The link between climate change, food security and fertility: The case of Bangladesh

Understanding climate-sensitive diseases in Bangladesh using systematic review and government data repository

BACKGROUND

Understanding the effects of climate change on health outcomes is crucial for effective policy formulation and intervention strategies. However, in Low- and Middle-Income Countries, like Bangladesh, the true extent of these effects remains unexplored due to data scarcity. This study aims to assess available evidence on climate change-related health outcomes in Bangladesh, to compare it with actual national occurrences, and to explore challenges related to climate change and health data.

METHODS

We first conducted a systematic review to summarize the climate-sensitive diseases examined in existing literature in Bangladesh. The review results were then compared with over 2.8 million samples from the government's data repository, representing reported cases of climate-sensitive diseases during 2017-2022. This comparison aimed to identify discrepancies between the diseases currently occurring in Bangladesh related to climate change and available knowledge through existing research. Additionally, we also explored the limitations of the data recorded in the government data repository.

RESULTS

The available literature in Bangladesh reports only a few specific climate-sensitive diseases, including Diarrhea, Dengue, Cholera, Malaria, Pneumonia, Cardiovascular Diseases, Hypertension, Urinary-Tract Infections, and Malnutrition, which were also considered in few studies. This represents a segment of the total 510 reported climate-sensitive diseases in Bangladesh, of which 143 diseases were responsible for 90.66% of the total occurrences. The most common forms of diseases were diarrhea and gastroenteritis of presumed infectious (28.51%), pneumonia (18.88%), anxiety disorders, panic disorders, generalized anxiety disorders (13.2%), and others (13.15%). Additionally, Urinary-Tract infections (7.87%), cholera (3.03%), and typhoid fever (3.27%) were other frequently reported climate-sensitive diseases. We also explored several challenges related to available data in the government repository, which include inadequate collection of patients' comprehensive socio-demographic information and the absence of a unique patient identifier.

CONCLUSION

The findings underscore the urgent need to tackle data challenges in understanding climate-sensitive diseases in Bangladesh. Policies and programs are required to prioritize the digitalization of the healthcare system and implement a unique patient identification number to facilitate accurate tracking and analysis of health data. Climate Change, including rising temperature and extreme weather events like cyclone and floods, poses a significant global health threat [1]. The World Health Organization estimates climate change already causes at least 150,000 deaths annually at the global level, and that number is projected to double by 2030. Beside these other impact of climate change are far-reaching, leading to forced displacement, malnutrition and increased incidence of diseases such as dengue, diarrhea, and pneumonia [2]. Additionally, climate change has established links to mental health issues, like anxiety and depression [3]. The effects are particularly severe in Low- and Middle-Income Countries (LMICs) due to limited resources and inadequate infrastructure for coping with erratic weather and disasters [4]. We undertook a comprehensive mixed-method study, incorporating a systematic review of existing studies conducted in Bangladesh, along with an analysis of government data repository. A detailed description of each component is presented below.

Climate change and sexual and reproductive health and rights research in low-income and middle-income countries: a scoping review

Introduction

This study aimed to provide an overview of the research landscape and to identify research gaps linking climate change events and sexual and reproductive health and rights (SRHR) in low-income and middle-income countries (LMICs), where the negative impacts of climate change are most severe.

Methods

We conducted a scoping review to map research studies that link climate change events or factors and SRHR aspects in LMICs. We performed a structured literature search across six databases to identify relevant peer-reviewed publications between January 1994 and 6 September 2023. The literature search yielded 14 674 peer-reviewed articles. After screening, 75 articles were included, spanning 99 countries across the globe.

Results

Climate change events such as extreme temperatures, drought, rainfall shocks, cyclones and floods were found to be associated with negative maternal and newborn health outcomes ranging from reduced or low birth weight, preterm births and low Apgar scores, to lack of pregnancy care, pregnancy complications, stillbirths, and newborn and maternal deaths. Associations were also found between climate-related events and increased gender-based violence and HIV prevalence, as well as fertility decisions and harmful practices such as female genital mutilations and early and forced marriages. About two-thirds (48/75) of the articles were from the African or Western Pacific regions. The main research gaps on climate change-related events and SRHR included abortion, reproductive cancers and contraception use.

Conclusion

Complementing existing evidence with targeted research to fill these knowledge gaps could enhance mitigation programmes and policies.

Effects of extreme climate events and child mortality on total fertility rate in Bangladesh

Floods, storms, and temperature extremes are examples of extreme weather events that have a substantial influence on a country's demographic dynamics, including migration, fertility, and mortality. Changes in population size, composition, and distribution may result from these occurrences. This study, which spans the years 1966-2018, looks at how Bangladesh's total fertility rate (TFR) is affected by extreme weather events and child mortality, including neonatal, infant, male infant, and under-five mortality. We use data from secondary publicly accessible sources, such as the World Bank and The Emergency Events Database (EM-DAT), and we investigate the correlations using the autoregressive integrated moving average model (ARIMA), complemented by bivariate and multivariable analyses. Our findings from the univariate analysis are noteworthy. Total extreme climate events (β = -0.345, 95 % CI: 0.510, -0.180), as well as individual extreme climate events, such as extreme temperatures (β = -1.176, 95 % CI: 1.88, -0.47), floods (β = -0.644, 95 % CI: 1.0729, -0.216), and storms (β = -0.351, 95 % CI: 0.63159, -0.07154), exhibited negative associations with the TFR. Additionally, factors such as contraceptive prevalence rate (CPR) (β = -0.085, 95 % CI: 0.09072, -0.07954) and gross national income (GNI) per capita (β = -0.003, 95 % CI: 0.0041123, -0.0024234) were negatively correlated with the TFR. Conversely, various categories of child mortality, namely, infants (β = 0.041, 95 % CI: 0.040474, 0.042748), males (β = 0.038, 95 % CI:0.037719, 0.039891), and under-five (β = 0.026, 95 % CI:0.025684, 0.026979) - are positively associated with TFR. Controlling for two pivotal confounding factors, time and GNI per capita, yielded consistent results in the multivariate analysis. These findings provide insight on the dual impact of extreme weather events, which can reduce TFR while also raising it through infant mortality. This phenomena may be due to the increased vulnerability of younger children in climate-event-prone areas, prompting parents to seek additional children as both a replacement for lost offspring and an insurance mechanism against future child loss.

Global Warming and Endocrinology: The Hyderabad Declaration of the South Asian Federation of Endocrine Societies

Global warming and endocrine disorders are intertwined issues posing significant challenges. Greenhouse gases emanating from human activities drive global warming, leading to temperature rise and altered weather patterns. South Asia has experienced a noticeable temperature surge over the past century. The sizable population residing in the region heightens the susceptibility to the impact of global warming. In addition to affecting agriculture, water resources, and livelihood, environmental changes interfere with endocrine functioning. Resulting lifestyle changes increase the risk of metabolic and endocrine disorders. Individuals with diabetes face heightened vulnerability to extreme weather due to impaired thermoregulation. A high ambient temperature predisposes to heat-related illnesses, infertility, and nephropathy. Additionally, essential endocrine drugs and medical devices are susceptible to temperature fluctuations. The South Asian Federation of Endocrine Societies (SAFES) calls for collaboration among stakeholders to combat climate change and promote healthy living. Comprehensive approaches, including the establishment of sustainable food systems, promotion of physical activity, and raising awareness about environmental impacts, are imperative. SAFES recommends strategies such as prioritizing plant-based diets, reducing meat consumption, optimizing medical device usage, and enhancing accessibility to endocrine care. Raising awareness and educating caregivers and people living with diabetes on necessary precautions during extreme weather conditions are paramount. The heat sensitivity of insulin, blood glucose monitoring devices, and insulin pumps necessitates proper storage and consideration of environmental conditions for optimal efficacy. The inter-connectedness of global warming and endocrine disorders underscores the necessity of international collaboration guided by national endocrine societies. SAFES urges all stakeholders to actively implement sustainable practices to improve endocrine health in the face of climate change.

Climate shocks' impact on agricultural income and household food security in Bangladesh: An implication of the food insecurity experience scale

Floods and extreme rainfall are common climatic phenomena in Bangladesh, and farm households are more susceptible to such shocks. This paper assesses the impact of climate shocks on agricultural income and food security of farm households in Bangladesh using an extensive nationally representative dataset from the Bangladesh Integrated Household Survey 2018-19, including 5604 sample rural households in 64 districts. However, this research considered 24 districts, representing 2131 sample farm households, by developing an exogenous climate shock indicator based on data from the Yearbook of Agricultural Statistics of Bangladesh 2018. Empirical findings on the grounds of simultaneous quantile regression reveal that climate shocks substantially lower agricultural income in the study regions. However, the presence of prime-age women (15-49) in the home, the male-headed family, farmland, and livestock ownership of the household are the decisive factors that safeguard agricultural income. Applying the Food Insecurity Experience Scale (FIES), descriptive statistics disclose that most farm households suffer at various food insecurity levels (considerably moderate, noticeably mild, and tiny severe), while the rest are at the food security level. The key finding regarding ordered probit regression uncovers that climate shocks significantly increase household food insecurity (at different levels of FIES). In other words, cropland damage due to floods and extreme rainfall reduces the food security of farm households in the study districts. On the other hand, increased farm size and educated households are profoundly protected against food insecurity. This study, therefore, recommends that raising livestock can complement agricultural income, and enhancing education would ensure households' food security in the climate-exposed areas of Bangladesh.

The influence of environmental factors on premature ovarian insufficiency and ovarian aging

Premature ovarian insufficiency and ovarian aging are complex conditions that affect women's reproductive health and overall well-being. They are both characterized by hypergonadotropic hypogonadism and infertility, and together affect about 1 in 100 women by the age of 40. This review explores the influence of environmental factors on the development and progression of premature ovarian insufficiency and ovarian aging. When referring to environmental factors, we include a wide range of external agents and conditions, including chemicals, socioeconomic factors and lifestyle choices. Through a review of the literature, we attempt to highlight the link between environmental factors and ovarian health. We examine the impact of endocrine-disrupting chemicals, such as bisphenol A and phthalates, on ovarian function and investigate the mechanisms by which these chemicals can disrupt hormone signaling pathways, leading to alterations in ovarian reserve, oocyte quality, and folliculogenesis. Moreover, we explore lifestyle factors like obesity, stress, smoking and alcohol in relation to their effects on ovarian aging. Epigenetic changes may play a crucial role in the prevalence of premature ovarian insufficiency. Understanding the impact of environmental factors on premature ovarian insufficiency and ovarian aging is very important in public and clinical health contexts. By identifying risk factors, healthcare providers can develop targeted and strategic prevention and intervention plans. Furthermore, this knowledge can promote reproductive health and minimize exposure to harmful environmental agents.

Small Area Estimation of Age-Specific and Total Fertility Rates in Bangladesh

Bangladesh has experienced a rapid national decline in fertility in recent decades, however, fertility rates vary considerably at the sub-national level (i.e., division). These variations are expected to be more pronounced at lower levels of geography (e.g., district level). However, routinely conducted demographic health surveys are designed for national estimates and do not have adequate samples to produce reliable estimate of fertility rates at lower levels of administrative units, particular when considering district level age-specific fertility rates. Data extracted from the Bangladesh Demographic Health Survey 2014 are used to derive direct estimates of age-specific fertility rates and associated smoothed standard errors. These are used as inputs for developing a small area model, which is expressed in a hierarchical Bayesian framework and fitted by Markov Chain Monte Carlo simulation. The model accounts for variation at different levels—women age-group, division, and district. The modeling results show large reductions in the estimated standards errors and provide consistent estimates of fertility at the detailed district age-specific level. There are significant differences in the fertility levels within and between districts and at the division level. Fertility rates are observed to be higher for Sylhet division and for women aged 20–24 years. We use geo-spatial maps of the fertility rates to visualize the variations over districts, and identify hot and cold-spots to have better targeted local level planning and policy decision making for further reductions in fertility rates in Bangladesh.

Reproductive Intentions Affected by Perceptions of Climate Change and Attitudes toward Death

Adverse climate change poses a threat to the health of pregnant women and unborn children and has a negative impact on the quality of life. Additionally, individuals with a high awareness of the consequences of climate change may be accompanied by a fear of the inevitable end, such as a fear of death. This, in turn, may discourage planning for offspring. Thus, both the perception of climate change and fear of death can have implications for reproductive intentions. Only a few studies to date indicate that concerns about climate change, especially when combined with attitudes towards death, may influence the formation of attitudes and reproductive plans. Thus, current research is aimed at looking at reproductive intentions from the perspective of both climate change concerns and the fear of death. This study was conducted from December 2020 to February 2021. A total of 177 childless males and females (58.8%) took part in the study. The Death Anxiety and Fascination Scale (DAFS) and Climate Change Perception Questionnaire (CCPQ) were completed online. Overall, 63.8% of respondents displayed a positive reproductive intention. Multivariable logistic regression analysis found that, in addition to the young age of respondents, the likelihood of positive reproductive intentions increases with death anxiety and decreases with death fascination and with climate health concerns. The results indicate that both climate change concerns and the fear of death are relevant to reproductive plans-positive reproductive intentions increase with death anxiety and decrease with death fascination and with climate health concerns. The results fill the gap in the existing research on predictors of reproductive intentions and can be used for further scientific exploration and practical activities addressing the issues of the determinants of decisions about having children. The individual consequences of climate change are clearly taken into account in the context of offspring planning and, therefore, should be considered in the design of social and environmental actions.