Research published last year by IpasA US-based reproductive justice NGO has found that global warming has exacerbated existing gender inequalities and directly or indirectly affected women’s sexual health, pregnancy outcomes, contraceptive use and fertility intentions in Bangladesh and Mozambique, two climate-sensitive countries.

The report says that during extreme weather events exacerbated by climate change, such as cyclones, access to medical care and contraceptives was limited. The researchers also found that the climate crisis has exacerbated economic instability and added an additional burden to women’s caregiving responsibilities.

In some cases, this could mean women taking on dangerous jobs to provide for their families, says Sally Deikerman, a senior researcher at Ipas who worked on the report.

“You, as a woman, may be forced to roam waist-deep in water where you catch fry to feed your family, and these rivers are not only polluted by cyclones and the destruction of sewer systems, but sea levels are rising, leading to more and more salinization of the water,” she said. “It directly affects their reproductive organs, causing infections, cancer and injury.”

In Sathira, salt water intrusion has cut off access to clean drinking water, Akhter said.

“There is not a drop of fresh water in the whole area,” she said. “It will take two hours to get fresh water.”

Fatima Idris Eva, a health worker in the Shyamnagar city of Sathira, said she had noticed an increase in the number of patients, including men, with sexual or reproductive ailments over the past two years. According to Eva, this includes women reporting irregular periods, discharge, and sores around the uterus.

“The water in different parts of Shyamnagar is extremely salty,” she said in Bengali. “We have a lot of patients coming in who have uterine problems due to drinking salt water. It’s worrisome.”

But the burden on some women may come long before climate-related health problems arise. Poor families may force their daughters to drop out of school to work or decide to marry off their girls at an early age to alleviate financial stress. Akhter said she herself stopped going to school and got married after Cyclone Ayla that hit Bangladesh in 2009 left her parents in a financial crisis.

“This salt water ruined my childhood, school and life,” she said.

Similarly, twelve-year-old Sakila Akhtar had her childhood years stolen to help her family out of poverty. She said that she once dreamed of becoming a politician in order to change the fate of people in her hometown, but now she is the mother of a one and a half year old daughter.

“I wanted to discover the world in different ways and be able to do many things, like crafts, but now I have to work as a day laborer with a child in my arms,” Akhtar said in an interview in Bengali. “My father has nothing. I had to settle down and get married. My husband is also poor.

Akhtar said she has irregular periods and heavy discharge and her doctor recommended fresh water bathing, but there is none nearby.

Jahanara Begum, 65, remembers when it wasn’t always like this.

“Once there was fresh water here,” she said in Bengali, adding that she now has to travel more than 4 miles to bring drinking water.

Even during the rainy season, households cannot store enough rainwater to last for a long time.

Begum said her husband was ill and she was suffering from uterine cancer and diabetes. Prolonged exposure to brackish water also caused her to itch all over her body.

“I visit doctors and take medication, but there is no solution,” she said. “So many diseases have settled in my body in these few years.”

Women’s reproductive health risks are expected to rise as cyclones and floods become more frequent and intense due to global warming, and as sea levels continue to rise. Studies show that global average sea levels have risen more than 8 inches since 1880, and scientists predict that by 2050 roughly 17% of Bangladesh could be flooded.

“Here everything turns into a cyclone,” said 12-year-old Akhtar. “Here, thinking about the future of people, the storm breaks houses, breaking people’s lives. Here everyone is happy, but everyone is sick.”