Bangladesh

Pesticide suicides have long been a major problem in Bangladesh, killing thousands of people every year. However, around 20 years ago, the Bangladesh government started to introduce laws to control the use of pesticides in the country and removed some highly hazardous pesticides (HHPs) from agricultural use.

Between 1996 and 2007, 21 HHPs were partially or completely banned, with the major bans occurring in 2000. As shown in the figure, the rate of suicides from pesticide poisoning fell markedly (red line), from 6.3/100,000 in 1996 to 2.2/100,000 in 2014, a decline of 65%. There was a modest simultaneous increase in hanging suicides (19.2% increase) but the overall incidence of unnatural deaths fell from 14.0/100,000 to 10.5/100,000 (25.0% decline).

We calculate that there were 35,042 (95% CI 25,502-45,666) fewer pesticide suicides in 2001 to 2014 compared with 1996 to 2000. Since the injury (unnatural) deaths fell over this time period (purple line in the figure), we found no evidence that people turned to another form of suicide.

The number of people dying in hospital from pesticide poisoning was also significantly lower after the bans (15.1% vs 9.5%, relative reduction 37.1% [95% CI 35.4-38.8%]). This effect on pesticide suicides occurred despite increased pesticide use and pesticide poisoning cases, with no apparent effect on agricultural output.

These data indicate that strengthening pesticide regulation resulting in bans of dangerous HHPs in Bangladesh was associated with major reductions in deaths and hospital mortality from pesticide poisoning, without any apparent effect on agricultural output.