Climate Impact on Women’s Health in Satkhira

Case Study: Participatory Community Assessment of Climate Change Impacts on Women and girls Health in Satkhira District, Bangladesh

Introduction:

Climate change is increasingly recognized as a major threat to public health, with profound impacts on vulnerable populations. In Bangladesh, a low-lying coastal region, the effects of climate change are already severe. Rising sea levels have led to increased salinity intrusion, contaminating groundwater and freshwater wetlands, significantly affecting the health and livelihoods of local communities (Anik et al., 2023).

Women and girls are disproportionately affected, as climate change exacerbates existing gender inequalities. They are highly dependent on climate-sensitive agriculture and have limited access to resources, making them particularly vulnerable (Ngcamu, 2023). Satkhira district, in the country’s southwest, illustrates these risks clearly. Communities there face rising water levels, salinity intrusion, frequent heat waves, and periodic cyclones factors that endanger maternal, newborn, child, and adolescent health. Salinity intrusion has disrupted access to safe water, leading to skin diseases, reproductive health complications, and water-borne illnesses, especially among women and girls (Bakul & Rahman, 2023). Soil salinization also reduces rice production, forcing reliance on costly salt-tolerant varieties (Dasgupta, 2017). Extreme heat worsens dehydration, heat-related illness, and strains already limited healthcare services (Rahman et al., 2019; WHO, 2023).

In response, Enfants du Monde (EdM) and the Eco-Social Development Organization (ESDO), a Bangladeshi organization actively engaged in climate change initiatives across the country, launched a collaborative project, to address the effects of climate change on the health of women and girls in Satkhira. This initiative aligns with Bangladesh’s national efforts to address climate-related health risks, particularly through the health-National Adaptation Plan (Health-NAP), developed in 2016 to mitigate the growing impacts of climate change.

In 2023, as first step of this project, EdM and ESDO carried out an assessment using the World Health Organization’s (WHO, 2017) Participatory Community Assessment (PCA) methodology, adapted to climate change. This participatory approach engaged women, healthcare workers, and community leaders to identify immediate needs and longer-term strategies for adaptation and resilient communities and health systems.

The objectives were to (I) highlight the specific impacts of water salinity and heat waves on the physical and mental health of women and girls, as identified by the people living in these areas, (II) identify community-driven solutions, and (III) underscore the importance of local engagement in shaping climate health adaptation strategies.

Methodology:

We used a Participatory Community Assessment (PCA) methodology, adapted from WHO (2017), which engages communities in identifying health challenges, assessing needs, and developing context-specific solutions. Data collection relied mainly on semi-directive roundtable discussions guided by thematic questions, enabling participants to share experiences and propose actions. The study was conducted by ESDO, with technical and financial support from EdM, and in collaboration with BRID and the Ministry of Health and Family Welfare, to inform an adaptation project improving women’s and girls’ health in Satkhira.

A total of 60 women from three unions participated, representing diverse socio-economic and family backgrounds, including reproductive-age women (14–49), mothers-in-law, women issued from families reliant on informal livelihoods such as shrimp farming or daily wage labour, as well as those facing unemployment were consulted through round tables. Additionally, 30 men, including partners of women in reproductive age and community leaders (school and religious figures), provided insights. Fifteen adolescent girls (9–15) also contributed.

Healthcare providers (doctors, nurses, midwives) and community health workers (assistants, providers, family welfare assistants) offered insights on clinical impacts, accessibility, and usage.

Findings were complemented by meetings with 50 institutional stakeholders including institutional stakeholders, local government representatives and healthcare authorities, in presence of community representatives from roundtables. This step was particularly important to gain the buy-in and support of local leaders for effective project implementation.

Results and discussion:

The PCA conducted in the Satkhira districts highlighted the severe impact of water salinity and heatwaves on the health of women and girls and emphasized the critical issue of water scarcity, with women, girls and children experiencing thirst. It echoed the concerns raised by the WHO regarding women and girls’ health, with insufficient water intake and growing food insecurity emerging as major concerns-particularly affecting women and girls.

The most pressing issue highlighted was the severe lack of freshwater, which has become a major concern for daily life: “We count each and every single drop of water to effectively utilize it. Sometimes we have thirst due to a shortage of fresh drinking water. In an extreme situation, we have no choice but to drink the contaminated water from the pond. But we try to boil the water hard before drinking, and still, it tastes very salty.” (WRA, Age 32, Anulia)

Participants described how the contamination of freshwater sources due to salinity intrusion forces families to spend a significant portion of their limited incomes on safe drinking water, leading to greater economic instability. This experience also brings to light gender disparities in facing climate change, showing that women are particularly burdened by the added responsibilities imposed by these environmental conditions. Women, often responsible for water collection, must travel around 2 to 3 kilometres to find freshwater sources, adding an extra burden, especially during pregnancy. To ration the limited water supply, women often prioritize their husbands and children, leaving themselves with less.

Furthermore, soil salinization significantly reduces agricultural production, making it difficult to cultivate traditional rice varieties and therefore reducing access to affordable and nutritious food. This growing food insecurity forces families to depend on local markets, increasing their economic vulnerability and creating a vicious cycle of malnutrition, debt, and impoverishment.

• Impact on physical and mental health:

  Participants showed major health impacts from salinity and extreme heat. Freshwater scarcity often drives women to limit their intake and rely on boiled saline water. Majority of women, to afford high-priced potable water, are compelled to fish to supplement household income. This work, which involves manually collecting shrimp, requires prolonged exposure to saline water, causing skin irritation, genital infections, and other health problems due to the corrosive nature of brackish water. Additionally, saline water is widely used for various household purposes, such as personal hygiene (face washing, tooth brushing, and ablution), laundry, cleaning, cooking, and dishwashing, further exacerbating these health risks. Women primarily reported experiencing burning sensations, irritation, itching and skin dryness due to frequent use of salty water. Doctors and health workers confirmed that pregnant women frequently suffer from anaemia, dizziness, high blood pressure, gastritis, and bone pain. Women also reported experiencing recurrent genital infections and discomfort, which they attributed to frequent use of saline water for personal hygiene.

  Most of these populations generally live far from health centres, making access to care challenging. Furthermore, the health centres themselves are often under-resourced, limiting their capacity to address the increased needs generated by these extreme climatic conditions. As a result, many women instead of discussing their illness with healthcare professionals prefer to solely rely on self-medication for treatment. They reported that diarrhoea and dysentery are so prevalent that they no longer consider these illnesses as a concern or feel the need to seek medical consultation. Instead, they self-medicate by purchasing medications from local grocery stores based on their perceived needs.

• Addressing gender inequalities in the face of climate change:

  The effects of climate change exacerbate existing gender inequalities, with women shouldering a large portion of domestic responsibilities and being the primary water providers for their families. In addition, due to the scarcity of freshwater, women often have to wash their reusable sanitary pads/clothes with saline water and dry them discreetly indoors, where they remain damp, encouraging persistent moisture. This challenge is further exacerbated by the strong cultural taboos surrounding menstruation, which discourage open discussions and prevent women from seeking proper support or advocating for better hygiene solutions. This situation frequently leads to gynaecological infections, worsening reproductive health issues and limiting women’s well-being. The lack of awareness and education on menstrual health, combined with societal stigma, makes it even harder for them to access safe and hygienic alternatives. As a result, these harmful conditions persist in silence, reinforcing cycles of poor health, social isolation, and gender inequality.

  “They prefer to hide their used cloth during menstruation due to shyness that is why they dry these cloths in unhealthy way, not in sunlight.” (CHCP, Male, Anulia)

  Girls are also disproportionately affected by these dynamics. As critical contributors to household labour, they are often removed from school to assist in child-rearing and economic activities, perpetuating cycles of inequality and limiting their future opportunities.

  These issues are rarely captured in official frameworks, which often focuses on direct health impacts rather than the broader socio-economic and emotional tolls experienced by women. The reality observed in Satkhira suggests that these broader impacts on women’s health and dignity are equally critical to address.

• Solutions:

  Community participants identified urgent solutions, including ensuring reliable, affordable, and safe household drinking water through rainwater harvesting systems and low-cost purification tools, alongside targeted health education programs addressing personal hygiene, skin disease management, heatstroke prevention, nutrition, and water treatment. They also recommended substantial rehabilitation of local health infrastructure and transport to health facilities, emphasizing the need for essential medicines, improved hygiene standards, skilled healthcare personnel, and reliable emergency transportation services.

Conclusion:

The findings reveal how rising sea levels, increasing water salinity, and recurrent heat waves exacerbate vulnerabilities, particularly among women and girls in Southern Bangladesh. Addressing these vulnerabilities as well as implementing adaptation measures is becoming urgent. However, the burden of adaptation cannot rest solely on the communities facing these challenges, with isolated efforts by NGOs to improve this situation. The international community must also contribute and hold governments accountable for implementing policies to support those most affected. Without urgent and coordinated action, climate migration might emerge as the only viable option for many of these affected communities in Sathkira district and similar areas.

The case study was conducted by Md Mosheur Rahman (Eco-Social Development Organization (ESDO)), Md Noman Amin (Bangladesh Research Institute for Development (BRID)), Dr Cecilia Capello (Enfants du Monde), and Thomas Rodrigues (Enfants du Monde).