Description
Background: Bangladesh is one of the most exposed countries in terms of climate vulnerability. In 2023, the Swiss NGO Enfants du Monde (EdM) and the Bangladeshi NGOs Eco-Social Development Organisation (ESDO) and Bangladesh Research Institute for Development (BRID), joined efforts to support the Ministry of Health and Family Welfare (MOHFW) to mitigate the impact of climate change on maternal, newborn and child health (MNCH), in the southern districts of Assasuni Sadar, Protapnagar and Anulia, affected by increasing salinity of water and severe heat waves.
Methods:
A bottom-up strategy was adopted to explore the context of climate change in its relations with MNCH. To design the approach, including selection of participants and compiling guiding questionnaires, a group composed of ESDO, BRID and MOHFW staff, with the support of EdM, adapted the World Health Organisation’s participatory community assessment (PCA) to the context of climate change. In October 2023, 9 roundtables brought together 122 participants representing childbearing age women of and mothers-in-law, male partners and community leaders, girls aged 9-15, health staff and community health workers. During the roundtables, ESDO/BRID/MOHFW facilitators guided the discussions to identify climate related health problems and potential solutions. A final institutional roundtable permitted to rank the problems and solutions and finalize an action plan for the area.
Results and discussion:
The roundtables results confirmed existing information on climate change and MNCH while providing a detailed and context-related analysis: some issues are related to health infrastructures (such as the crumbling of concrete in health facilities, making them unusable); others to development issues, typical of a weak primary health care system (such as the lack of health staff); others to both (ie: the dengue losing its seasonal peak and geographic circumscription, becoming a country-wide challenge).
We found that climate change accentuates already existing gender inequities. For example, in the salinity/extreme heat context, women are traditionally impacted by dehydration as they access 1-2 glasses of clean water per day, preferentially leaving the scarce clean water for the men and children. Salinity causes skin problems, more impactful in the women/girls’ genital and perigenital area, as during menstruation, the clothes used as sanitary pads are washed with salty water. Because, traditionally, menstrual clothes cannot be hanged outside the house for drying, and are used humid and salty, reproductive organs irritation/infections are common. Due to taboos, women/girls neither talk about perigenital/genital diseases nor seek medical care, leading to chronic medical problems. Severe heat waves badly affect pregnant and postpartum women, who, regardless of their conditions, continue to be obliged to fetch water from farer water sources being exposed to higher temperatures without protection from heat strokes. Moreover, affected people are not aware they are victims of the impact of climate change.
Conclusion: By involving the affected people, the PCA identified solutions to mitigate the health consequences of climate change, including providing information to communities on climate change and MNCH and other diseases and addressing local beliefs and challenging gender inequities, in addition to creating water sources, improving infrastructures, providing training to health providers/managers.
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