Still, nothing is happening in Bangladesh. There has been no action of the government especially regarding women’s health. It goes without saying that if no action is taken now, it is not too late to face a dire crisis.
Teenager Aasia often helps her father in the grocer’s of the latter in a village under Shyamnagar Upazila (sub-district) of Satkhira, a coastal district of in southwestern Bangladesh.
Much to the surprise of many, she takes contraceptive pills in a bid to control her irregular menstruation.
‘We suffer extreme itching during our periods due to saline water. So, we stop menstruation by taking the pills,’ said the girl with immense shyness, who has yet to be married off.
Like Aasia’s, this has been the case of countless teenage girls living along the coastline of the South Asian country of more than 170 million.
Shockingly, a massive number of them are unmarried or virgins, with the trend of consuming the pills on the rise.
Investigations found that the demand for birth control pills is way higher than that of sanitary napkins or pads in the areas in question.
Millions of Bangladesh women living in coastal areas are greatly suffering to reproductive health issues, thanks to the rising sea levels. Around 45% of them are found to be already affected with uterus tumors while 55% are facing irregular menstruation – all because of high salinity in water. Additionally, around 100% of coastal people are suffering from different skin diseases.

Chilling estimates
A study launched by the Centre for Participatory Research and Development (CPRD) in March last year said that nearly 64% of women in Mongla Upazila in Bagerhat and 54% in Satkhira’s Shyamnagar Upazila are facing reproductive health problems.
There are 30 million people living in the coastal area of Bangladesh among which 2.5 million are facing an acute crisis, per the World Bank.
An estimated 20 million people in coastal Bangladesh are affected by increased salinity in drinking water, according to a 2018 article in the Journal of Agricultural Economics.
Meanwhile, a study published in 2022 year by Ipas, a US-based NGO that focuses on reproductive justice, found that global warming exacerbated existing gender inequality and directly and indirectly affected women’s sexual health, pregnancy outcomes, contraceptive use and fertility intentions in Bangladesh and Mozambique, two climate-vulnerable countries.
The report found that during extreme weather events made worse by climate change, such as cyclones, access to health care and contraceptives was limited. The researchers also found that the climate crisis deepened economic instability and added extra burdens on women’s caregiving responsibilities.
In the country’s southwest, more than half of the women living in two sub-districts reported infection or inflammation of the vagina, uterus, fallopian tubes, or ovaries, says a 2024 Journal of Migration and Health study.
More than one in three respondents reported menstrual hygiene management problems, and one in five complained of hypertension during pregnancy. More than 1 in 100 had their uterus surgically removed because of chronic bleeding, infection, or tumors.

Account of a development worker
A development worker tasked with women’s health the area for four years, Nasrin Sulnata, too, got affected and suffers from the same problem.
“Women in the area are the worst victims. Cervical cancer and problems in private parts are very common here, owing to saline water. Sufferings weigh heavily during menstruation. One has to go to washroom five to six times,” she said.
Nasrin went on to say, “That’s why teenage girls take birth-control pills to stop irregular periods. Two types of contraceptive pills – both named Sukhi (red and white) — are available in government health facilities.
“They avoid the red ones (iron tablets), only to resort to the white pills. Many also get injected to control periods. These are affecting vaginal tube and causing cervical cancer, eventually causing the cervix to be removed. The affected women are finally failing to taste motherhood,” she added.
What does the government say?
Contacted about the mindless use of birth-control pills by teenage or underage girls, Deputy Commissioner Humayun Kabir said they were working to tackle the situation.
“We are trying to build mass awareness by visiting pharmacies so those stop selling pills at least to the underage girls,” he added.

Grave findings
Sharing her experience, Dr Rumana Chowdhury, a gynecologist at Friendship Hospital in the upazila for two years, said that government field workers who are treating these grils and women are not actually doctors.
“The patients come to us when the field workers can’t treat them well. Then I try to understand whether a case hormonal and upon a case study, I continue to give treatment accordingly,” Rumana added.
In other words, Dr Chowdhury often sees this kind of patients. As the Sundarbans coastal area became salinised, the climate also adversely changed. It also affects women’s health. Especially those, who work in saline water, suffer from various diseases. Early marriages, childlessness, cervical cancer and even deaths occur commonly in the area.

Citing that there is no official estimate of the life-threatening health issue and deaths, the physician said, “Hence, we opted to conduct a survey on the issues.
“At the beginning, we asked several women of the coast. We conducted a survey on some 40 women in six villages under the Munshiganj and Gabura unions of Shyamnagar Upazila,” she added.
The results of the survey say that everyone is suffering from skin diseases.
“Twenty-two people have irregular periods, 13 have tumors in the uterus and four have already got their cervix removed. The rest are waiting to get theirs cut once they can afford it.”

Some case studies
The Munshiganj Union is surrounded by the Sundarbans, where inhabitants are badly affected by climate change and salinity.
This reporter and his team crossed the Malanch and Kholpetua rivers to Chakbara village of Gabura Union to find out how much the reproductive health of local women has suffered.
Sajida Begum spends a large part of the day in salt water as the locals are heavily dependent on catching fish to earn their livings. This female shrimp farmer was telling about the problems caused by working in salt water for a long time.
“I have been having problems including itchiness, ulcers inside the stomach, and dysmenorrhea for two years. And during menstruations, the lower abdomen hurts for seven to eight days. The ache vanishes after taking medicine but resurfaces when I stop having medicine.
“It continues for 10-12 days centering my period. Is there anything left in a human body after all these?”
The shrimp farmer, who works almost half the day in saline water, recalled that she had not suffered from the physical problems earlier.
Other than her work, she is also forced to use the saline water for household chores starting from doing the dishes to taking a bath.

We next moved to Central Kalinagar village of Munshiganj Union, to talk to Parul Begum, who walks two and a half to three kilometers every day to collect drinking water.
Responding to our questions involving the saline and potable water, Parul straight pointed to uterine infection, which she termed the main problem.
“We have to stay in water from 7 am to 1 pm; we have to bring water from far away and it causes pain in the lower abdomen. We also face problems running family,” she said.
Doctor forbids going down in salt water, Parul said, adding, “If so, who will do the family chores? Even medicine does not heal completely. The pain lessens for some time.”
Parul says a surgery requires a lot of money, which she cannot afford. “This shows that many people get cervical cancer. Due to lack of proper treatment, many of us have died here. What can we do when all our works are involved in saline water?”
Fresh water is available only during monsoon – but not in the rest of the year, she lamented.
“We are massively dependent on saline water. Consuming salt water gives us nausea, flatulence and acidity,” she added.
In her early 40s now, Rizia Khatun suffered from several diseases in her 22-year conjugal life. She, too, blames saline water for her physical problems.
On this front, Dr Chowdhury said, “A number of poor patients come here. As I see more gynecological patients, PID-pelvic inflammatory infection, leukorrhea and urinary infection patients come here. Many with skin diseases come here too.
Leucorrhoea, also known as Likoria, is a medical condition in which women experience the presence of yellowish or whitish vaginal discharge. This discharge generally has a thick consistency. Most women worry about this consistency, thinking they have a disease, but it is often just a vaginal infection.
“Here the maximum cases are likoria, some patients have hygienic problems. They work in salt water, or in the fields; so their health issues may happen because of that,” she said.
Humidity is very high here and so is the number of UTI patients, the gyneacologyst stated.
“If you talk about 50% UTI cases, the number of likoria patients is higher. I will talk of likoria since the patients work in fields, sink in ponds and cannot maintain hygiene. This is why the number of licorice is high,” she added.

Water woes
A study carried out by the United Nations Development Programme (UNDP), suggests 73% of the people living in five coastal upazilas of Satkhira have to drink saline water on a daily basis.
The study also depicted the hardships faced by the people of the coastal areas due to not having access to any other source of drinking water. Even during the dry season, the salinity level of tube well water in some parts of Satkhira goes up to 6,600 milligrams per litre (mg/l).
The UNDP study also revealed that many people in the coastal areas consume water with very high levels of salinity, causing various health problems, while many people spend more than two hours per day fetching drinkable water from long distances.
According to the Satkhira District Department of Public Health Engineering, the salinity level is 4,400 mg/l in most areas of the coastal district compared with the permitted threshold of 1,000 mg/l.
Not only girls and women in coastal areas, but children are facing health problems due to climate change. Humans are greatly responsible for the climate change issue. Let us also observe the scene of how we ourselves are destroying the environment.
We get fresh water very easily. But people living on the coast, especially in Bagerhat, Khulna and Satkhira, have to walk three to four kilometers to fetch a glass of fresh water. It is difficult to imagine the scene without seeing it with our own eyes. No one will understand the lack of fresh water in Shyamnagar unless they go there. Rainwater is their only hope. If it does not rain there, the people of Shyamnagar have to walk for miles to collect water. There is water for food, but water for bathing has to be bought in cash.
Such is the plight of Daulat-un-Nesa, a resident of Western Atulia, who narrating her miseries, said, “There is so much water around us — but there is no way to use it. There is no potable or useable water.
“I look at the sky and eagerly wait for rainy season. We are forced to buy drinking water the rest of the year. The cooking water is not worth talking about,” she added.
The woman challenged if the investigation team that was interviewing for the report her can taste the salty water she generally uses for household purposes.
“Even the water pumped out of our tube well is too bad.”
The reporter talked to another patient Nilima Mandal named in Aitpara area of Munshiganj Union.
Nilima was telling that she has a tumour in her lower abdomen for many days. But she is not able to dare the operation.
“I’ve been suffering for 20 years. The doctor said I may not survive if I get the tumour removed. I may not regain consciousness.”
Prajapati Mandal of the same village, however, is counting the days of her operation. She is aware of facing the risk of cancer if the tumour is not removed.
Sorry tales
We managed to talk to Roushan Ara of Dhankhali village, who works all day long for a living. Like others in the area, she also suffers from various diseases due to working in saline water.
As the woman grapples with her limited income, she also sews clothes for the village children to support her family.
“If medicine fails to cure, I’ll have to go for a surgery for my uterine infection.
If she touches water, her uterus faces issues and she suffers from lower abdominal pain.
Raushan’s daughter, too, faces similar physical problems that surfaced from the same source: saline water.
We took the mother-daughter duo to a specialist doctor to understand whether there is really a problem in the uterus.
The doctor, after hearing everything from them, said, “Raushan has various diseases including skin disease, but screening or examination will confirm if there is a tumor.”
And the relevant test is done in government hospitals for only Tk100. If someone feels the need to have their uterus examined, they can do so for the small fee.
Now we moved to Shyamnagar Upazila Health Complex, where there is an expert gynecologist. But she was not at work when we went there.
A patient at the health complex, expressing her disappointment, said she, too, came to see the doctor – but in vain.
We looked for another doctor, who was also absent. Then we approached the head of the health facility, who too could not be found at the office. We tried to speak with the civil surgeon of the district at the latter’s office. But he was not available there either.
Most of the women are very disturbed in terms of reproductive health and affected by salinity. Some opened up about their physical issues, but most of them do not want to talk as they find it uncomfortable.
Still, we managed to talk to many victims and confirmed that there have been cases of uterine shedding due to salinity. The deterioration in reproductive health is a fatal blow to the people of the region.
Sufia Begum of Samata Guchchha (cluster) village in South West Atulia said that tumors in the uterus are a regular occurrence there.
“Saline water has caused itching and tumor has developed. So, the doctor said that it will not be good if the operation is not done. I underwent an operation at a local clinic. A little delay could have caused cancer,” Sufia remembered.
Stating that two of my neighbours also had their uterus removed, she said her husband often expresses his resentment as she is unable to conceive now.
“He keeps silent sometimes – but reacts heavily when he speaks about parenthood,” said an upset Sufia.
Researcher Abdur Rahman Rana was worried that this change in the southwest region would lead to more problems in the lifestyle of the coastal people.
“Increased acidity means problems in reproductive organs. No one is talking about this in the south. But another problem is manganese. Scientists are not directly saying that sodium chloride is affecting women’s reproductive health, but manganese is increasing, which is directly harming reproductive health,” he said.
Level of salinity
We again set off for Shyamnagar. Coming here, we also had to use saline water. The water we washed our hands and rinsed with in a restaurant in the coastal area is completely salty. The people of this region live in this salty water. We have seen that people who live here are always affected by this water. If we want water other than this water, we have to buy bottled water, which is very expensive for the people of this region. We wanted to check the salinity of the water.
Shawkat Hossain works in a local development organisation. He used mechanical tests to show how much salt the water contains. Let us first look at some pond water. Here it looks like half past three, close to four.
Now let us check the water in an enclosure inside Buri Gowalini Union. It is half past eight here. But our normal salt intake capacity is five. That means, we are getting 3 more than usual in these enclosures and that too, during rains.
After that, we went to the Chuna River near the Sundarbans. Shawkat Hossain was telling us how salty the water in this region is.
He said, “We conduct the test upon the measurement of PPT (parts per thousand’). My machine actually cannot take readings above 30 PPT. After this test, it appears that the water of this river is so salty that it is above the mark.”
Water supply in dire straits
A neighbourhood of fishermen, locally known as jelepara, is next to where we were testing saline water. No one can drink this water because of the salt in river and canal water. There is no source of fresh water here. Residents of the Kalbari jelepara survive only by saving rainwater. All the water storage tanks seen here have been given by some organisations to them. Some tanks are broken and some are being used somehow. Many tanks damaged by natural calamities could not be repaired due to fund crunch.
The Department of Public Health and Engineering is supposed to supply district-wise water. We queried what steps had been taken for fresh water storage and supply in this region?
Mostafizur Rahman, assistant public health engineer of the district, said, “There are 12 unions in Shyamnagar, the most southwestern upazila of Bangladesh. Two of these are islands, meaning they are separated from the mainland.
“So, the salinity level in the water here is five-six times higher than normal. In such a situation, rainwater is the only solution and the second solution is reverse osmosis plant. And in the area which is not saline, we collect water through deep tube wells, shallow tube wells and VVST. And where surface water can be used, we supply water through PSF,” he said.
Still, locals do not get potable water.
In this regard, the engineer said, “There are various government projects for this, but you must agree with me that the main problem here is the embankment. The embankment on the banks of the Khol Petua River is damaged by the storms that occur in the months of May and October every year.
“As a result we dig a fresh water pond or whatever, but this embankment breaks down, causing our source of freshwater to be flooded with salt water and whatnot.”
He added, “Where we provide community-based tanks, many of our beneficiaries are reluctant to take care of those, as there is no sole proprietorship. They are reluctant to even bother about maintenance. I see many of the NGO or GO establishments that we have here are not functioning.”
Gabura Union Chairman Masudul Alam said, “There is a lack of fresh water in our region. There are fifteen villages in our union, but only four of them have partial water supply. And people in eleven villages depend on saline water.
“If you see the appearance of the people of our locality and the color of their clothes, you can understand how terrible the situation is,” he said.
Local girls, the chairman said, face more problems.
Plus, there are reproductive problems and stomach ailments among the girls and women here, he said, terming the girls most affected.
“Girls in our area get married at a young age, as a result of which their appearance and health are affected badly. Saline water contributes to the debacle, causing random divorce and separation,” the chairman said.
“Saline water harms health greatly. Financial crisis also plays a strong role in such crises,” he concluded.
Khulna-based Salinity Management Research Centre provides various agricultural advices by examining the salinity of the southwestern town. Its principal scientific officer, Amarendranath Biswas, was telling us what is changing in this region due to the effect of saline water.
“The area is naturally saline. In April and May, the soil and water are highly saline here. Farmers can’t grow crops here due to high salinity. But some farmers retain fresh water by damming themselves,” Biswas said.
“In 2008-09, the level of salinity decreased at times. Now it has increased again. If the water becomes saline, there will be no irrigation water and farmers will not be able to grow crops. And if the soil becomes saline, there will be no crops.”
“This fresh water needed is found 800-900 feet down in the coastal area and it is gradually going down, and if it is not available, everyone will be forced to migrate,” he feared.
Unclear history of salinity
Researcher Rana was telling about how this problem of saline water started and whether there was any study in the implementation of shrimp farming project in the coastal region. He said, “Not only Khulna, Satkhira, Bagerhat, we also worked in Patuakhali and Noakhali. Especially, those farming shrimp are bringing in saline water.
“In the 1980s, shrimp farming was promoted here, and big projects were undertaken then.”
In other words, while giving importance to the economy, the environment was damaged. While farming shrimps and crabs, people bring salt water from the deep sea and pour it into freshwater enclosures. As a result, along with freshwater sources, salt is also increasing in the soil. Agriculture in the area has also been affected.
But it is not only women’s health that is at risk from climate change. Men in the region also suffer from various diseases. As the amount of salt in the water increases, the number of deaths due to respiratory problems, heatstroke or heat issues are also increasing. However, this climate change in coastal areas did not happen overnight. This man-made silent killer has been linked to natural disasters.
Poor embankment protection
Many dams have been built here to prevent saltwater from entering the cropland during cyclones. But here it is seen that local people are allowing salt water during high tide. A victim woman said, “I have to be here all the time to open the sluice gate. All the water goes to shrimp and crab projects and that is why I have to always remain standby.”
Questioned if it is from the government, she said, “Hatchery owners from this region erected the sluice gate. If the gate is not damaged, there is no loss. But if it gets broken, it causes harm as saline water enters aplenty.
“Those involved in the projects take water. If they did not take water, there was no need to allow the saline water inside. This is not right. It leads to a great havoc.”
These barrages save locals from the cyclones caused by climate change. Many sluice gates were built here so the saline water of the Sundarbans, the sea and the Kholpetua River does not enter the locality.
But the local moneylenders who farm crabs and shrimps, for their convenience, lift the sluice gates at high tide to ensure saline water flow to the hatcheries, resulting in increased salinity even during monsoon, when fresh water is available from rains.
Govt’s take on the embankments
The Bangladesh Water Development Board (BWDB) built these embankments. So, we quested how the sluice gates were set up on the embankments.
Salah Uddin, executive engineer of the BWDB, said that one of the mandates of the board is that saline water cannot enter the locality or public life.
“That’s why we started building dams in 1960. In Satkhira, such embankments span over 673 km. There are such dams, specifically in Shyamnagar Upazila, covering some 150 km,” he said.
Nevertheless, he said, “Since these areas require saline water for fish, shrimp and crab enclosures, it is also necessary to allow the access of the water. So, we build regulators.
“Through these sluice gates as much saline water as required is brought in, and when it ebbs, the water is released. But the effect of global warming, which is causing sea levels to rise day by day, is increasing the upward movement of saline water, causing the access of salt even upstream areas. It also makes the soil salty.”
The engineer further said, “When saline water is allowed in, it is done as intended. Since the water is needed in the enclosures, we have check whether the spot is safe to make an enclosure. If there is a plan for agricultural work and the water can be taken out, the nature can revive on its own.”
International concern
How worried is the international community over to the negative impact on the environment, increasing salinity and women’s health issues in Bangladesh’s coastline?
We talked to Nayoka Martinez-Bäckström, the first secretary of Climate Affairs of the Swedish Embassy in Bangladesh, in this regard.
“As of last year, the UN climate summit actually had a specific discussion on the impacts of climate on health, and now Bangladesh is prepared to go there and talk about the problems of coastal women in the UN climate summit, popularly dubbed as COP, and more and more the issue is being addressed in terms of adaptation, financing and also inevitably loss and damage, and how to compensate communities who are suffering from increasing salinisation and the lack of safe water. So, it is getting there. We are working on it. It requires efforts from many parts from the policy, strategy, planning parts and also the investments that come together to protect these communities,” she said.
“I mean, this is an emerging problem, really. I mean, it’s so prevalent in many coastal settlements. In fact, it’s so important that the World Health Organisation (WHO) have actually launched an alliance of countries that are facing these challenges in their hostile settlements. So, what we know is that they still need more research about that to link directly these emerging diseases with the rising salinity and also the impacts of climate change on these things,” she added.
“The alliance has many countries from Southeast Asia and also from East Africa. For example, Sweden is a partner that supports this this whole alliance to learn and take ideas. And, you know, we try to learn from the examples that are being implemented in these countries to actually address these challenges (due to climate impacts),” added Nayoka.
The envoy went on to say, “There are two ways to address the issues. You know that the problems have already been identified. So, then you can say, ‘Well, let’s develop special soap for these women or let’s provide them with extra vitamins.’ But there is also the need to address it systematically.
“So, you look into their livelihoods and why they don’t have an alternative to changing livelihood. After that, you offer them other livelihood opportunities. However, they’re not exposing themselves to saline water all the time. We are already doing a lot with regard to treated water,” she added.
“So, we have invested as part of climate adaptation. We have invested in water purification systems. But there is also this important point about using coastal development and regeneration of mangroves of our wetlands as part of this protection against increasing salinisation,” she explained.
“So, the response has to happen in many parts, and the investments have to be on the solutions that are more systematic and long-lasting. So, what many of our partners are trying to do is that adaptation projects that are being financed now in Bangladesh should include this health challenge,” she concluded.
Climate conference is organized every year in the world where the risks from climate impacts are highlighted. A budget of billions of dollars is being allocated to tackle climate issues.
Still, nothing is happening in Bangladesh. There has been no action of the government especially regarding women’s health. It goes without saying that if no action is taken now, it is not too late to face a dire crisis.
A brief history of water in southwestern Bangladesh
Approximately 30 million people in Bangladesh live along the 19 coastal districts. Here, the rivers flow through a wide and muddy plain, their channels spread across the land like a mesh net, with the lines between land and water always mutating.
There are no borders that divide fresh water from the sea. Every day, like clockwork, the tides reach a few kilometres inland, inundating coastlines and bringing the saltwater in, then retract a few hours later. For generations, people have lived in harmony with the water, tuning their lives and livelihoods with the ebb and flow of the river tides.
Until the sea levels started rising – and, with them, the salinity levels in the rivers.
Some 20% of the total land in Bangladesh is coastal, over half of which is affected by varying degrees of salinity. Salinity intrusion is seasonal, with minimum salinity during the rainy season (June-September), and maximum in the dry season (March-May).