The Low-Lying Country Where Drowning Is the No. 1 Killer of Kids

In Bangladesh, water is everywhere. So why can't children learn to swim?
Children learn to swim in one of the portable pools public health advocates have deployed to Bangladeshi cities. (Center for Injury Prevention and Research Bangladesh)

DHAKA, Bangladesh — Water is everywhere in Bangladesh. The South Asian nation squats on one of the world’s largest deltas, and rivers run through this low-lying land like capillaries. In the countryside, chartreuse rice paddies are broken up by countless small ponds—patches of murky olive water that people use for washing and drinking. During car and boat rides across the country, I saw children splashing, bathing, and playing in the water. In Bangladesh, however, there is a dangerous undercurrent to this seemingly idyllic scene.

News from Bangladesh tends to involve natural and industrial disasters, or violent political protests. But the biggest killer of children aged one to 17 is a silent one: drowning. A 2003 countrywide study found that about 18,000 children under 18 drown each year. Most deaths occur among unsupervised children between one and five years old who tumble into ponds that are literally in their backyards. Seventy-five percent of drownings happen within 65 feet of home, and a horrifying 7 percent of young victims drown in buckets (large storage vessels are common in Bangladesh, where there is often no running water). Below age one, pre-term births, asphyxia, and sepsis are the most common killers of newborns. All this is occurring in a country that is mostly at or slightly above sea level, and one of the most vulnerable in the world to rising water levels and climate change.

Aminur Rahman, the director of the International Drowning Research Centre in Dhaka, told me the story of one mother in a village whose two sons died in a “twin drowning” in which her 10-year-old tried rescuing his drowning five-year-old brother in a nearby pond, only to be pulled under himself. People “don’t consider water a big hazard until something happens,” said Rahman, whose center is part of a larger non-profit called the Center for Injury Prevention and Research Bangladesh (CIPRB), one of the only organizations in the country focusing on preventing drowning.

In most developing countries, pneumonia and diarrhea—illnesses related to poor hygiene, sanitation, and nutrition—are the largest killers of young children. Not so in Bangladesh, which has made great strides in improving child health over the last 20 years. Diarrhea, for instance, accounted for just 2 percent of deaths for children under five from 2007 to 2011, thanks to widespread use of oral rehydration solution, a simple electrolyte blend of salt, sugar, and water that American and Bengali researchers developed in the late 1960s. For decades, Bangladesh’s government and NGOs have invested heavily in vaccinating infants, training birth attendants to help with home deliveries, and deploying health workers to give prenatal advice to pregnant women in their homes. All of these efforts have helped make Bangladesh one of only five countries in the world on track to meet the UN Millennium Development Goals of dramatically reducing child and maternal deaths by 2015. But this kind of progress has proven more difficult to achieve when it comes to drownings. As a 2011 survey by the Bangladeshi government noted, "With reductions in other causes of deaths, drowning is now responsible for 43 percent of all deaths between ages one and five."

Bangladesh Health and Injury Survey

Most young drowning victims are from poor, uneducated families in rural areas, where it is common for children to wander on their own around fields, roads, and ponds. And since precautions like protective fences around ponds are an alien concept here, the results can be tragic. More than 40 percent of child drowning deaths occur in ponds, followed by ditches, rivers, and buckets. The 2003 study also found that 60 percent of victims drowned between 9 a.m. and 1 p.m, when older siblings are at school and mothers are preparing food, gathering wood and water, or tending to crops—in other words, the busiest time of day for a mother in rural Bangladesh, where 70 percent of the population lives.

To address these problems for children under the age of five, CIPRB is advocating simple precautions like covering buckets and building thatched fences around bodies of water. It has also organized the rural equivalent of day care, where a local woman is paid to look after children while mothers work and do chores. More than 16,500 children were enrolled in these nurseries from 2006 to 2010. In 2013 about 40,000 were enrolled, with another 40,000 expected in 2014.

But CIPRB has a different strategy for children between the ages of five and 12: free swimming lessons. From 2006 to 2013, the center’s programs have taught nearly 350,000 children to swim across Bangladesh, mostly in villages but also in cities (the organization estimates that it needs to reach 25 million children to reduce child drowning on a large scale). The children also learn to extend objects like sticks to someone in trouble rather than attempt ‘wet rescues’ themselves. From 2006 to 2010, the swim program coincided with a 48-percent reduction in fatal drowning of children between the ages of five and nine, according to a 2012 CIPRB paper published in the U.S. journal Pediatrics. The study also found that if a child five years or older learns to swim, there is 96 percent less of a chance of them drowning.

“Swimming is our vaccine,’” explains A.K.M. Fazlur Rahman, the director of CIPRB.

It’s a vaccine, of course, that’s more complicated to deliver than an injection. But at least it’s a lot more fun. On a hot spring afternoon in Dhaka, nine boys ages seven to 11, wearing blue swim caps and white T-shirts, stood chest-deep in a portable above-ground pool, taking instructions from a young Bangladeshi man in a wetsuit. First, the boys practiced getting used to the water. They held hands in a circle and then bobbed up and down, dunking themselves repeatedly. Next came gliding, with arms outstretched and the body flat as a board—though most of the boys looked more like crabs with flailing legs.

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Amy Yee is a journalist based in New York. She lived and worked in New Delhi from 2006 to 2013.

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