GOSABA, India (Thomson Reuters Foundation) - Dripping wet and looking exhausted, Shompa Pal winces as she walks into her home, holding tightly to a knot at the end of her saree.
From it she extracts and lays out to dry a soggy 100 rupee note, her earnings from wading waist deep in the brackish waters of the Bidyadhari River for four hours, dragging a triangular net behind her.
On a good day, she catches a thousand thread-like baby prawns that swim in during the two daily high tides, earning 100 rupees ($1.40) from a dealer who sells them to private firms that grow and export prawns.
Such work is common for poor women in her village in India’s delta Sundarbans region - but it also may be a health threat.
The work “does not require much skill or physical strength. It brings a little extra money to the poorer families, but with a huge health risk,” said Kolkata-based Barun Kanjilal, a professor retired from the Indian Institute of Health Management Research (IIHMR) in Jaipur.
Long contact with salty water, or bathing in contaminated pond water, gives many poor women skin diseases or reproductive tract infections, the health economist told the Thomson Reuters Foundation.
As he lead research studies in the region, he said, he also found a slightly higher rate of uterine cancer in the Sundarbans than in India’s West Bengal state as a whole.
And “in the Sundarbans the number of 50-plus women with eye problem is much higher than men, especially from the economically weaker groups,” he said.
A 2014 study by the World Health Organization found that salty drinking water in coastal areas of Bangladesh appeared to be linked to pregnant women there suffering high blood pressure and eclampsia or pre-eclampsia, both life-threatening conditions.
But scientific research to link the conditions to saline water exposure is lacking, both the WHO study and Kanjilal said, which is holding back efforts to deal with the problem in a region increasingly hit by climate change-related sea level rise and flooding.
Across South Asia’s coastal deltas, fresh water is in ever-shorter supply as global warming brings wilder weather, more flooding and harsher droughts, and exposure to salty water is increasing, researchers say.
In the Sundarbans - the world’s largest delta, created by the confluence of the Ganges and Brahmaputra rivers in Bangladesh and India - the changing conditions are particularly perilous for women, they say.
In coastal Bangladesh, storms and sea level rise mean many sources of drinking water are now contaminated by salt, and wells must be drilled ever deeper to find any fresh water.
In some areas of southwestern Bangladesh “you can dig 2,000 feet deep down but fresh water may still elude,” said Khairul Islam, the Bangladesh country director for Water Aid, an international clean water charity.
For Kishore Mandal, who lives in the village of Joymoni, on the edge of Bangladesh’s southern tidal forests, that means drinking water is no longer free, except during monsoon months when it’s captured in rainwater harvesting drums.
“Every week from November until July I buy three 30-litre jerry cans of water. We keep aside 240 taka ($2.80) for water every month,” he said. Women and girls carry the containers the 2 km home, he said.
When drinking water falls short, it’s also the women who often go without, or are forced to drink from salty ponds nearby, said Mandal’s wife Tripti.
“Our goats have priority over womenfolk for the sweet water because salt water causes cattle diarrhea,” she said. With goats acting as a form of savings, in a community increasingly hard-hit by extreme weather, keeping them alive is crucial, she said.
Women’s hygiene also suffers when water runs short. Women in Dulki, a village on the Sundarbans island of Gosaba, say washing their cloth menstrual pads in salty water turns them hard when they dry, often causing discomfort, lesions and sometimes infections.
In neighboring Sonagoan village, Namita Mandol, 32, recently had a 1.5 kg uterine tumor removed at a private clinic, at a cost of more than $350.
She said she knows of at least seven other women in the three surrounding villages who have suffered similar tumors - and all of the women worked long hours in the sea, trawling for baby prawns, she said.
In remote areas like Gosaba island, treating health threats can be a particular struggle, women living there say.
The island, for instance, has a lone government primary health clinic that serves 50 villages.
“A snaking queue is always there. Medicines meant to be free are rarely in stock,” said Namita Karmaker 23. Instead, women buy the medicine they need, eating into the family’s cash, she said.
Others say they instead turn to informal clinics run by rural health practitioners with limited education.
Worsening salinity in coastal areas may also become a major driver of migration, warns a report published this month by the International Food Policy Research Institute.
It said salt intrusion linked to sea level rise is likely to force 200,000 coastal Bangladesh residents to migrate at some point.
“Migration due to salt contamination is already underway and will accelerate,” warned Joyce Chen, an author of the study and a development economist at Ohio State University.
Many coastal residents right now are coping with the saltier conditions by turning to seafood farming rather than raising crops, said Valerie Mueller, another study author from Arizona State University.
For many households, however, the cost of converting crop land to fish or shrimp ponds is prohibitive, the study noted. That is leading families to head to nearby cities within their districts in search of scarce work, it said.
Reporting by Manipadma Jena ; editing by Laurie Goering : Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, climate change, resilience, women's rights, trafficking and property rights. Visit news.trust.org/climate