Women in coastal Bangladesh face health risks caused by saline water and shortages of drinking water due to climate change, as well as risks of prolonged psychological stress and hypertension. A study of 4,693 women in coastal areas of the country found that 75.4 percent were experiencing moderate to severe psychological stress and 24.9 percent were hypertension. The study also found an association between high sodium levels in drinking water combined with severe psychological stress and an increased risk of hypertension.
The findings were published in a study titled “Combined association of drinking water salinity and psychosocial distress with hypertension among reproductive-aged women in coastal Bangladesh: a population-based cross-sectional study” in a Springer Nature journal. The study was published in August. It was conducted by researchers Ashraful Alam Siddique and Mahin Al Nahian of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), with support from the National Institute of Population Research and Training (NIPORT).
The study analysed data on women aged 18 to 49 from nine upazilas in seven coastal districts. Six of the upazilas were areas highly exposed to salinity, while three had low salinity exposure. In addition to directly measuring the participants’ blood pressure, the researchers assessed sodium levels in their drinking water and the severity of their psychological stress.
The average age of the women who participated in the study was 33. Of them, 44.1 percent were aged 35 or above. A total of 42.8 percent of the women drank water containing more than 2,000 milligrams of sodium per litre. 27.3 percent lived in high-salinity areas.
Over the past 10 years, 76.3 percent of the women reported experiencing at least one major climate-related disaster. During the same period, 58.3 percent said their household income had declined due to climate-related impacts.
The study also found an alarming level of psychological stress among the women. Of the participants, 40.1 percent experienced moderate stress and 35.3 percent severe stress. In total, 75.4 percent were experiencing moderate to severe psychological stress, and 24.9 percent of the women were found to have hypertension. In addition, 10.2 percent had both hypertension and moderate to severe psychological stress.
The prevalence of hypertension also increased with the severity of psychological stress. Among women who reported no psychological stress, 13.9 percent had hypertension. The rate rose to 28 percent among those experiencing moderate stress and 29.1 percent among those experiencing severe stress. In other words, the prevalence of hypertension among women experiencing moderate or severe psychological stress was more than twice that among women with no psychological stress.
Even after adjusting for factors such as age, education, financial status, area-level salinity, disaster experience and declining income, the researchers found an association between psychological stress, sodium levels in drinking water and hypertension. Compared with women who were free from psychological stress, those experiencing moderate stress were 1.86 times more likely to have hypertension, while those experiencing severe stress were 1.88 times more likely. Similarly, every 100-milligram increase in sodium per litre of drinking water was associated with a 10 percent increase in the likelihood of hypertension.
The risk increased further when high sodium levels in drinking water and severe psychological stress occurred together. Women whose drinking water contained more than 2,000 milligrams of sodium per litre and who were also experiencing severe psychological stress were 2.45 times more likely to have hypertension than women who drank low-sodium water and had no psychological stress.
In coastal areas, seawater enters groundwater and other freshwater sources, increasing sodium levels in drinking water. While people can exercise some control over the amount of salt in their food, sodium intake through drinking water is largely unintentional. It is consequently more closely linked to environmental and infrastructural problems than to individual behaviour.
This is compounded by prolonged stress caused by cyclones, floods, rising salinity, the threat of losing livelihoods and declining incomes. According to the researchers, these crises do not end as one-off disasters; rather, recurring environmental uncertainty can create long-term psychological stress. Prolonged anxiety and depression can alter the functioning of stress-related hormones and the nervous system, disrupting normal blood vessel function and potentially increasing the risk of hypertension.
Researcher Mahin Al Nahian told Bonik Barta, “Everyone knows how disasters such as storms and cyclones affect mental health in coastal areas. But there has been very little research into how gradually increasing salinity is affecting women’s mental health, blood pressure and other health risks there. We’ve tried to highlight these issues. Our study found an association between drinking saline water and hypertension among women. We’ve also tried to identify the types of healthcare they need because of these challenges and the services that should be incorporated into existing healthcare. We hope this will help the government take further steps.”
Experts say treating hypertension alone is not enough to address health risks in coastal areas. Mental health screening and necessary support should be integrated into primary healthcare and hypertension management. Initiatives are also needed to increase the supply of safe freshwater, harvest rainwater, recharge groundwater and desalinate water at the local level.
Public health expert Dr Lelin Choudhury told Bonik Barta, “Salt from saline water enters the body in various ways through the food chain, increasing the risk of hypertension and heart disease. So the use of saline water must be reduced, the supply of safe drinking water increased, and people with hypertension brought under treatment promptly. For this, community health centres in coastal areas also need to be strengthened.”
Noting that weather uncertainty, storms and tidal surges have long-term negative effects on people’s mental health in coastal areas, he added, “When many men go deep into the sea to fish, the women who stay at home experience additional psychological stress because of the risk of storms and tidal surges. So mental health counsellors could be appointed at health centres in these areas, while employment opportunities could be expanded and life insurance could be provided for fishermen.”