CHAPTER 6
Impact of Climate Change on Women’s Health in Bangladesh
Mst Marzina Begum
Department of Public Administration, University of Rajshahi, Rajshahi, Bangladesh
Introduction
The total population of Bangladesh is approximately 161 million as of 2015 (Global Partnership 2016), and the United Nations Population Division (UNPD) projected that this would reach around 218 million by 2050 (Peter and Zunaid 2008). There is no doubt that the current population size itself is a burden given the geographical territory. No doubt that it is very hard to ensure a proper balance between the size of the population and actual requirement of health services. In 2015, the Bureau of Statistics (BBS) of the Government of Bangladesh (GoB) pointed out that the country was still considered as a rural-based country, since more than 70 percent of the total population lived in rural areas, which were not adequately covered with proper health services. Though the extent of poverty has been reduced from 57 percent in 1991 to 24.7 percent in 2015 (Ahmed et al. 2015), poor health care facilities still remain, particularly in rural areas. In 24 percent of urban people are also not served well in basic health necessities including sanitation and portable water (Islam and Biswas 2014).
Climate changes very rapidly at both the national and global levels. Given the context, the Intergovernmental Panel on Climate Change (IPCC) in its third assessment report predicts climate change as likely to be compounded by poor human health (McCarthy et al. 2001). People of Bangladesh suffer from poor health due to extreme natural events including floods, storms, droughts, and heat waves. Alarmingly, it is projected that the worst impact of climate change on health will have future consequences for most of the population in Bangladesh. Climate change brings new and emerging health complexities and women are especially affected. The vulnerabilities caused by climate change may put the health and very lives of women at risk. This chapter examines the impacts of climate change on the health risks and vulnerabilities of Bangladeshi women.
Climate Change and Health
The IPCC refers to climate change as any change in climate that occurs over a period of time, due to natural variability or human actions (McCarthy et al. 2001). Climate changes are always varied due to natural phenomena; on the other hand, human activities also contribute to global climate change. For example, increased global temperatures and extreme heat waves are associated with burning of fossil fuels. Considering the role of human activities in climatic change, United Nations Framework Convention on Climate Change (UNFCCC 1992, Article, 1) finds climate change directly or indirectly due to human activities is responsible for change in the global environment.
However, the meaning of health is explained as “a state of complete physical, mental and social well-being and merely not an absence of disease or infirmity” (Ministry of Health and Family Welfare [MoHFW] 2008, p.1). There is no doubt that sustainable development starts with a safe and healthy life (Nanan and White 2014). Therefore, Sustainable Development Goal (SDGs) 3 focuses on better health care and well-being for all ages and is at the forefront of the agenda of the UN goals. However, health is not only a subject of biology, but also a societal architecture that requires human intervention (World Health Organization [WHO] 2008a).
Health and well-being is a primary indicator to the improved quality of life. Highlighting the importance of health care system, the international declaration of health rights adopted by the WHO says in its preamble that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” While defining women’s physical and mental health; women’s well-being will be measured considering the social, political, economic, and biological context of their daily lives. On a particular note, when it comes to global health status of women, it is found that 43 percent of all women suffer from iron-deficiency anemia, and for pregnant women it is 56 percent (on average). It should be noted that in every year, about 10 million women suffer from health complexities and even death in the pregnancy period. Even if they are survived, this may sometimes lead to long-term physical and mental disability (Paul et al. 2014).
Nexus between Climate Change and Human Health
During COP 21 (Paris) summit various news media reported that Bangladesh ranks as the sixth riskiest zone due to climate change. In order to meet the future challenges, the GoB established the “Climate Change and Health Promotion Unit.” The terms of reference of the unit include promoting health services to fight against the negative effects of climate change. The unit is also responsible for ensuring healthy lives for the residents, and projecting health risks and vulnerabilities in the country.
However, climate change poses a wide range of risks and vulnerabilities to human health in the twenty-first century and have been analyzed both environmentally and economically. IPCC (2014) acknowledges that health risks and vulnerabilities between men and women due to climate change are varied on a number of levels, due to different economic, social, and psychological factors. Bangladesh achieved some parts of the targets of the Millennium Development Goals (MDGs), and progressed in reducing maternal death, but still there are huge challenges in the health sector. On the other side, Sustainable Development Goals (SDGs) 3, 6 and 11 by the UN directly focus on health issues and well-being. Over the last two decades, Bangladesh has achieved success in human development index (for example, sustained increases in the life expectancy rates, and reduction of child and maternal mortalities). However, changing climatic conditions are expected to hamper achieving the desired quality of health for people as changing climatic conditions increases the number of illnesses and deaths. These are regarded as weather-related morbidity and mortality (Muthukumara 2014). Hence, extreme climate events drive many of the health-related problems of women.
WHO focused on three key messages in a report entitled “Climate Change and Health Impacts: How Vulnerable Is Bangladesh and What Needs to Be Done” (Muthukumara 2014).This report points out that climate change will have a serious consequence on health by 2050. The report also says that the consequences of environmental migration contribute to the growing urban slum that is rapidly changing population dynamics. This environment-generated migration has considerable adverse consequences for climate-induced health risks and vulnerabilities in the urban areas in Bangladesh. The report continued to argue that in a cost-effective way, health services should be provided. A cost-effective approach in the health sector can reduce the burden of vulnerable and poorer groups of the population. In the process, the country must deal with effective budgetary allocation to ensure better health support for the most vulnerable people who have a low capacity to adapt to the health complications arising out of climate change.
People are exposed directly to changing climate, such as increases in temperature and rainfall events, changes in precipitation pattern, and rising sea-level. It is noted that agricultural production is directly linked to the patterns of precipitation, and this impacts on food security and nutritional status of the population. However, medical sciences have already proven that continuous intake of low calories result in a form of malnutrition, particularly in women and young children of reproductive age. On the other hand, climate change has also been one of the main causes to land degradation, decline of freshwater and coastal ecosystems, destruction of biodiversity, and stratospheric ozone depletion; hence, these issues have a large impact on health (Rahman 2008).
About 8.3 million people in Bangladesh are now living in cyclone-prone areas in Bangladesh and that is expected to increase to 20.3 million by 2050 (WHO 2015). Climate change is felt at a deeper level by the vulnerable people, who have the low resources and capacities to deal with the hazard. More interestingly, research has shown that women and young girls have very low level of knowledge on disaster preparedness and organizing for recovery. As a result, women suffer to higher death rates than male after a disaster. For instance, the cyclone of 1991 in Bangladesh showed that among the reported 140,000 dead or missing, 90 percent were found to be women (Kamal and Umama 2015). An important study on sexual harassment, carried out by Nasreen (2012), showed that 71.6 percent of women were victims of sexual harassment during disasters, and women and young girls faced with increased physical and psychological violence. Nasreen (2012) also reported that some women and girls faced sexual harassment even in cyclone shelters. So, state machineries have failed to provide personal safety and security of women during disasters. These conditions become worse, if women and young girls had any form of physical and mental disability (Nasreen 2012). On the other hand, it was highlighted that due to changes in climate, men are usually concerned about the irrigation process and agriculture production, while women are worried about their health rights issues (Sachi 2015).
Temperature and Extreme Weather
According to the Global Climate Risk Ranking, Bangladesh had 4,729 deaths due to extreme climatic conditions from 1994 to 2013 (Kreft et al. 2015). Bangladesh Centre for Advanced Studies (BCAS) and the National Institute of Preventive and Social Medicine (NIPSOM), in a joint study, point out that temperature (maximum and minimum), rainfall (annual and seasonal), and salinity in water and soil caused the occurrence of several weather-related infectious diseases. There are yearly records on temperature conducted and maintained by public agencies and researchers as well in Bangladesh that present extreme heat waves (Ministry of Environment and Forest 2009). On the other hand, there are some health-related complications connected with heat illness, for instance, heat exhaustion, dehydration, respiratory and cardiovascular-related diseases in elderly people (Rahman 2008). So, the country is particularly susceptible to heat waves.
In 2008, WHO (2008b) estimated that heat wave and extreme temperatures increase vector-borne diseases, such as the transmission of malaria in some locations. Heat waves are responsible for killing approximately one million people every year in the world. When it comes to the case of Bangladesh, having visited the MoHFW website, it does not provide specific data on illnesses and deaths due to extreme heat waves. But, without providing any data, the MoHFW claims some progress toward the elimination of vector-borne diseases has recently been made. Pregnant women and young girls are still exposed to malaria, as mosquitoes are the main transmitter of malaria mostly found around household areas, where, on an average, women spend 66 percent of their daily time at home, compared to men who spend on an average 45 percent of their daily time at home (The Daily Star 2016). Malaria in pregnant women is associated with the risk of miscarriage, premature delivery, increased risk of low weight at birth, and other adverse health consequences. Rahman (2008) in a study on women affected by malaria found that the abdomen of women during pregnancy is more likely on average 0.7°C warmer, compared to nonpregnant women.
It is also observed that diarrhea diseases increased whenever there was an increase in temperature and heat waves (Rahman 2008). Diarrhea remains leading infectious cause of death in Bangladesh. In May 2014, WHO published a report stating that diarrhea-related deaths in Bangladesh reached 15,928, which is 2.19 percent of the total deaths of the country (Rahman 2008).
Some earlier studies explored the nexus between excess temperature and the extent of eclampsia during pregnancy. Increased hypertension is linked with greater occurrence with the pregnant women who are staying in the coastal areas, when temperature is high. Research showed that the hypertension rates related to pregnancy was the highest in June, since at that time the level of temperature was very high, and the humidity level gets at its lowest point. There are well-established research findings that an extreme heat wave poses serious health risks, causing many deaths in each year. There is also a likelihood that a 2°C increase in temperature would amplify the death rates in the world. However, it is reported that direct exposure to heat could kill as many as 60,000 people in Bangladesh in the coming years ahead (Rahman 2008).
Waterlogging and Saline Contamination
In the southwestern part of Bangladesh, waterlogging has emerged as a big challenge for women’s health. Women are often more severely affected than men in their multiple roles of agriculture as producers of food and primary household providers to maintain health and well-being of other members of family. Women are the first responder in each family who do all sorts of water security for their family members and for livestock. Hence, women need to spend much time in waterlogged premises. Women are forced to drink water that is not safe, as many of the tube wells get contaminated in different settings, which poses serious health risks. It has been found that there are increased rates of gynecology-related health complexities due to the use and drinking of polluted water. Pregnant women also have difficulties with mobility in slippery conditions and waterlogging. Therefore, effects of climate change are varied between males and females in Bangladesh.
The coastal region has 19 districts, which cover 32 percent of the total area of Bangladesh, and more than 35 million people live there (Mahmuduzzaman et al. 2014). However, there is increased salinization of water and soil and the coastal people suffer heavily from the lack of water for safe drinking water, agricultural production, and other household purposes. Apart from that, the ecological environment of the coastal region is affected by salinity, as it has negative effects on agricultural production, water quality, and terrestrial biodiversity. However, a study showed that the salinization of fresh water is continuing to increase, for instance, in 1973 it was 8,330km2 but increased to 10,560km2 in 2009 (SRDI 2010).
As stated, salinity intrusion in drinking water has direct adverse impacts on health. In the coastal areas, the sources of natural drinking water (including rivers and groundwater) in the coastal areas are affected by saltwater intrusion from the sea. Furthermore, groundwater, soils, and many rivers are threatened due to salinization arising from tidal waves and heavy storms (Rony et al. 2016). On a particular note, salinity intrusion is projected to get worse in the future due to sea-level rise (WHO 2008b). A report on salinization of fresh water carried out by the WHO that more than 7.6 million additional people could be affected by the “very high salinity” (>5 parts per thousand) by 2050 in coastal areas (WHO 2015). Approximately 20 million people in Bangladesh are prone to climate risks due to the higher level of salinity as they highly depend on the flow of water from rivers, tube wells, and ponds for their daily washing, taking shower, and drinking water (Rony et al. 2016).
Sodium helps keep the body at a normal water balance. On the other side, if people overconsume the level of dietary intake of sodium, there will be negative consequences on their health, such as high blood pressure, brain problems, kidney problems, and other health complications (Rony et al. 2016). Throughout pregnancy physiological adaptation of women is very significant, where any variations from fetal to neonatal can be fatal to their life. Normally, hypertension (both diastolic and systolic blood pressures) is diagnosed in most cases after the 36th week of pregnancy (Rony et al. 2016). Pregnant women in coastal areas depend highly on the saline water for drinking. In that case, there is the presence of higher sodium level found in urine, and increased blood pressure.
Research by Rony et al. (2016) was undertaken to examine the impact of saline water intake on the health status of pregnant women in the two districts at Barguna and Patuakhaliin, Bangladesh. The extent of sodium (Na) in their urine was examined, and their blood pressure was also measured. The diagnostic report presented that sodium (Na) level, and blood pressure (BP) during the pregnancy was the highest in the 2nd trimester followed by the 3rd trimester and the 1st trimester (Rony et al. 2016). Just to say that a trimester means a period of3months in case of pregnancy, as normal pregnancy is divided into three trimesters.
As stated, the salinization of water and soil are projected to further deteriorate through future changes in climatic conditions, more specifically due to sea-level rises. Khan et al. (2011) conducted research and found that there are higher incidents of gestational hypertension diagnosed in pregnant women who lived in the southwestern coastal area that lead to preeclampsia, compared to those living in other areas. Local doctors and community representatives have blamed the excess salinized content in the drinking water. To them, this condition exposes risks to women in the coastal areas that may result in excess maternal mortality and morbidity (Khan et al. 2011).
Drought and Arsenic Poisoning
Drought is a form of natural disaster that leads to food insecurity and many health complications that can damage livelihood patterns of people. Women and young girls hold water pots and buckets or narrow-mouthed big containers that are placed on top of their head and carried until home. During the emergency period of drought, women have to make a long journey in order to reach the nearest tube wells and then bring back the weighty water pots, which causes fatigue and early damage to bones. However, in the northwestern region of Bangladesh, during the dry season, women and young children may have to go out to find out their sources of water for at least two times each day depending on the water requirement of their family members. Added to that, the first trip often takes place before the sunrise, which minimizes the required amount of sleeping; these skipped hours of sleep pose terrible side effects on women’s mind and body in the long run. It is revealed that during the dry season in rural Bangladesh, a significant percentage of women’s daily lives involved collecting water for their families and livestock. Furthermore, carrying heavy loads on head or waist for a long time causes huge damage to the cervical cord, the back muscles; and this can weaken and accelerate premature ageing of women.
Arsenic contamination was first detected in 1993 in Bangladesh (UNICEF 2008). The maximum level of acceptable level of arsenic contamination in water is 50 ppb (parts per billion).Tube wells are the dominant source of drinking water in the drought-prone areas of Bangladesh, but tube wells are highly exposed to arsenic contamination (WHO 2008b). Bangladesh Atomic Energy Commission finds that the concentration ranges between 150 and 200 ppb in most of the tube-well water in the different administrative districts near West Bengal of India, and almost 80 million people of the country who depend on tube well are exposed to arsenic who have the possibility of getting cancer in the future from arsenic poisoning (Uddin et al. 2004). There are 8.6 million tube wells in Bangladesh, among them 4.75 million (55 percent) were measured to test the level of concentration of arsenic. The experiment showed that 3.3 million (39 percent) were identified as green without contamination, and these tube wells are considered as a safe source of drinking water (UNICEF 2008). On the other hand, 1.4 million (16 percent) were identified in the “red” category, meaning these are not safe for use as drinking water source due to a high arsenic level (UNICEF 2008). However, medical science has already proven that health complexities due to arsenic contamination cause skin lesions, kidney and liver problems, swelling of the affected areas, and numbness in the hands and legs (WHO 2018).
Water and Vector-Borne Disease
Having reviewed the data on flood, every year Bangladesh faces flood risks due to climate change. It is estimated that by 2030, 4.2 million people would be exposed at higher risks due to river floods annually (WHO 2015). No doubt, flooding causes difficulties to the livelihood of people in the affected areas. McCarthy et al. (2001) point out that flooding causes an increase in the occurrence of vector-borne and water-borne diseases. Given the scenario, it means that Bangladesh is vulnerable to outbreaks of infectious diseases including water-borne diseases (e.g., diarrhea, dysentery), and vector-borne diseases (e.g., malaria, dengue, etc.). According to data retrieved from the disease control cell of the Health Department of the GoB, from January 1 to November 30, 2016, a total of 5,823 people were diagnosed and admitted to the different hospitals with dengue fever. Global data shows that one-third of the world’s population lives in areas where dengue transmission is very high (Rahman 2008). Therefore, more actions are required to uncover health complications related to water-borne, water-washed, and water-related ailments.
On the other hand, WHO says that malaria is the deadliest vector-borne disease. To them, malaria is responsible for an estimated 660,000 deaths in the single year 2010 worldwide and most of the deaths were of African children. However, dengue has become one of the world’s fastest growing vector-borne diseases, which has seen a30-fold increase over the last 50 years. The Institute of Epidemiology Disease Control and Research (IEDCR), and the Centre for Communicable Diseases conducted an empirical study (Jabbar 2014) from 2008 to 2009. They took samples of different medical college hospitals to measure the magnitude of dengue and malaria in six districts in Bangladesh. The study team found that dengue transmission was equally present in the urban (51 percent) and rural areas (49 percent), and it is common throughout the year but most commonly occurred (19 percent) during the post-monsoon period (September and October) (Jabbar 2014).
Long-standing values and norms of society and the poor attitude toward women makes them vulnerable during any climatic disaster. Apart from that, loss of privacy in cyclone shelters, and physical assault during the relief, simply discourage women to go to the designated location even during an emergency. Even after disasters, women are not allowed to go the community health care center alone, and they must be accompanied by their male counterparts.
Climate Change: Dealing with Women’s Health in Bangladesh
McCarthy et al. (2001) refer to adaptive capacity in the form of human abilities to deal with ensuing climate change and its consequences. However, the adaptive capacity remains inherent in the system that requires the resources and strategies in order to use it effectively for the purpose of adaptation. At the global level, in order to properly address climate change, there are some guidelines maintained by the UNFCCC. According to Article 4 of the UNFCCC, when proposing any new adaptation strategies, every country must evaluate the impact on people’s health considered together with other environmental and economic factors and issues. When it comes to developing impact assessments, it fully recognizes the well-being of people with regard to health, and other related issues. The UNFCCC as a mission is to deal with the “adverse effects” of climate change; more importantly, it highlights its impact on “natural and managed ecosystems or on the operation of socio-economic systems” and also focuses on “human health and welfare” (UNFCCC 1992).
To lessen the impacts of climate change on human health, there are many approaches that range from infrastructure planning to a more development-oriented transformation. No doubt that any approaches must address the issues and build broader resilience to climate change. The question is how successful will Bangladesh be in coping with the climate change challenges to women’s health? To deal with these crises, the GoB has already taken some major steps to address climate change risks and vulnerabilities. In responding to the question, the National Health Policy in Bangladesh, introduced in 2011, mentioned some limited progress in climate change about salinized water and soil, drought, and emergency response through better preparedness system. Furthermore, the National Health Policy claims some achievement for eradication of some respiratory diseases, heat- and cold-wave-related health complications, water-borne and parasite-related problems such as malaria and dengue, and malnutrition (MoHFW 2011).
The GoB through the “Sixth Five Year (FY 2011-2015) Plan” recognized the future health risks due to climate change. The plan focused on “build(ing) capacity in the area of environmental health through both public and private sectors” (Planning Commission 2011). On the other side, in the Seventh Five Year Plan (FY 2015-2020), it has specific programs to implement the “Gender Action Plan on Climate Change (CCGAP)”. There is no denying the fact that the impact of climatic changes on women’s health differs due to the varying possession of individuals’ access to resources, and the ability to make their own decisions that can help to build a climate-resilient society.
In order to deal with the future challenges of climate change, governments, partner countries, and international organizations plan to include women in their climate change adaptation programs at the community level. It is suggested that all programs regarding climate change are required to identify and reduce gender-based inequalities. Recently, the Ministry of Women and Children Affairs (MOWCA), Bangladesh Climate Change Trust Fund (BCCTF), and various nongovernment organizations have started to integrate gender sensitivity in their respective project design and monitoring aspects in climate adaptation programs.
The GoB introduced a National Climate Change Fund, which focused on climate change adaptation strategies. Apart from that, health has been included in the climate change strategy and action plan that was introduced in 2009. Again, it should be noted that there is the 10years’ perspective plan for health for the period of 2010 to 2021 in regard to climate change (General Economic Division 2011). However, it is expected that a significant amount of the climate fund must go into adaptation programs in order to lessen negative impacts on women’s health arising from climate change. This is argued to focus on the potential of women’s capability and their initiatives to address risks and vulnerabilities. No doubt that women can be powerful agents whose indigenous knowledge will be helpful in coping with changing climate conditions, but the role of women is undervalued in the society of Bangladesh. It has been found that the potential responsibilities of women to respond to the changing climatic conditions, and resilience building, are generally underutilized at family, and community levels. Hence, women are needed to be fully incorporated into different climate change adaptation strategies and programs.
FAO (2009) revealed that women lack access to climate-related information and the shortage of information is a great obstacle for early preparation for their health issues and beyond. The IPCC explains that future healthcare must relate to climate change, because of the fact that sound physical health of population helps to sustain an adaptive capacity (Rahman 2008). From the findings, it can be said that in the changing climate change scenario, the health status of women is still far from the standard level, and women have very few roles to know risks and vulnerabilities.
Conclusion
From the above discussion, it is clear that Bangladesh now faces some challenges due to the impact of climate change, particularly for women’s health. The government should introduce extreme-weather-tolerant efficient health services for all and develop a dataset for climate-related health complications, particularly for women. Undoubtedly, if strategies to deal with climate change are not efficient, then certainly climate-related infectious diseases could become more prominent, and bring new health risks and vulnerabilities to women. In every particular stage of climate change, women and young girls face health complications. So, priority should be given to include them in the disaster risk management process in order to build their own resilience capacity. Last but not least, it is necessary to focus on the emergence of community participation in dealing with the continuously changing climate, which relates to women’s health risks and vulnerabilities in Bangladesh.
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