‘Headache, organ damage and even death’: how salt water endangers pregnant women in Bangladesh

By Liam On Apr 2, 2024

IIn the small, busy ward of the Upazila Health Complex in Dacope, new and expectant mothers lie exhausted under fans spinning noisily above their heads. There are no partitions in the maternity room shared by more than 20 women, so visiting husbands are ushered out by nurses if someone needs to be attended to.

On one of the beds is Sapriya Rai, 23, who is due any day. “My first pregnancy was difficult, the baby was born two months early, so I worried all the time,” says Rai. “I have high blood pressure and the doctor found protein in my urine, so now I am being closely monitored. I may need to be induced or have a caesarean section.”

Rai has preeclampsia, a condition that affects some women during the second half of pregnancy or shortly after their baby is delivered. Diagnosed women are followed until delivery is possible. Normally this is around 37 to 38 weeks of pregnancy, or earlier in more severe cases.

Freshwater is essential for drinking water, irrigation and healthy ecosystems. As sea levels rise, freshwater systems around the world are becoming increasingly contaminated with saltwater, gradually contaminating soils and wreaking havoc on land, lives and livelihoods.

These salts can be removed by rainfall, but climate change is increasing the frequency and severity of extreme weather events, including droughts and heat waves. This leads to more intensive use of groundwater for drinking water and irrigation, which further depletes freshwater sources and releases even more salt into the soil.

The climate crisis is driving salinization in several ways. The temperature of the oceans is rising, and Warmer water takes up more space. Ice caps and glaciers are melting and flowing into the oceans. Rising water salinity is already affecting agricultural production and internal migration, especially in low-lying coastal areas.

Average sea levels have risen by more than 8 inches since 1880, including about three inches in the past 25 years. Even with significant reductions in greenhouse gas emissions, researchsuggeststhat sea levels could rise by thirty centimeters by 2050.

This process is already pushing saltwater onshore along coastlines from Bangladesh to the Mississippi Delta, and will continue to affect more regions around the world as the threat of climate change increases.

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Why is the world’s fresh water becoming saltier?

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Average sea levels have risen by more than 8 inches since 1880, including about three inches in the past 25 years. Even with significant reductions in greenhouse gas emissions, research suggests that sea levels could rise by thirty centimeters by 2050.

Rai is not unusual. Alarming numbers of pregnant women in the coastal area of Dacope, southwestern Bangladesh, have been diagnosed with preeclampsia, eclampsia and hypertension. Scientists believe this is related to rising salinity in drinking water.

“High blood pressure is one of the leading causes of maternal mortality in developing countries,” says Aneire Khan, a researcher in environmental epidemiology who conducted the 2008 study initial investigation into the correlation between high blood pressure-related conditions in pregnant women and salt intake from drinking water sources. “It also makes pregnant women particularly vulnerable to preeclampsia, which can lead to severe headaches, organ damage and even death.”

Khan executed a second study in 2011 with Imperial College London and the Bangladesh Center for Advanced Studies, which found that salt intake among women in Dacope was well above the World Health Organization’s recommended levels. It confirmed a strong relationship between salt intake and the risk of developing preeclampsia and hypertension.

Dacope has long been on the front lines of the climate crisis. The rural population depends on rivers, ponds and groundwater for cooking, drinking and bathing. But these natural water sources are contaminated by varying degrees of salinity due to salt water intrusion by cyclones and rising sea levels.

“When Cyclone Aila struck in 2009, it left a trail of destruction, breaching embankments and flooding the entire region,” said Dr Santosh Kumar, a gynecologist at the hospital. “With most freshwater infrastructure destroyed, the coastal region is facing an acute drinking water crisis. The extent of the impact on people’s health is only now becoming clear.”

As a result of Khan’s researchseveral initiatives have been taken by NGOs and the government of Bangladesh to reduce salinity in Dacope waters, including reverse osmosis, rainwater harvesting and managed aquifer recharge; a technique that collects water from ponds and roofs, treats it and injects it underground for storage and future use.

In 2019, Khan returned to Dacope to see if these interventions had worked. She interviewed 740 women and checked whether blood pressure among the local population was still the same. But due to Covid restrictions, she was unable to complete her analysis. Khan is now planning a new study with Imperial College London to assess whether the interventions have had a positive impact on the health of the community.

Meanwhile, in Dacope, Kumar is concerned that the situation is worsening. “Climate change and rising sea levels will further exacerbate salinity problems here in the future,” he warns. “All women and girls in the area are at risk. Without easy access to safe drinking water, their reproductive health will deteriorate.”

Nirmalya Sarker, 56, has been a healthcare worker for more than two decades. Every day she travels to villages around Dacope, door to door, to speak to families about the importance of clean drinking water. “Despite the high incidence of related health problems, Most people here are not aware of the increasing salinity and its consequences,” she says.

Sarker works with more than 5,000 pregnant women in Dacope; she visits them regularly for check-ups and holds information sessions at the Upazila Health Complex, where women and girls can come and discuss any problems they may have.

“The main problem is a lack of awareness,” says Sarkar, who is working with Bangladesh’s health ministry to create information that can be easily disseminated to villages. “Awareness that builds on good pregnancy care and safe drinking water practices will enable better health and nutrition choices to directly improve maternal health.”

Preeclampsia also affects the unborn baby, who is at risk of dying in the womb, being born too light or too small due to a lack of nutrition for the developing fetus. Children affected by early malnutrition have less immunity to diseases and are prone to respiratory infections, pneumonia and other health problems.

In the busy bazaar outside the hospital, a group of men arrive on tricycles with wooden carts filled with empty barrels and containers. A number of shops here sell clean, filtered water by the liter.

Some families take out loans to purchase filtered water or large tanks. Rainwater can be collected during the monsoon season, but households need a tank to store it. This is not possible for many families in Dacope, who live in houses with thatched roofs, where the tanks do not fit. The Bangladesh government has installed tanks on school roofs and other buildings, but people still have to travel and queue to get water.

An often overlooked effect of salinity intrusion is on the menstrual health and hygiene of women and adolescent girls, a problem that compounds broader social insecurities.

Shopna Dhali, 36, cannot afford to buy sanitary pads for her teenage daughter, so when she gets her period, she uses old rags that are washed with salt water and reused. Research suggests Such practices can expose women and adolescent girls to various hygiene risks, such as rashes, skin diseases and uterine infections.

Mukhti Shanker, 25, regularly drank groundwater from a tube before having her baby. Despite having the highest sodium content in the water, tube wells are the most common source of drinking water in Dacope, highlighting the urgent need to promote alternative sources. Khan’s research found that women who drank spring water had significantly higher average sodium levels in their urine than those who drank rainwater.

During her pregnancy, Shanker had no idea of the impact the salt content of the water could have on her pregnancy. “When they told me I needed to be closely monitored, I got worried,” says Shanker, whose hands, feet and face became swollen during pregnancy. After giving birth to a healthy baby girl, she vowed never to drink salt water again.

As the sun sets on Dacope, Shanker walks around the pond in front of her house, with ten-month-old Abonika on her hip. About 6,000 people use this communal pond every day. Women climb down steep, muddy steps to collect pond water; they move dirt and floating leaves aside with their hands before dipping their jars in the water and filling them to the brim.

The women carry the heavy jars against their waists or on their heads and walk slowly home, being careful not to spill anything. Most of them perform this arduous task every day, simply to fetch water for their families.

“It is a tragedy that these difficulties still exist,” says Kumar. “Access to clean and safe water is a basic human right – no one should risk their health by drinking salt water.”

But as Bangladesh reaches the limits of its ability to adapt to climate collapse, Dacope’s water crisis could worsen.

“We cannot fight nature,” says Kumar, “so we must find alternative, more sustainable ways to survive.”