Francesca Mancini and Shweta Dabholkar explore the problem of pesticide self-poisoning in Pakistan, including the challenges and opportunities for tackling the issue.
*Warning: This article discusses suicidal behavior. If you have questions on self-harm or feel suicidal, use this link to find an international helpline.*
Pesticide self-poisoning is now a recognised public health problem in many countries across South Asia, where vulnerable people in rural areas have easy access to lethal pesticides. Overall, it is estimated that a staggering 14 million people have died since the Green Revolution in the 1960s.
In Pakistan, where small-scale farming is widespread, evidence suggests that 20% – 30% of all suicides are a result of poisoning with pesticides – making it the second most common method of suicide.
Using official figures from the World Health Organization (WHO), which estimates around 19,000 suicides in Pakistan every year, this would suggest between 3,800 and 5,700 annual deaths from pesticide self-poisoning.
However, we know that these numbers underestimate the true magnitude of the issue, as self-harm and suicide are severely underreported.
Exploring the evidence
Recent studies have helped shed light on the prevalence of pesticide self-poisoning in Pakistan, while simultaneously highlighting the need for improved reporting.
Last year, in collaboration with Aga Khan University, the Centre for Pesticide Suicide Prevention (CPSP) published a systematic review of existing literature on pesticide self-poisoning in Pakistan.
We found that lack of official data on suicides significantly impacted research. There are limited data on means of suicide and, in the case of pesticide poisoning, the type of pesticide involved. We were also unable to find any studies that provided information on how many people died before reaching a hospital. The government itself does not collect any data on suicide.
Of the 52,323 poisoning cases we identified through the literature review, 47% were due to pesticide poisoning. However, very few studies gave details on the particular pesticide involved or whether or not the person survived.
More recently, we conducted a small-scale survey in rural villages in Multan, in partnership with the MNS University of Agriculture, Multan. Overall, 382 interviews were conducted, gathering evidence of pesticide poisoning over the last 12 months. The results of this survey were consistent with earlier findings, with 30% of pesticide poisoning cases found to be a result of intentional poisoning. Sadly, two thirds of people who had self-harmed with pesticides did not survive.
However, these are only indicative results, based on what people could remember. Further research is still required to fully understand the situation.
Banning pesticides to prevent deaths
Global experience has shown that the most effective way to prevent deaths from pesticide self-poisoning is to remove deadly pesticides from use. This is achieved through regulation and bans.
This approach has already worked in other South Asian countries, including Sri Lanka, Bangladesh, and South Korea. Sri Lanka is a particular story of success, with a staggering 70% drop in the annual suicide rate following a series of carefully considered bans on highly hazardous pesticides.
As pesticide self-poisoning is usually an impulsive act of self-harm, it is the easy availability of harmful pesticides that puts people at risk. If lethal pesticides are regulated and replaced by less toxic, preferably non-chemical alternatives, the chance of survival is greatly improved.
Importantly, analysis of existing bans has shown that when implemented correctly – ensuring safe alternatives are available to farmers – there has been no adverse impact on agriculture. Food production, and farmers’ livelihoods, are protected.
Of course, this approach does not replace the need for mental health services, which remain crucial for any suicide prevention strategy.
Pakistan’s encouraging approach
Recently, Pakistan has taken an encouraging approach to suicide and pesticide poisoning prevention.
In December 2022, Pakistan took an important step of decriminalizing suicide, repealing the penal code criminalising attempted suicide. This is an extremely progressive move that should improve reporting.
In 2019, the government also proposed a ban on all World Health Organization (WHO) hazard class Ia (extremely hazardous) and class Ib (highly hazardous) pesticides, subject to availability of alternatives. This proposed ban will restrict access and use of some of the most toxic pesticides, which will undoubtedly have an impact on deaths from poisoning.
However, our recent analysis has shown that one of the two main pesticides responsible for self-poisoning deaths in Pakistan is not included in this WHO hazard class. It is therefore not on the list of bans and will remain available when the ban goes through.
Progress and opportunities
Progress is certainly being made to tackle the problem of pesticide self-poisoning in Pakistan.
CPSP has recently established a partnership with CABI, an international not-for-profit organization that promotes nature-based solutions, including biological control solutions for pests. CABI has been working in Pakistan for many years and its Plantwise Plus programme has been instrumental in encouraging use of low-risk alternatives.
Over the coming years, we hope this collaboration can help facilitate cross-sectoral policy consultations among agricultural and health stakeholders to develop strategies for the prevention of pesticide poisoning and to promote the large-scale use of cost-effective, biopesticides and other low-risk alternatives.
We are also collaborating with the WHO country office in Pakistan, who invited us to join a national technical working group on mental health. Through this forum, we have been able to take part in a WHO webinar to publicly address the issue of pesticide suicide in the country. Discussions are now in progress with both the WHO team and the Aga Khan University to design studies to start closing the data gap.
Opportunities and recommendations
However, there is still much more that can be done.
First, the ongoing efforts of the government to ban WHO I hazard class pesticides must be supported. But regulation should not stop there. Further investigations are needed to identify and ban other pesticides causing serious harm to people, which aren’t currently covered by the ban.
For Pakistan’s health sector, there needs to be standard practices for training emergency department doctors on how to manage pesticide self-poisoning cases.
Furthermore, we would like to see the development of a national strategy for the prevention of pesticide poisoning. This should be produced in consultation with representatives from research, agriculture, health, and the environment – bringing these different sectors together in a common goal.
Finally, Pakistan’s efforts would be strengthened if data on suicides were to be centrally collected. As there are currently no official survey systems, it is difficult for policymakers to make informed decisions on suicide prevention.
By taking a comprehensive approach to the problem, Pakistan will be able to prevent thousands of unnecessary deaths from pesticide poisoning.
Francesca Mancini
Consultant, Centre for Pesticide Suicide Prevention (CPSP)
Francesca is a tropical agronomist with 22 years’ experience in agriculture in Asia, Africa and now the Pacific. Her work at CPSP focuses on strengthening regional capacity and collaboration on identification, reporting, regulation, replacement, and monitoring of highly hazardous pesticides in Southeast Asia. She currently leads CPSP work in Pakistan, including collaborations with CABI and the WHO.
Shweta Dabholkar
Project and Policy Officer, Centre for Pesticide Suicide Prevention (CPSP)
Shweta has worked as a Project and Policy Officer for CPSP since 2019 and has taken an active role in international conferences and negotiations to address highly hazardous pesticides. She was the lead author of ‘Suicides by pesticide ingestion in Pakistan and the impact of pesticide regulation’ – a literature review on pesticide self-poisoning in Pakistan.
Related articles and publications
Blog: How pesticide poisoning became a global health problem
Publication: Suicides by pesticide ingestion in Pakistan and the impact of pesticide regulation