THE World Health Organisation estimates over 19,000 suicide deaths every year in Pakistan, with evidence suggesting that the actual number could be significantly higher due to under-reporting.

Previous research from across South Asia indicates that 20-30 per cent of these deaths are a result of pesticide self-poisoning. This is a particular problem among women and young people below the age of 30.

Counselling, therapy, and medication have been the most popular approaches in policy discourse for suicide prevention. However, to benefit from these services, a person either needs to survive an attempt or have access beforehand.

Strategies that would help a person avoid or survive a suicide attempt could therefore prevent deaths.

Many suicides in Pakistan can be prevented through stricter policy regulations.

Low intent to die: Not every person who dies from suicide intends to take their life.

Evidence shows that most suicides in low- and middle-income countries are of low intent. Often, it is an impulsive act of self-harm, or cry for help, taken in the heat of the moment without premeditation.

Young people may self-harm after being shouted at by parents, scoring low marks in school, or being bullied by their peers. Many instances of self-harm among women are due to domestic violence issues.

These low-intention suicides can be prevented by restricting easy access to lethal means of suicide.

Access to lethal means: During moments of crisis, the method of self-harm available can determine whether someone will survive. If a person has easy access to lethal means of suicide, such as an acutely toxic pesticide, there is a very high chance that the person will die.

However, if they do not have access to these lethal means, their chance of survival greatly improves. Either they will use a non-lethal means, or the self-harm impulse may pass before they act.

Surviving an act of self-harm allows people to access services and support from within their community. The evidence shows that they are unlikely to reattempt.

For this reason, restricting access to lethal means of suicide is recognised as a cost-effective suicide prevention strategy by the WHO. In particular, the WHO, along with the United Nation’s Food and Agriculture Organisation (FAO), recommends banning highly hazardous pesticides.

The problem of pesticide suicide: Pesticide poisoning is the second most common method of suicide in Pakistan. It is also a major global health crisis, responsible for an estimated 150,000 deaths every year. The majority occur in low- and middle-income countries, where rural farming communities have easy access to lethal pesticides.

All pesticides are toxic, with some designated as Highly Hazardous Pesticides (HHPs). These are particularly dangerous to people or the environment. A relatively small number of pesticides are extremely toxic to humans and it is these that cause most deaths in cases of self-harm.

Pakistan is predominantly an agrarian nation, with more than 40pc of the country’s workforce employed in the agricultural sector. Most farmers and agricultural workers use HHPs, believing they protect their crops and livelihoods. Unfortunately, many are unaware of the risks of HHP usage, and lack any means to mitigate those risks. They are also generally unaware of safer, more sustainable alternatives.

In the absence of stricter national regulations and effective enforcement, these deadly pesticides are sold in local shops without controls. They are then kept in homes and fields, within easy reach of family or community members.

As pesticide self-poisoning is usually an impulsive act, it is the easy availability of HHPs 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.

Examples from across Asia: This approach has already worked in other countries across South-East Asia. Between 1980-2010, Sri Lanka implemented a series of carefully considered bans on a number of HHPs, resulting in a staggering 70pc drop in the annual suicide rate. There has been similar success in Bangladesh and South Korea.

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 the issue of HHPs and suicide. In 2019, the government proposed a ban on all WHO hazard class 1a (extremely hazardous) and class 1b (highly hazardous) pesticides, subject to availability of alternatives.

However, Pakistan’s efforts would be bolstered if data on suicides were centrally collected. Currently, there is no official data on suicides, which makes it difficult to inform policy. It is hoped that Pakistan’s progressive step to decriminalise suicide will improve suicide reporting.

There is also little information on how many deaths are due to pesticide poisoning, or which pesticides are responsible in these cases, as hospitals and police record poisoning cases under the broad category of ‘injuries’.

New analysis of research papers has recently identified the two main pesticides responsible for self-poisoning in Pakistan. However, only one of these is included in the WHO hazard class, used as the criterion for proposed bans. The other pesticide, despite being responsible for many deaths, will remain available.

Hope for the future: If all acutely toxic pesticides are removed from agricultural practice, it is estimated that the global pesticide suicide rate will fall rapidly from 150,000 deaths a year to less than 20,000.

A nuanced understanding of mental health-associated risk factors, suicidal intent, and methods of self-harm, will help policymakers to frame effective policies to save lives.

The writer is project and policy officer, Centre for Pesticide Suicide Prevention.

Published in Dawn, November 18th, 2023