‘Bleeding’ for Water

Moyna, a teenage girl in Bangladesh’s Satkhira, misses school again. Instead, she needs to walk a few kilometres with her mother to collect fresh drinking water. They rely on the water treated by the Pond Sand Filter (PSF), as they cannot use water from ponds or tube wells due to salinity in the area.

As if her day can’t get any worse, Moyna starts menstruating. Moyna and her mother can only collect a few jars of water per day, so girls like her don’t have sufficient clean water for hygiene purposes. She has been watching her mother suffer from uterine disease for a long time now. Some of her friends and neighbours also suffer from skin irritation and gastrointestinal diseases after having to resort to using pond water. 

Eventually, Moyna decided to take matters into her own hands, and started using birth control pills to control her menstrual cycle to be ‘safe’.

This isn’t an isolated incident. It is the reality of countless women and girls across Bangladesh’s coastal regions. While Moyna’s challenges may seem like private battles, they are emblematic of a larger crisis unfolding along the vulnerable coastal areas of Bangladesh. 

The United Nations anticipates that global climate change may force an additional 158 million women and girls into poverty. Yet, before this future unfolds, in the climate-vulnerable coastal areas like Satkhira in Bangladesh, women are already lagging behind the poverty line. For these women, the climate crisis is already a matter of life and death.

While Bangladesh’s national birth rate is 1.37%, Shyamnagar Upazila in Satkhira experiences a lower rate of 0.89%. This is attributed to various health conditions suffered by women in these areas, linked to climate issues. Saltwater intrusion due to rising sea levels and shrimp cultivation mean that the only water available for hygiene is saline water, which leads to infections. As a result, women in coastal regions like Satkhira resort to continually using birth control pills to halt their menstrual cycles. Used correctly, birth control pills are taken together with seven placebo pills over a 28-day cycle to facilitate menstruation, but more and more young girls in the region are continuously taking the birth control pills without the placebo pills, which allows them to reduce the frequency of menstruation or to halt their period altogether.

This is a dangerous solution. Misusing birth control pills in this manner without medical supervision can lead to a number of health problems, including hormonal imbalances, increased risk of blood clots, breakthrough bleeding, and fertility issues, as well as symptoms such as irregular bleeding or spotting, mood swings and depression, breast tenderness, weight fluctuation, and disrupted sleep patterns. While such side effects are generally reversible, in rare cases, long-term misuse can permanently affect reproductive health. Moreover, the continuous suppression of menstruation may mask underlying health issues such as hormonal imbalances, polycystic ovary syndrome (PCOS), or endometriosis. Young women are even more at risk of long-term effects of misusing birth control pills. And yet, this practice seems to be increasing in regularity among the women in coastal regions. 

Despite the severity of the situation, women’s health issues in these regions receive scant attention. Limited media coverage and sporadic NGO activities fail to provide long-term solutions for dealing with the basic physiological processes of menstruation. And as the scarcity of clean water becomes a central theme, more teenage girls in this region are turning to birth control pills to avoid this problem.

Residents of coastal areas, including Shyamnagar, Kaliganj, and Ashashuni in Satkhira, struggle to acquire drinking water because of the area’s salinity problem, and the ordeals the women have to go through on daily basis to maintain hygiene during menstruation is unimaginable. Most women in the area can’t even afford sanitary napkins, instead using cotton pieces, further compounded by water with high salinity content, which increases the risk of various diseases.

As reported in the Khulna Gazette, a local newspaper based in Khulna, women in the Khulna area are experiencing an increased rate of premature abortion and uterine problems due to soil and water salinity. Another report by JagoNews24 reveals that approximately 10% of annual operations in private clinics in Shyamnagar Upazila are related to the uterus, with a high incidence of uterus removal. The report further indicates that in 2019, 5% of patients underwent uterine surgery at the Sundarbans Nursing Home, while urban clinics reported an 8% rate of uterine operations. Additionally, 11% of individuals at Banshipur Clinic have undergone similar procedures. The same report highlights that at least 60 women suffer from cervical diseases, with 25 of them having already undergone uterine removal procedures.

The highest level of action taken to address this life-threatening crisis is a few projects of installing water tanks to collect rainwater. Needless to say, Bangladesh doesn’t experience sufficient rainfall throughout the year, even with the current state of unpredictable weather. There is no concrete plan of action to address the fates of thousands of people, who have been affected by this crisis all their lives, from national or international arenas.

In a move which is said to be a historic one at the recently concluded COP28, wealthy countries most responsible for the climate crisis have pledged a combined total of mere US$700 million to the loss and damage fund. This can accommodate less than 0.2% of the irreversible economic and non-economic losses developing countries are facing from global warming every year.

The representatives of Bangladesh returned from COP28 without a clear plan on how to collect the pledged fund or ensure its proper disbursement. The urgency of addressing the immediate needs of affected communities seems to be lost in bureaucratic shuffle. It is hard to imagine that there will soon be an action plan about disbursement, or that the fund will be put to proper use. 

The year 2023 is also when UN Women published an action plan, titled ‘Feminist Climate Justice: A Framework for Action’. It is a climate justice framework for policy-making. The report points to a growing body of evidence which finds that gender inequalities and a failure to take gender issues into account in environmental policy-making have negative impacts across a range of economic and social outcomes for women, girls, and gender-diverse individuals.

‘Without action to halt climate change, the world’s women and girls now face wholesale reversal of their human rights […] [This] requires not tinkering around the edges, but the transformation of every part of the world’s economies and societies,’ the report claimed.

The world now stands witness to the evidence, where the coastal women are adjusting their menstrual cycle to the never-ending nightmare of ensuring national and international funds, and the proper disbursement of such financial relief. And, among many other sectors of damage where the climate crisis has taken a toll, the health crisis of underprivileged women is also a matter of discussion. 

At a time when urban women can resort to using more comfortable and environmentally friendly menstrual products, like menstrual cups, these women from coastal areas don’t even know if they will be able to collect fresh drinking water each day, let alone for hygiene purposes. For this group of women, the time for rhetoric without robust action has ended long ago. The lives of these resilient women, tethered to the ebb and flow of climate-induced challenges, demand immediate attention and decisive solutions. 

It is high time for the world to act, not just in words but in deeds, to ensure that the cycle of hardship endured by coastal women in Bangladesh can finally come to an end. Their stories of resilience and adaptation should serve as a rallying cry for a world ready to confront the silent crisis borne out of climate change.