted on 202 pregnant women receiving treatment at the Dacope Upazila Health Complex in Khulna stated that one of the major causes of anemia and gestational hypertension among pregnant women in the southern part of the country is the presence of excessive salt in drinking water. The research investigated the link between salinity levels in drinking water and the risks of pre-eclampsia and pregnancy-induced hypertension. The research paper was published in September 2014 in the UK-based journal PLOS ONE. On 14 November 2015, The Lancet reported, based on this study’s data, that the risk of high blood pressure is increasing in Bangladesh’s southern region due to climate impacts. The researchers included 1,006 pregnant women from a northern locality of Khulna city in this study, conducted from October 2009 to April 2011.

Research from the Institute of Advanced Research at the private United International University indicates that stroke rates are highest in the districts of Khulna, Satkhira, and Bagerhat. Due to the excessive intake of salt through food and water, hypertension, heart disease, and stroke are more prevalent among the population. Under the Samriddhi program of the Palli Karma-Sahayak Foundation (PKSF), researchers collected socioeconomic and health-related data from 1,341,589 individuals in 242,034 households across seven divisions for people aged 18 and above. This union-level data was gathered between July 2018 and June 2021.

Physician Mohammad Shahin, Upazila Health and Family Planning Officer of Mongla Upazila Health Complex, said many people are arriving at the hospital with complications at ages earlier than the typical onset of hypertension caused by climate-related factors. Pregnant mothers are experiencing high blood pressure during pregnancy, and protein is leaking into their urine. Their hands and feet are swelling. Without early treatment, this leads to convulsions, the death of the unborn child, and even life-threatening danger for the mother. Irregular menstruation, vaginal infections, leucorrhea (white discharge), uterine tumors, burning sensations in the uterus and urinary tract, eczema, and allergies are also increasing.

It is not only marginalised women; urban women are also facing various problems. Khulna University has arranged potable water through electric filters for dining in five of its male and female dormitories. However, this water cannot be used for bathing or other purposes. Several female students, speaking on condition of anonymity, said their hair is falling out and their skin is becoming rough. The university’s Vice-Chancellor, Professor Md. Rezaul Karim, said that in addition to salinity, the water in the area contains chlorine. Hair loss and other problems are therefore inevitable.

Cyclone Remal struck on 26 May last year. In the early hours of 27 May, Fatema Akhter, who had taken shelter in a cyclone centre in Mongla, began to go into labour. Although she somehow reached the Mongla Upazila Health Complex, she was advised to be taken to Khulna. But the river was turbulent, and travelling to Khulna was impossible. After visiting two clinics in the area, she had to return to the health complex. Due to the impact of Cyclone Remal, the area had no electricity for two days. The operating theatre (OT) at the health complex was under repair. The repair equipment was cleared away, and diesel was purchased to run a generator so the operation could be performed. Fatema gave birth to a baby girl.

On the night of 15 November 2007, the devastating Cyclone Sidr struck the country’s coastal region. In the shelter adjacent to St Mary’s Church in Chila village of Mongla, Sathi Sarkar delivered a baby. The child was named ‘Sidr Sarkar’ after the cyclone.

In some coastal regions, children face climate-related challenges even before they are born. A study titled “Health Effects of Climate Change and Mitigating Effects of Climate Policies: Evidence from Bangladesh”, published late last year by the Asian Development Bank (ADB), stated that due to reduced rainfall caused by climate change, the income of farming households is declining. Mothers are unable to access nutritious food during pregnancy. As a result, children are suffering from malnutrition both in the womb and after birth. This study was conducted on 6,802 children aged 0 to 60 months in rural areas of the country.

In December 2023, Manusher Jonno Foundation published a study titled ‘Salinity Threat in Women’s Sexual and Reproductive Health and Rights.’ Conducted in Shyamnagar of Satkhira, Mongla of Bagerhat, Kathaltali and Patharghata of Barguna, Rangabali of Patuakhali, and Borhanuddin of Bhola, the study states that to reduce the risks associated with using saline and contaminated water, adolescent girls and adult women in coastal areas use birth-control pills or injections to stop menstruation for long periods.

The risk of child marriage is also increasing in coastal regions. In a statement sent to the media on 24 January, UNICEF cited data from a report titled “Learning Interrupted: Global Snapshot of Climate-Related School Disruption in 2024” and said that various natural disasters disrupted the education of 33 million children in the country that year. When schools remain closed for long periods, the risk of girls dropping out and facing early marriage increases.

According to UNICEF’s Children’s Climate Risk Index, Bangladeshi children are among the most affected and vulnerable in the world due to climate and environmental crises. Save the Children’s Global Girlhood Report 2023 states that Bangladesh is among the top 10 countries facing the highest risks from climate change and child marriage.

On 27 September at the Mongla Upazila Health Complex, two mothers who had recently given birth were found to be only 18 years old on paper. One of them is Fahima Akhter. She delivered her baby through surgery. Among her four siblings, the youngest brother is only six years old.

Sohana Sultana, the health officer of Mongla Upazila Health Complex, said that many girls are married off at the age of 14. Soon after, they become mothers of multiple children. Alongside household responsibilities and other work, many of them lose their uterus at a very young age. Many come in with various long-term skin conditions during pregnancy.

A report titled ‘Bangladesh Climate Change and Gender Action Plan,’ jointly published in March last year by the Bangladesh Climate Change Trust and UN Women Bangladesh, states that Bangladesh is the seventh most climate-vulnerable country in the world. From 2000 to 2019, 185 extreme weather-related disasters occurred. During any disaster or its aftermath, violence against women increases. The burden of women’s unpaid work also rises.

The BBS and UNFPA report titled “Violence Against Women Survey 2024” does not provide separate data on coastal regions. However, it states that married women in disaster-prone areas face more violence than those living in stable regions. Yet, in areas like Mongla, none of the women admitted directly to these correspondents that they faced spousal abuse due to conditions such as uterine removal and other physical complications.

Climate change is also affecting women’s mental health. On 27 June last year, a study titled ‘Climate Change and the Mental Health of Women in Two Vulnerable Communities in Bangladesh: An Anthropological Study’ was published. Researchers from two universities in France and Senegal, along with Bangladesh’s BRAC James P. Grant School of Public Health, the International Centre for Diarrhoeal Disease Research, and the National Institute of Mental Health and Hospital found that climate change places additional burdens on women. Food insecurity and husbands migrating to cities for work increase the risk of anxiety and depression. Gender-based and domestic violence rises. To survive economically, girls are married off at a young age.

Since 2019, the United Nations Development Programme (UNDP) and the Department of Women Affairs have jointly been implementing a project titled “Enhancing Adaptive Capacities of Coastal Communities, especially Women, to Cope with Climate Change-induced Salinity in Bangladesh.” Under this project, safe drinking water is being provided to 43,000 women. With financial support from the world’s largest climate fund— the Green Climate Fund (GCF)—the project, costing over Tk 3.08 billion is being implemented in Dakop, Koyra, and Paikgachha in Khulna, and Assasuni and Shyamnagar in Satkhira.

The project’s national project director, Muhammad Abdul Hai Al-Mahmud, told Prothom Alo, “It is true. The issue of women’s health in coastal regions has not yet been prioritised. Without coordinated efforts from the Ministry of Health and other government and non-government bodies, and without adopting large-scale national programmes, these problems cannot be solved.”

Manusher Jonno Foundation has been implementing the Community-Based Resilience, Women’s Empowerment and Action Project since September 2022. The project is set to end in August 2026. It is being carried out in coastal, char/flood-prone, haor, and hilly regions. According to individuals involved, women’s health is not addressed directly under this project.

From 2022 to 2024, BRAC worked to improve the lives of over 72,000 people in Mongla under the project titled 'Enhancing Safe Drinking Water Security and Climate Resilience through Rainwater Harvesting.’ Among them, more than 39,000 were women. BRAC is currently implementing another project called ‘Rain for Life’ in Mongla, Assasuni of Satkhira, and Patharghata of Barguna. This project also includes storing water for livestock.

Abu Sadat Moniruzzaman Khan, head of BRAC’s Climate Change Program, told Prothom Alo, “It is true that while access to safe drinking water has been provided, women still have to use saline water for cooking and daily household work. Women’s and children’s health has not yet received sufficient attention. However, due to the project, women no longer have to spend the previous amount of time and face the hardships of fetching drinking water. They can now participate in income-generating activities. Awareness campaigns on health and other issues have brought about some changes.”

The international NGO Ipas Bangladesh conducted a study on women’s sexual and reproductive health and rights in Dakop, Khulna, between 2020 and 2021. Following this, Ipas Bangladesh carried out another study last year and this year in the haor region of Sirajganj and in urban slums of Dhaka, examining the impacts of climate hazards on women’s health. These studies found that post-disaster, violence against women increases. Events such as giving birth to multiple children in hope of sons, and marital separations occur. Due to fewer economic opportunities, many women are forced to engage in risky activities such as fishing in saline water or sex work. The use of saline water has also caused hair loss, darkening of hair color, and signs of premature aging.

Based on the findings of these two studies, Ipas Bangladesh drafted a policy guideline. They are discussing this guideline with government policymakers and donor communities. Physician Sayed Rubayet, Country Director of Ipas Bangladesh, told Prothom Alo that so far, there has been very little work on women’s reproductive health and rights in the context of climate change.

Nourin Haque contributed reporting.