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Salt and tears

  • Published at 04:49 pm July 19th, 2018
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Bangladesh sees 27.77% rise of pre-eclampsia cases since 2012


Nine-months-pregnant, on May 18 this year,  22-year-old Rekha Begum was brought to Dacope Upazila Sadar Hospital with trouble breathing.

“I could not even breathe let alone speak and I was panicking. So my mother brought me here,” the resident of Gourdas Kathi village in Bagerhat’s Rampal Upazila told the Dhaka Tribune. 

“This is my second pregnancy and I did not feel this way when I had my first child five years back.” 

Dr Md Mozaammel Haque Nizami, Dacope’s medical and family planning officer, explains that Rekha was suffering from gestational hypertension. He attributes it to increased levels of sodium chloride (salt) in drinking water in the coastal region.

“Although it is not uncommon during pregnancy, what is alarming is that the frequency of such cases is on the rise,” added the doctor who runs the government hospital.

Gestational hypertension causes pregnant mothers to suffer from very high blood pressure and poses the risk of maternal death and stillbirth—according to the doctors at the Sadar Upazila hospital. 

Like Rekha, many other women have been admitted to the hospital in last few years with similar symptoms. Between 2011 and 2014, the hospital’s records show a 36.9% rise in cases of pregnant women with hypertension.

Dr Sontosh Kumar Mojumder, the hospital’s gynaecology consultant, points out that many of the cases in recent years have transgressed the category of chronic and gestational hypertension and falls into that of pre-eclampsia, where patients endure high blood pressures alongside excessive muscle spasms. 

The frequency of such cases has spiked 27.77% between 2012 and 2017 according to the hospital’s records.  

Sontosh links the hikes in these cases to increased salinity of the coastal belt because, when salinity is at its highest, during the dry season (November to May),  more pre-eclampsia patients are admitted to hospital. . 

Additionally, Research examining the correlation between drinking water salinity and maternal health in Bangladesh, by London Imperial College and the Bangladesh Center for Advanced Studies, in 2008, found that the frequency of pre-eclampsia and gestational hypertension were higher in coastal areas when compared to non-coastal areas.

The study titled ‘Drinking Water Salinity and Maternal Health in Coastal Bangladesh: Implications of Climate Change’ also found that frequencies of these medical conditions hike during dry season.

The salt predicament

Bangladesh’s coastal population, comprising of approximately 40 million people, relies heavily on natural water sources like ponds, rivers and tube-wells to obtain drinking water. 

However, seawater intrusion caused by environmental change, and man-made factors (including poor water management and shrimp farming) have severely salinated these sources - as found by a government study conducted in the coastal region. 

Bangladesh’s Department of Public Health and Engineering (DPHE) determined that the salinity of groundwater in most areas in the coastal districts is several levels above the acceptable drinkable level—also when measured against amounts established by the World Health Organisation. 

The study found that in most coastal areas, the level of salinity (chloride count) in the main or second aquifer ranges from 103 to 12433 milligram/litre during the dry months and 34 to 11366 milligram/litre in the rainy season. 

In both cases, the extremes are far above the prescribed 300 milligram/litre for fresh water and drinkable range of 300-600 milligram/litre.

Meanwhile, the 5th Assessment report of Inter-governmental Panel on Climate Change (IPCC) places Bangladesh at a specific risk from climate change because of its exposure to sea-level rise and extreme events like: salinity intrusion, drought, erratic rainfall and tidal surge.

Already, salinity has encroached on areas more than 100km inland from the Bay of Bengal, and the impacts are projected to be exacerbated by sea level rise caused by climate changeThis jeopardises the country's food supply, endangers public health and minimizes any security for livelihoods.

A study by Centre for Environmental and Geographical Information Service (CEGIS), a subsidiary of Bangladesh’s water resources ministry, measured the average extent of seawater intrusion in Bangladesh’s coastal area, and classified it into three sections.

The study titled, “Assessment of Sea Level Rise and Vulnerability in the Coastal Zone of Bangladesh through Trend Analysis,” which is based on 30 years of data, found that on  average, seawater intrusion in the Ganges tidal floodplain is 7-8mm per year; in the Meghna estuarine floodplain, it is 6-9mm per year; and the Chittagong coastal plain 11-20mm per year. 

The poor pay more

While rich and urban people spend more for food, housing, water, and sanitation than those living in marginalised areas, the scenario is different in Bangladesh’s coastal belt.

Food, housing and sanitation are costlier in cities, but coastal area residents have to expend far more for water due to the salinity problem. 

Those living in Dhaka, the capital, pay Tk8.49 for a 1000-litre unit of water for household use from Water Supply and Sewerage Authority. Those living in Khulna, a city on the coastal belt, gets it for nearly half that price, Tk4.50. 

But this is as far as the logic extends. Unfortunately, the situation across 19 coastal districts further south, towards the coast, which have been crippled by increased salinity, is completely different.

Even those living just 20 kilometres from Khulna have to pay at the rate of Tk 10 for 20 litres of desalinised water. 

So for a 1000-litre unit, the people living in the coastal regions would have to pay Tk 500, roughly 100 times more than what residents of the nearest city corporation, Khulna, pay.

Sacrificing well-being

Due to high costs, residents in the coastal region try to harvest rainwater to meet their needs during the three to four month monsoon. 

“During monsoon, we collect rainwater in our own harvesting pots for drinking” said Taposhi Gayen, a resident of Dacope’s Saheber Abad village. “The rest of the months, we have to buy our drinking water.”

On average, the rates charged by both private and public providers are similar, Tk 0.50 per litre. 

“So, we try to use water from the ponds or rivers for washing, cooking and bathing—as using desalinised water would be impossible to afford,” added Taposhi. 

Incidentally, the salinity-affected districts fall mostly under the Barishal and Khulna divisions— both of which recorded a monthly household income below the national average during a survey conducted by the Bangladesh government in 2010.

The Bangladesh Bureau of Statistics said in the report titled 'Household Income and Expenditure Survey 2010,' that the national average income stood at Tk11,479—while Barishal’s was Tk9,158 and Khulna’s was Tk9,569. 

Mira Gain, a 45-year-old mother of three, buys drinking water for her family from a saline water treatment plant of the local union parishad complex in Dacope. 

The five-member family can only afford Tk 300 per month for drinking water, which, at the standard rates, gets them 600 litres. Each member must sustain themselveson just four litres of desalinised water per day.

“Thus, they try to make up the shortage by using saline water for cooking and other purposes, which ends up having severe health impacts on the long run,” hydrologist Prof Ainun Nishat said.