The years-long itch

M

any women in villages in and around the Sundarbans are still reluctant to talk about their problems “down there.” But the reproductive health problems that have been plaguing them for years have been an open secret for quite some time now, and there are a few residents of a riverine village in India’s state of West Bengal who eventually agree to talk about what they have been going through, even to a stranger.

“Every month, I struggle with persistent itching in my private parts, which is so severe that it leads to bleeding and takes several weeks to recover,” 26-year-old Tanuja Mali, mother of two, tells ADC somewhat sheepishly. “Often, the period of pain and discomfort continues till months.” 

Salima Mondal meanwhile says that she had to visit the hospital a few weeks ago to treat the severe rashes that appeared all over her body.

 “I was sick for several days and did not understand what was happening,” says the 29-year-old mother of three. “I started bathing and cleaning myself more frequently, but it only made the issue worse. Initially, I consulted with a traditional healer but the problem worsened, following which I had to go to the nearest hospital.”

Similar tales have been told elsewhere in the Sundarbans that spans across India and Bangladesh. In fact, the women’s plight has even become the subject of a few academic studies and news stories in recent years. For all that, however, there seems to have been no real measure yet addressing the reproductive health woes of women in the Sundarbans region in West Bengal. 

“I have faced worse situations than all these women have faced,” says 50-year-old Razia Madol. “In today’s times, we can go to the hospital or talk about reproductive health problems among families. But despite the awareness, nothing has changed in all these years, even though our lands and waters continue to change due to no fault of ours.”

Then again, this should be no surprise, considering that women’s issues are rarely prioritized in patriarchal India. At the very least, though, India has set ambitious goals in response to climate change, which plays a major factor in the Sundarbans women’s reproductive health issues.

Angrier Mother Nature

Known for its massive mangrove forests, the Sundarbans is the world’s largest delta, created by the confluence of the Ganges, Brahmaputra, and Meghna rivers, whose waters spill into the Bay of Bengal. Its 10,000 sq kms are spread across southern Bangladesh and eastern India, with both sides of the Sundarbans declared as World Heritage Sites. 

That distinction, however, has obviously not spared the Sundarbans from climate change. Indeed, while cyclones have been common in the Bay of Bengal for centuries, they have become more and more severe in the last few decades. That’s because the sea surface is now warmer, leading to more evaporation and stronger winds. Sea levels have also risen due to global warming, causing seawater to push farther inland, which in turn has led to flooding, soil erosion, and water and soil salinization. 

The Sundarbans women’s reproductive-health problems stem primarily from local water bodies that have increasingly become saline, including those from which the people draw their drinking water. Indeed, studies have asserted that water drawn from tube-wells in the Indian Sundarbans is usually unpotable or having salinity beyond one part per thousand (ppt). At least one 2021 study on salinity exposure and women’s health in the Indian Sundarbans said that samples gathered and tested by its researchers showed that water from wells or taps there could have as much salinity as 2.66 ppt, while local rivers had a median salinity of 22.55 ppt.  

Men and women alike, as well as children, have been suffering all sorts of ailments — among them diarrhea, skin and eye infections, and even high blood pressure — because of this. But women bear heavier burdens, in part because they are the primary caregivers in families. Modal, for example, has been worried about her seven-year-old son, who is covered with sores and rashes. She says that he got them from playing in the fields. 

“He keeps scratching the rashes which have now developed into wounds,” says Modal. “I took him to the traditional healer twice who gave him some tablets and solution to apply, but the child needs to rest and stay away from the water. He doesn’t agree…and hence, his rashes are not going away.” 

For sure, too, children and men are prioritized over women in accessing treatment. And since men control the family purse, they can decide on their own when to seek healthcare. They are also more mobile compared to the women, who are unable to go too far, especially when unaccompanied, because of various concerns that in these parts include the risk of falling victim to human trafficking. 

In West Bengal, proper healthcare facilities remain few and far between. The nearest hospital to Modal’s village, for example, is about 35 kms away. Modal says that she was in great discomfort during the three-hour trip by e-rickshaw to the hospital.

Half-submerged in saline water

Unfortunately, more women in the Indian Sundarbans may need to make similar trips because of the effects of climate change.

“Men and women are impacted differently by climate disasters such as cyclones, and floods,” comments social activist Nihar Ranjan Raptan, who specializes in gender and community development. “Women are exposed to salty water for longer hours for various reasons.” 

Like the rest of the Indian Sunderbans population – which was estimated to be already at 4.4 million in 2011, when the most recent national census was done – the women bathe in or with the murky water that is not only salty but contaminated with other substances. And as in the Bangladeshi Sundarbans, the women are also constantly exposed to saline water while fishing for prawns and crabs and doing a myriad of household chores, such as washing clothes and dishes, cleaning the house, and bathing their children. 

Experts say that it is fishing that seems to be the major cause of the women’s reproductive-health problems as it requires them to be submerged waist-deep in brackish water for hours – and they are doing so for longer and longer as time passes. It used to be that the task would take them three to four hours to accomplish. But because climate change has also led to shrinking prawn and crab populations, the women now take as much as six to eight hours to fish. 

A New Delhi-based government doctor who declines to be named says that there are “technical reasons” that indicate a connection between saline water exposure and female reproductive health issues.

“Since the vagina is a highly sensitive area there are many local micro organisms that are available in the vagina and are helpful for the organ,” the doctor says. “Its Ph and acidic system is important to maintain the natural functioning of the organ but the salinity may impact the microbiome and micro organisms there, and any change in the microbiological system in the vagina or salinity may be interfering there, which may lead to bacterial vaginosis. Bacterial vaginosis further is associated with increasing vulnerability of other bacterial infections like urinary tract infection (UTI), leukorrhea, (abnormal) discharge, and even sexually transmitted diseases.”

Many of the women also suspect fishing is the blame for their aches and illnesses, and not just the one related to their reproductive health. Fishing, however, helps keep their family fed, and they are thus not keen to stop doing it. 

Observers, though, say that women with reproductive-health afflictions are particularly hesitant to seek help right away. A 2020 study on the reproductive-health problems of young married women from another part of West Bengal noted that only 22 percent of those who participated in its survey sought medical advice for these. Aside from financial considerations, the study’s researchers pointed to “a ‘culture of silence’ associated with gynecological problems” that “often (hindered) the participants to have an open discussion about their problems.” 

They also cited the “lack of decision-making” power among the young women, with only seven percent of the participants saying that they had decided on their own to seek treatment for their reproductive-health issues. The researchers observed as well that the women and their families often ignored reproductive health problems as these were usually considered “not so serious health issues.”

Then again, some of those who have consulted bona fide medical practitioners now think their effort to do so was an exercise in futility. 

Mondal, who endured a three-hour, bone-jarring ride just to get proper medical advice, says, “The doctor advised me not to use saline water to wash my private parts or for taking a bath. How is it possible to fetch (clean) water for bathing when we have to walk miles to get drinking water from a community well?”◉