Women in coastal Bangladesh are losing their uteruses to the climate crisis

In the words of Rini Begum (pseudonym), a fisher from Mongla, in southwestern Bangladesh:

On a crisp September morning 14 years ago, I climbed down the riverside with my fishing net and stepped into the water like I did every day. The familiar burning and itching greeted my skin as I dipped into the gray, murky water of the Pashur river in Mongla, southwestern Bangladesh.

The water was cleaner even just two years ago, when I married my husband, Nazrul Islam (pseudonym), and moved to live with him here in his hometown - the tiny fishing village of Chilabazar in Mongla. In the two years following the move, I gave birth to a son and got acclimated to the life of a fisherman's wife, which meant spending 8-10 hours neck deep in the river to catch fish.

I held on to the fishing net with all my might and kept walking, with only my hands and my head visible above the water. Every day now, it was getting harder to find fish, and the only thought in my mind was that I needed to catch enough to make BDT 50 (USD 0.46) to buy rice for dinner.

Suddenly, I felt something unusual. I reached down. Something was sticking out between my legs. I gave out a bloodcurdling scream and fainted. Hearing my screams, my sister and mother-in-law ran over and found me unresponsive in the water. They dragged me by my arms and legs out of the water and up the riverbank, and into the back of a battery-powered autorickshaw.

We drove to the nearest jetty and travelled by launch (ship) for two hours to reach the nearby public health facility, 40 km away. The doctor diagnosed me with a prolapsed uterus. I learned that this condition was caused by the polluted, saline water I spend hours in everyday. I spent the next few months taking medication for it, spending approximately BDT 10,000 (approximately $90), a fortune I borrowed from my relatives.

It has been 14 years since that fateful morning, but my life remains unchanged. Medical help is expensive, and my husband sold our family's fishing boat to afford my treatment. I had another baby, a daughter, eight years ago. In August 2023, the doctor told me that I needed to undergo a hysterectomy if I wanted to live. 

I have an infection in my uterus, and it is going to turn cancerous. The procedure will cost approximately BDT 50,000 (almost $500), which is 500 times our family's daily income. We cannot afford it. I still go fishing every morning. 

The doctor asked me to use pads and wash myself with clean water during my period. Where will I get clean water for washing? We travel miles just so we can collect a small amount to drink."

A brief history of water in southwestern Bangladesh

Approximately 30 million people in Bangladesh live in the coastal areas of southwestern Bangladesh. Here the rivers flow through a wide and muddy plain, with their channels spread across the land like a mesh net, where the lines between land and water are always mutating. There are no borders that separate fresh water from the sea. 

Everyday, like clockwork, the tides reach a few kilometres inland, inundating coastlines and bringing the saltwater along, only to retract hours later. For generations, people have lived in harmony with the water, tuning their lives and livelihoods to the ebbs and flows of the river tides. 

Until the sea levels started rising, and with it the salinity levels in the rivers.

20% of the total land in Bangladesh is in coastal areas, over half of which are affected by different degrees of salinity. Salinity intrusion in Bangladesh is seasonal, with minimum salinity during the rainy season (June-September), and maximum in the dry season (March-May).  

In any form of crisis, women are the worst affected, and the climate crisis is not an exception. 

In Chilabazar, where Rini Begum lives, salinity is so severe that even ponds and deep tube wells, installed at approximately 500-750 feet underground, pump saltwater. Some houses have water tanks for rainwater harvesting installed on their premises, but those are not enough to meet the requirements except during rainy seasons.

There are only two large ponds that provide fresh water for the entire village. Women and children line up with jerry cans once every week to collect water from these ponds, which are revered by all to the point where nobody even dips their toes in that water, let alone bathe or wash in them. These two ponds are strictly for drinking purposes only and are considered sacred - a divine gift to the people. 

The water they collect must last an entire week. Using them for washing dishes or clothes, or even bathing, means less water for the family to consume. Compelled by this shortage of clean water, women and girls - who typically use old rags during periods, are forced to wash using the saline water from the rivers. Doing so for years exposes them to various reproductive health problems, such as  uterine cancer, prolapsed uterus, chronic gastrointestinal problems, and skin disease.

This scenario from Chilabazar is a common occurrence in the villages along the coastal belt of southwestern Bangladesh, where women are more vulnerable and experience more problems during their menstrual, maternity, and postnatal periods; resulting in higher rates of miscarriage and child mortality. Proper medical care is inaccessible and unaffordable for these tiny fishing communities.

The problem is becoming more acute as salinity continues to increase, to the point where young girls in coastal Bangladesh are self-medicating with birth control pills to stop their menstrual cycles, and many women in their 30s and 40s are undergoing voluntary hysterectomies just to stay alive. Even that is not affordable for all women. 

Those who cannot afford a hysterectomy suffer a slow, painful death over the course of a few years.

"My neighbour developed an infection in her uterus after spending years in saline water to catch fish. The infection turned cancerous within a few months, and she couldn't afford the treatment. I watched her health slowly deteriorate, until she was a ghost of her former self. Towards the end, she bled constantly. She passed away after two years of suffering. I don't want to meet the same fate," says Rini Begum. 

The cost of surgery, treatment, medication and aftercare can amount to up to USD 500, whereas the average daily income in these communities is usually USD 1-3. People prefer going to public health facilities in either Bagerhat or Khulna (40-50 km away) rather than the one in Mongla, despite the travel cost being higher than their daily average income, because of subpar service in the latter. Some families, like Rini's are resorting to selling their only assets and their source of livelihood - usually fishing boats—to be able to access life-saving healthcare.

In Bangladesh, approximately 1.056 million hectares (2.6 million acres) — an area roughly the size of Lebanon—of arable land is affected by varying degrees of salinity. 

According to the local population in Mongla, they usually had to deal with high salinity for roughly six months every year. However, a drastic change occurred during the past five years. 

The communities are having to deal with high salinity for almost nine months a year, leaving a short three-month window to consume and store water with low salinity during rainy seasons. Even that window is getting smaller every year, and the continued inaction and consumption of fossil fuels are only worsening the disaster. 

One of the most fundamental rights of human beings are their reproductive rights, and the climate crisis is taking away women's rights to reproduce. While people in developed countries are grappling with the inconvenience of, for example, having to switch from plastic straws to metal ones, women in marginalised communities are facing a whole new level of inconvenience. 

Rini has hardly consumed or enjoyed any benefits of fossil fuels in her life, but she is one of the worst affected by it. Rini Begum, and millions of other women in Bangladesh and around the world, are paying a steep price for other people's choices.

Miftahul Jannat Chowdhury is a Content Specialist at BRAC Communications. 

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.