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Study of Panchayat members’ and farmers’ perceptions of pesticides and DSH/suicide

DSH and suicide by pesticide consumption is a serious public health problem in many agricultural communities and the Sundarbans region is no exception. A pilot study among the 13 community Developmental Blocks of Sundarbans under South 24 Parganas district revealed extensive mortality and morbidity from pesticide poisoning (Chowdhury et al. 2007; Banerjee et al. 2009).

This study aimed to elicit the Panchayats’ and farmers’ perception about the nature and extent of pesticide use, the former’s role in regulating and promoting safe pesticide use and the epidemiology of pesticide use in DSH/ suicide in the region. This study also explored the different psychosocial dimensions that acted as proximal risk factors for self-harm in vulnerable individuals admitted to hospital. The Namkhana Block, under South 24 Parganas district, was selected as the study area. Most of the inhabitants of this area are Hindus (88%). It has seven GPs. The Panchayat Samity is located at Namkhana, the village bearing the same name as the Block. There are 110 members in 7 GPs and 26 in the Panchayat Samity. The research questions included:

  • 1. Is the easy availability of pesticides in the region facilitating the increase of intentional self-injury behaviour and consequently emerging as an important public health issue in the community?
  • 2. Are pesticides replacing other traditional methods (burning, drowning, and hanging) of self-harming behaviour?
  • 3. Do farmers practice and adhere to standard safety rules of pesticide use and custody?
  • 4. What are the specific sociocultural contexts other than mental illness that prompts self-harming impulses in the local population?

The study was conducted in four stages. First, a focus group discussion (FGD) was conducted in each of the seven GPs, in the Panchayat Samity, and with farmers to explore perceptions about mental health and DSH/suicide. Secondly, information was collected through semi-structured questionnaires completed by Panchayat members and farmers. Thirdly, in-depth interviews were conducted with farmers. Finally, a case register was designed for Block Primary Health Centres (BPHCs) to record details of incidents of DSH/sui- cide and in-depth interviews were conducted with people who had attempted self-harm and family members.

FGDs with Panchayat members:

124 Panchayat members participated in FGDs. The major findings are summarised in Table 32.1.

Panchayat members’ questionnaire:

124 GP members completed the questionnaire, including members of Panchayat Samity of Namkhana block. An overwhelming majority (95%) of the GP members knew someone who had consumed pesticides with the intention of harming him/herself. Pesticide consumption was acknowledged to be a health problem by 86.3% of the members. Of the 124 GP members

Table 32.1 GP and Panchayat Samity members FGD findings

• GP and Panchayat Samity Members' Perceptions About DSH/suicide.

All GP and Samity members acknowledged that DSH and Suicide is a major public health problem in the region.

Nearly all (98%) members were of the opinion that pesticide ingestion was replacing other methods of self-harm like hanging and burning.

A little less than three-fourth (72%) said that more women are attempting self-harm as well as a result of social injustice, oppression and discrimination.

Nearly 81% of the members alleged that demand for dowry, domestic violence, spouses' extramarital affairs, alcoholism, economic distress, broken love affairs and failures in examination were commonly reported reasons for attempting self-harm.

DSH was perceived to be a behaviour adopted to seek attention or to escape from a distressing situation by 32% of the GP and Samity members.

Eighty-five per cent of the GP and Samity members expressed that BPHCs and PHCs of the region were not always well equipped to ensure prompt management of the poisoning cases.

87% of respondents stated that collaboration between the Panchayat and various government departments such as health, agriculture, and the Public Works Department to address the issue of pesticide poisoning would yield better results

• GP and Panchayat Samity Members' Views on Pesticide Practices in the Community.

Ninety-one per cent of the respondents reported noticing increased dependence on pesticides for agricultural practice.

All (100%) members said that the number of shops selling pesticides has increased over the years, and that these shops did not possess a proper license to sell pesticides.

Nearly all (97%) reported the Panchayat's limited role in the regulation of pesticide sales in the region.

More than three quarters of the members said that farmers had little or no knowledge about the safe use and custody of pesticides.

who responded, 88.7% of the members were of the opinion that the GP could play an active role in the DSH-/suicide prevention programme by training farmers on safe pesticide practice in collaboration with the agricultural department, generating awareness in the community about issues that may lead to domestic violence and by imposing stringent rules on pesticide sale. Approximately 80% of the members felt that the GPs should be empowered to regulate pesticide sales which in their opinion would strengthen the GP’s role in controlling pesticide-related self-harm. However, all members unanimously acknowledged that although they wished to have more autonomy in regulating pesticide sales, nonetheless they were not empowered to do so. A little over three-fifths (62%) of the members conceded that they were unaware of the total number of shops selling pesticides in their respective

Table 32.2 Farmers' FGD Findings

An overwhelming majority (92%) of the respondents opined that farmers lack proper knowledge about safe pesticide practices including use and storage, which lead to deliberate self-poisoning or accidental poisoning.

Approximately all (98%) farmers reported pesticide shop owners continued to be the only source of information about pesticides.

More than three-fifth (65%) of the farmers expressed that banned and spurious pesticides continued to be marketed.

All farmers (100%) felt they needed proper education and training on safe pesticide practices and Panchayat intervention in supervision of the local pesticide market.

The active involvement and participation by the Block Agricultural department in imparting advice on agriculture and pesticides to the farmers was advocated by 97% of the farmers.

areas. Approximately one-third (32%) of the GP members said that they participated in dowry-related[1] dispute arbitrations in their respective villages.

FGDs with farmers:

Seven FGDs formed from different farmers’ groups from seven GPs were conducted (N = 62). Each FGD was tape-recorded with participants' consent and transcribed and analysed. The major findings are presented in Table 32.2

Farmers’ questionnaire:

A 20-item Bengali-language questionnaire investigated farmers’ attitudes to pesticide use and DSH. It enquired about pesticide practices, viz., nature of pesticide use, storage, knowledge about danger of pesticide use, health hazards of pesticide use and any accidental and deliberate poisoning in the household. Twenty farmers were selected on the basis of their willingness to respond from each GP and thus a total of 140 responses were collected, from which 18 responses were rejected because of incomplete answers resulting in 122 responses. In addition the FGD participants (n=62) also completed the questionnaire and were included in the analysis bringing the total to 184 (122+62).

Of the 184 farmers who completed the questionnaire, the majority (88.04%) reported possessing cultivable land and only 22 (11.95%) cultivated others’ land. All farmers reported using pesticides. More than half (98, 53.23%) of the farmers using pesticides reported storing it inside the house. Of those storing indoors, 91 (92.85%) reported storing it in a box. Only a small number (7, 7.14%) stated that they did not keep it in a box. Less than half (42, 46.15%) the farmers had provisions for storing pesticides in locked boxes. The remaining 49 (50.00%) did so in open boxes. Respondents primarily expressed concerns about the safety of children, and thus 90 (91.83%) farmers indicated storing pesticides in places that were out of reach of children. Forty-five (25.46%) farmers reported storing pesticides outside the house and 12 (26.66%) reported storing it elsewhere. Only 61 (33.15%) were aware of whether the shops selling pesticides possessed a valid license. The rest (123, 66.84%) reported not knowing about the nature of the shop. One hundred and ten (59.78%) of the farmers purchased pesticides a week before use. Only 42 (22.82%) declared buying it on the day of application. Others either bought it a day (24, 13.04%) or a week (8, 4.34%) in advance. 116 (63.04%) farmers had knowledge on ill-effects of pesticides on crops, while the remaining 68 (36.95%) were unaware about the deleterious effects. They gathered information primarily through fellow farmers (30, 35.29%), the agricultural department (20, 23.53%), pesticide shops (18, 21.18%), own experience (11, 12.94%) and pesticide companies (6, 7.06%).

The majority of participants (134, 72.83%) had experienced discomfort while spraying pesticide, the most frequently cited form of discomfort being headache (44, 32.84%). Intentional self-injury by pesticide consumption was reported by 161 (87.50%) of the farmers. Just under 77% (141, 76.63%) believed that self-harm by pesticide ingestion could be reduced by adopting appropriate programmes such as public awareness generation about the dangers of pesticide use, circumstances in which pesticides may be consumed (48, 34.04%), farmer’s training (84, 59.57%), including safe storage of pesticides and reducing domestic violence. Sixteen (8.7%) farmers reported DSH incidents in their families among which two (12.5%) deaths had occurred.

In-depth interviews with farmers:

A total of 39 in-depth interviews were conducted with farmers in different villages of Namkhana. The interviews were designed to address four important areas of pesticide practice, viz., pesticide selection, storage, precaution in use and health effects of pesticides. Interviews were recorded with the permission of the participants. Recordings were later transcribed and manual content analysis was carried out to identify common themes/issues. Some examples of a brief transcript on each issue are given below.

Reflecting on the topic of pesticide selection, Mr SG, 42 years, from Fraserganj GP, said:

How can we know about the details of the pesticides? We are illiterate. We mainly ask the pesticide shop owners about the type of pesticides for a particular type of crop and they give us what is required. We have to believe them blindly because most of us can barely read and understand the instructions written on the packet, mostly in English and in tiny print. Yes, sometimes we don’t get the desired results and we report to the shop owner. They say that they cannot help us. The pesticide companies said that a particular brand is suitable for a particular crop and they advised us accordingly. No one wants to take any responsibility. If we argue, then they ask us to lodge our complaints with the company dealer. But, we have not met any company dealer. Sometimes, we also take the advice of our fellow farmers. We are eager to know if someone has a good harvest, what pesticide he used. I haven’t seen any KPS (Krishi Prajukti Shahayak- agriculture welfare officer) in our village in the recent past. We are not getting any help from either the local agriculture department or the Panchayat. We rely on our common sense.

With regard to pesticide storage, Mr NM, 45 years, from Dwariknagar GP, said:

I am a share-cropper. I have to hand over half of the produced crops to the owner of the land. I use different types of pesticides. How can I tell you the names? Each year the market is flooded with new pesticides! I can’t tell you the names. I keep the pesticides in a wooden box in my cowshed. I have only one room—how can I keep it secretly? It is not a secret place. The children do not have access to the pesticides, but my wife does. I am aware of the risk of suicide by consumption of pesticides. There have been two such incidents in our village during the past year. Whenever I quarrel with my wife, I immediately hide the pesticide packet so that she cannot find it. Farmers in the region are mostly living in a one room thatched cottage with a cowshed- there is no separate room to hide pesticides.

Expressing his precautionary views on pesticide use, Mr CG, 32 years, from Sibrampur GP, said:

What precaution we will take? We don’t receive any safety devices like gloves or mask from the shop. These may be available if you purchase the whole carton. We purchase small quantities, and don’t get the safety apparel. I don’t know of anyone who received them even if they purchased the entire carton. I am aware that pesticides may enter the body through respiration. We wrap our noses and faces with a cloth while spraying. However, nothing is used to protect the hands.

I have experienced burning sensation in the palm. I wash my hands after spraying. I often feel nauseous and heaviness inside the head combined with burning sensation in the eyes after spraying. I haven’t been seriously ill after spraying pesticides. My brother once had severe vomiting while spraying. I think now companies are employing people like you to make surveys of their product before launching them in the market. I think the idea of using protective articles is merely an advertising gimmick.

Commenting on pesticide-DSH/suicides in the community, GP, 55 years, from Maisani GP, said:

Pesticide ingestion is a serious problem in the entire Sundarban area. My daughter-in-law committed suicide by consuming pesticide 6 years ago. One of my brother’s daughters attempted twice with pesticides. Pesticide is a great danger in our homes. We cannot do without it; we have to keep pesticides for our agriculture. Farmers here are not very careful of these poisons. In a family everybody knows where the pesticides are kept. So out of anger or during a quarrel, anyone can access it easily. In the heat of the moment they ingest it and in many instances lose their lives. Pesticides are available everywhere, even a child can procure them from the village grocery shop!

Block Primary Health Centre (BPHC) DSH case register:

A DSH register (20-item DSH-Bengali Case History sheet) was designed for the BPHCs to record the socio-demographic and clinical data of self-harm cases. A medical officer in each of the 13 BPHCs was trained for this purpose. A detailed clinical interview was conducted to elicit underlying cause/trig- gering factors of DSH behaviour, and a psychiatric diagnosis was done using ICD 10 criteria (WHO 1994). For suicide cases, history was taken from the next of kin. There were 74 DSH cases (66-89.2% survived and 8-10.8% died) admitted to the Dwariknagar BPHC, Namkhana, in the year 2006 (1 January to 31 December).

Of the 66 individuals who attempted self-harm but survived, 43 (65.15%) were women and 23 (34.84%) were men. Attempters were predominantly Hindus (49, 74.24%). The mean age was 28.10 ± 13.32 years. Pesticide (54, 81.81%) was the most frequently used substance. Other methods included burning, hanging, ingesting indigenous poisons (Yellow Oleander- Cascabela thevetia and Datura Datura stramonium seeds).

The underlying causes and triggering factors of DSH included marital disharmony (19, 44.8%) and domestic violence (11, 25.58%), primarily pertaining to dowry-related issues. Other causes and triggering factors included financial difficulty, infertility, physical and verbal abuse, alcoholism, broken love affairs, failure in examination. Only 15 (22.72%) of the DSH cases fulfilled the ICD 10 criteria for the following psychiatric diagnoses: 6 (40%) moderate depressive episode with somatic syndrome (ICD 10 Code 132.11), 4 (26.7%) severe depression without psychotic symptoms (ICD 32.2), 2 (13.3%) mixed-anxiety disorder, 2(13.3%) Emotionally Unstable Personality Disorder.

Among the eight suicide cases, five (62.5%) were men and three (37.5%) were women. Marital discord (25%), domestic violence and dowry-related abuse (12.5% each) were reported to be the common triggering factors.

Pesticides employed included rat poison (Zinc Phosphide: Zn3P2) which is easily available in the market. In 8 (12.12%) of the DSH cases and one (12.5%) case of suicide, rat poison was the chosen method. The use of rat poison was noticed to be popular in the region as a method used in DSH. Companies use aggressive marketing techniques such as demonstration of the effect of rat poison on a live rat. This demonstration is seen by many villagers and helps to spread the message of its lethality across the community.

In-depth interviews with people who had committed DSH and family members:

Patients admitted to the BPHC in Namkhana between 2005 and 2006 were interviewed when stable (2-5 days after admission). Relatives of those who had committed suicide were also interviewed. Informed consent was obtained from the patient and family.

Interviews identified situational and cultural stressors associated with DSH attempts The disadvantage of female gender roles contributed to the vulnerability of women. Domestic violence and dowry-related torture were frequent themes. The following section highlights a few such narratives.

The first case named SD, 25 years, female died as a result of suicide (self-immolation). She sustained 95% burn injuries. She was Hindu by religion. It was her second marriage. Her brother gave the following narrative account:

SD had been married for one-and-a-half years. During this period, there had been few days that she was happy. SD’s husband was a chronic alcoholic. Moreover, her mother-in-law did not fail to remind her every day of her one- and-a-half years of married life that her father had not kept his word: he had not paid the dowry that he had promised. This was the source of constant fights at home. SD was subjected to verbal, physical and emotional abuse along with forced starvation. SD felt very alone in her husband’s house since both her husband and his mother harassed her constantly. On the day of the incident, her husband had too much to drink and was completely inebriated. He returned home in the afternoon and SD was in a foul mood as well as there was no rice. The rice he had purchased last week had finished. She reminded him that his drinking and not working was not helping matters. He slapped her. Insulted, hurt, she said she would kill herself if he did not stop hitting her. To this, the husband replied that he did not care if she lived or died. He added that if she died, there would be one less mouth to feed. Her mother-in-law supported her son. SD felt utterly traumatised and helpless. When her husband left in a huff, she went to the kitchen and doused herself with kerosene and set herself on fire.

The second case, MD, was a 19-year female. She was Hindu and had been married. She ingested Zinc Phosphide (rat poison) in the paddy field. Fortunately, she was discovered by a passer-by who took prompt action which saved her life.

The woman provided the following narrative account of why she engaged in DSH:

I am his second wife. When I got married, I did not know that he was already married. When I discovered this, I felt very disappointed. I wondered could my parents not have not gathered more information about him before arranging the marriage? I told my husband that there could be only one woman in his life, either me or her. You see, he also provided her financial support. I had to think of my future. However, he did not pay heed. He continued his relation with her.

He became physically abusive and started quarrelling with me. When I threatened to report him to the Panchayat he beat me severely and broke my nose. I had to be hospitalised. He continued his relation with the other woman. In addition, he began having an affair with another woman. I felt like garbage. I felt there was no need for me in this house apart from doing the household chores. And what do I get in return? Some food and this terrible behaviour! I thought it would be better to end my life. I went and purchased some rat poison and consumed it.

  • [1] The custom of dowry in Indian marriages is a deep-seated cultural phenomenon. India’s DowryProhibition Act of1961 defines a ‘dowry’ as ‘any property or valuable security given or agreed to be givendirectly or indirectly by one party to a marriage to the other party, or by the parents of either party to amarriage’ (Ministry of Women and Child Development 1961, p. 5). As a cultural practice the dowrysystem propagates domination, torture and killings of women (Adegoke and Oladegi 2008). Despite lawsprohibiting the practice, there has been little change in India. In the last three decades, brutality againstwomen in the name of dowry seems to have risen. Social activists, sociologists and cultural anthropologists have indicated that the dowry system has serious implications for women in India in the sense thatit advances discrimination against the female child in the form of infanticide and sex-selective abortions(Das Gupta and Bhat 1997). In the context of dowry and son-preference, female children are believed tobe an economic liability and are subjected to differential treatment with regard to food, shelter and educational opportunities (Arnold 1992). Violence towards a bride which results in her death is called a“dowry death” or “dowry murder” (Rudd 2001). A suicide committed by a bride who is mentally and/orphysically pressurised to pay dowry is also classified as a dowry death. The first national law was TheDowry Prohibition Act of1961. Following this law, the Dowry Prohibition Amendment Act of 1984, theCriminal Law Act of 1983 and the Protection of Women from Domestic Violence Act, 2005 are laws inIndia that aim to address the issue of dowry and protect women. However, a number of loopholes in eachof the laws have rendered them largely ineffective.
 
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