According to the WHO, at least 20 per cent of pesticide suicides could be prevented through restricting access to poisons. Restrictions on highly hazardous pesticides will prevent suicides and save thousands of Nepali lives
Pesticide self-poisoning is the second most common method of suicide in Nepal. Globally, out of 800,000 individuals who die from suicide each year, about 15-20 per cent die from pesticide self-poisoning. Most suicides due to pesticide ingestion happen in agricultural communities around the globe, where—as in Nepal—small-holder farming is an important source of income. Statistics on suicide are notoriously unreliable and prone to underestimation. In Nepal, the under-reporting is happening due to stigma, fear of negative consequences on the part of families, and perceived illegality of suicide attempts.
Available data for Nepal show suicide rate considerably higher than the global average—in 2012, it was 24.9 per 100,000 population compared to the global average of 11.4 per 100,000 population. Generally, the WHO estimates that its South- East Asia Region accounts for 39 per cent of global suicides, but only 26 per cent of the global population.
Pesticide suicides are usually impulsive decisions that happen at the moment of crisis, with people thinking about killing themselves for less than 10 minutes. Most people who engage in suicidal behaviour do not want to die; rather suicide serves as a response to psychosocial stressors. If a person is prevented from using a highly lethal method, s/he may use a method with lower lethality, thereby increasing the chance of survival, or the suicidal impulse may pass. Surviving a suicidal period usually allows the person to find support from family, community, and medical/ psychological services or another way to deal with the stress. Evidence from other countries suggests that removing highly toxic substances from the market significantly reduces suicide rates by giving people more time to think about their decision.
According to the WHO, at least 20 per cent of pesticide suicides could be prevented through restricting access to poisons. This approach to suicide prevention is called means restriction. In view of the WHO, this is one of the most effective methods of suicide prevention. The means restriction approach suggests that if there is no easy access to the means for suicide, more people with no longstanding desire to die will survive their crisis and find solutions to their problems.
Means restriction has proven to be highly effective in the reduction of suicide in the UK after the domestic gas supply was made less toxic. Barrier installation on bridges and railway platforms to prevent jumping in front of trains also showed to be successful in Hong Kong and other countries.
Implementing legislation to limit the use of highly hazardous pesticides (HHPs) in agriculture has been a highly successful approach to suicide reduction, reducing the overall suicide numbers in countries where small-scale farming is common, such as Sri Lanka. In Sri Lanka, banning certain HHPs has led to major reductions in case-fatality for pesticide poisoning and suicides, resulting in a 70 per cent reduction in the suicide rate over 20 years.
In Nepal, as in other agricultural societies, where small-holder farmers use highly toxic substances to increase farm productivity, the wide availability of highly toxic pesticides makes them an easy option to be used for poisoning at the moment of crises.
In comparison with high-income countries, where agricultural strength toxins are only available to licensed workers, in low income countries, strong pesticides are freely sold in shops and are frequently stored at home. Unlike low toxicity substances commonly used for poisoning in the West many of these pesticides are highly lethal if ingested. This means that fatality of self-poisoning is much higher in agricultural communities such as Nepal than in other countries.
Restricting access to the means of suicide (ie banning and removing HHPs from agricultural practice through legislation and importation limitations, and otherwise reducing availability) is the most effective way to prevent deaths due to pesticide self-poisoning. This is especially true where the intent is low, and pesticide poisoning a common means of suicide. Implementing legislation to limit the use of HHPs in agriculture has been a highly successful approach to suicide reduction, reducing overall suicide numbers in countries where small-scale farming is common.
To facilitate a means restriction approach to suicide prevention in Nepal, a two-year research project has begun to identify which HHPs are most commonly used for suicide, and to implement a stricter regulation to them. The research is conducted by the Centre for Pesticide Suicide Prevention (CPSP)—an initiative of the University of Edinburgh in partnership with the Nepal Public Health Foundation with ethical approval of the
Nepal Health Research Council. At present 10 hospitals across Nepal are involved, with a further three hospitals about to be included. Researchers collect anonymized data from hospital records about pesticide poisoned patients to find out chemical compounds that are involved in poisoning.
This research initiative opens up an opportunity for the Government of Nepal to make a significant contribution to national suicide prevention, supporting the government’s target to reduce the national suicide rate by 2020.
Utyasheva is policy director of Centre for Pesticide Suicide Prevention at University of Edinburgh
A version of this article appears in print on September 10, 2018 of The Himalayan Times.