The Low-Lying Country Where Drowning Is the No. 1 Killer of Kids
December 30, 2013
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.
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)

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.

We were in a city park in Dhaka where CIPRB offers swim programs through schools for low-income boys and girls. The organization has just six portable pools, since they’re expensive at $5,000 each and require large amounts of piped, clean water (not to be taken for granted in Bangladesh). The vast majority of the group’s swimming lessons take place in village ponds with special bamboo platforms that create an enclosed area for children.

In villages, friends or family members often teach children to swim in ponds and rivers that are murky, with uneven bottoms or strong currents (90 percent of rural Bangladeshis bathe in water bodies, so kids in the countryside are at least used to the water, if not to swimming). Many children I saw in these situations doggie-paddled and clung to branches. I wondered if they could really swim 25 meters and tread water for 30 seconds—CIPRB’s modified baseline for survival swimming in Bangladesh.

Children practice extending sticks to distressed swimmers within a bamboo platform in rural Bangladesh (Center for Injury Prevention and Research Bangladesh)


These deficiencies aren’t all that surprising in a country that has only 13 public swimming pools for a population of 152 million people (10 of these pools aren’t even in operation, according to Fazlur Rahman). Expensive hotels, private schools, and even some apartment buildings in Bangladeshi cities have pools, but these are only accessible to the most privileged of Bangladeshi children. And in cities, ponds, lakes, and rivers are pretty filthy.

Here’s a case in point. Fazlur and Aminur Rahman (no relation) both have public health doctorates from Karolinska Institute in Sweden, which specializes in injury prevention. Both 50-something men have an alphabet soup of advanced degrees on their business cards. But when I asked Aminur, the head of the International Drowning Research Centre, how he learned to swim, his colleague Fazlur laughed from across the office. “He doesn’t know how to swim!” Fazlur chortled. Slightly chagrined, Aminur explained that he grew up in Dhaka and had few chances to swim. (Fazlur knows how to swim.)

In the Dhaka park near the portable pool, I met four kids, including two girls wearing headscarves and a chubby six-year-old boy in a T-shirt that declared “I Can Swim,” who took CIPRB’s 12-session swim course in 2012. Tasmim Humaira, a thin 11-year-old, claimed learning to swim wasn’t too difficult. “If we have danger in our life we can swim,’” she declared.

CIPRB teaches an equal number of boys and girls to swim—an achievement facilitated by the surprising fact, in this Muslim country, that 60 percent of the program’s swim instructors are female (the organization has trained a total of 2,700 local swimming instructors according to international guidelines). In the water, these women wear shalwar kameez (loose-fitting tunics and trousers). “Our initial thought was that people would be resistant, but there was no objection from the community,” said Fazlur.

In a congested Dhaka neighborhood called Niketon, a group of children told me about their experience learning to swim with CIPRB last year. We sat near their school, which had a dirt courtyard with stubby patches of grass where boys played cricket. Another portable pool sat to one side, looking out of place in the modest surroundings. It was a hot, humid day and the pool’s blue water looked tantalizing behind a fence topped with barbed wire. Halima Sadia Tina, a 12-year-old girl with a moon-shaped face, told me floating was the most difficult skill for her to learn.

Their swimming instructor was Mustafazar Rahman, a third-year college student studying computer science in the Bangladeshi capital who teaches swimming part-time. He is from the village of Shirpur, about 100 miles from Dhaka, where his father taught him to swim when he was seven. Rahman remembers that there was another seven-year-old boy in his village who drowned. In the rush to save him, he had been pulled from the water and spun over an adult’s head to induce vomiting. CPR isn’t well-known in rural areas and rescuers often resort to superstitious practices instead, vainly pounding a victim’s stomach or putting rotten food in his or her mouth to induce vomiting. Rahman estimates that he has now taught 1,400 children to swim, including some from his village.

Back at the schoolyard in Niketon, one young student fondly remembered his swim lessons—and how they empowered him. “First time I was scared but after some time I became normal with the water,” 13-year-old Rezul Islam told me. “Now I can save myself from drowning and also I can save other children’s life.”


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