Discussion

The case studies presented in this report all show that acute pesticide poisoning affects a significant proportion of the farmers questioned (Table 5). The study which recorded the lowest level of APP was from Moldova where 10% of respondents said they experienced poisoning, meanwhile 82% of respondents in Belarus reported a poisoning event in the previous 12 months. Both of these surveys had low sample sizes.

TABLE 5. SUMMARY OF RESULTS OF SURVEYS OF SMALLHOLDER FARMERS WHO USE PESTICIDES, SHOWING % SELF REPORTING INCIDENTS OF ACUTE PESTICIDE POISONING OVER A 12 MONTH PERIOD.

YEAR

2011 2015 2015 2015 2015 2015 2015 2016 2016 2018 2018

COUNTRY

Mali Armenia Belarus Georgia Moldova Kyrgyzstan Ukraine Georgia Benin Ethiopia Benin

N (PESTICIDE USERS)

357 25 49 117 73 124 161 591 493 90 507

% APP

25 44 82 14 10 56 59 20 42 28 51

Just three studies revealed poisoning rates of less than 20%, while more than half of the surveys uncovered rates in excess of 40%. Many of these poisonings involved “minor” and general symptoms such as headaches or dizziness, but the studies also uncovered many serious incidents including loss of consciousness and seizures. The studies also showed that a significant minority of farmers experience multiple poisoning incidents in a year. In Benin for example, around a fifth of farmers questioned reported experiencing more than six poisoning incidents in the previous year. Some of the case studies presented explored the “conditions of use” – the way that pesticides are used in reality – to identify common routes of exposure and risky practices or behaviour that can lead to poisoning. This information is helpful to guide policy makers in targeting interventions to reduce poisonings. These show that many of the assumptions made by regulators when approving pesticides for use in their countries – such as access to PPE, training and information – are not valid. In Tanzania for example, farmers regularly mix the same type of insecticides or different insecticides in a spray. And very few farmers use internationally recognised PPE. Just 6% of farmers in Mali and 0.2% of the farmers questioned in Georgia used PPE. Other common practices identified included spraying into the wind, reusing pesticide containers, storing pesticides at home, repackaging pesticides into other containers, and using pesticides licensed for use on animals on food crops. Alarmingly, some, of the studies revealed that vulnerable groups such as pregnant women and children work with pesticides. Over a third of the children questioned in the Moldovan case study, and a quarter of those questioned in Kyrgyzstan reported handling pesticides. The risk to farming families and communities living on or near these farms is significant. The study in Senegal showed that 7% of women surveyed reported acute pesticide poisoning incidents despite the fact that they did not themselves apply pesticides.

A striking finding was that hardly any of those poisoned sought professional medical treatment. Just 5% of farmers poisoned in Tanzania, and just 8% in Mali visited a hospital. Even in relatively wealthy Georgia, just 12% of those who said they had experienced APP sought medical help. This could be because health coverage is poor in many of these countries and the incidents occurred far from the nearest health workers; or it could be because treatment is expensive and most of the farmers lack resources to pay for it; or it could simply be because – as the study found in Tanzania – farmers simply expect to feel ill after applying pesticides so it is considered normal. Whatever the reason, the result is that most poisoning events do not enter official records and as a result are under-reported and the problem rarely comes to the attention of policy-makers. Pesticide poisoning is a hidden health crisis. None of the countries listed in this study had adequate post-registration monitoring systems. Most had no system at all for recording deaths or ill health associated with pesticide use. Yet, the studies support the conclusion that acute pesticide poisoning in smallholder farming is common. In six out of 10 countries in the study, prevalence rates among farmers and farm workers who apply pesticides were over 40%. And the high poisoning rates uncovered by these studies are not exceptional. Other recent surveys that have uncovered high rates of poisoning include Bangladesh (85%), India (94%), Pakistan (100%) and Tanzania (93%) (Miah 41 et al., 2014; Singh 42 and Kaur, 2012; Tahir 43 and Anwar, 2012; Lekei 44 et al., 2014b). Worldwide there are more than 500 million small/family farms (Lowder 45 et al., 2016). If this level of APP is mirrored in smallholder farming globally, it suggests that more than 200 million farmers could be poisoned by pesticides every year. The problem of occupational exposure to pesticides is huge. All of the studies presented here were conducted by civil society organisations, sometimes in collaboration with national authorities, to gather data and to bring it to the attention of different sectors, including health and agriculture. The conclusions that we have drawn from these experiences include: 6 6

6

6

6

6 Acute pesticide poisoning is a widespread and serious problem

Women and children are at significant risk, but data is generally lacking on the extent of their exposure to pesticides

Common issues face many countries where farmers lack access to good quality training or information about the hazardous pesticides they are offered. They also lack appropriate PPE and the regulation and management of pesticides is weak

The proportion of incidents of pesticide poisoning that reach medical services is low in many countries

Health systems often lack the means to diagnose and report incidents of pesticide poisoning to national authorities. Low numbers of reported incidents, therefore, do not reflect the true scale of the problem

Better information on pesticide poisoning and its causes can help policy-makers to target more effective action and encourage them to allocate resources to tackle the problem These studies support the conclusions drawn by a report presented to the UN Human Rights Council in 2017 46 which pointed out that people and the environment are still being failed in terms of protection from hazardous pesticides. And that implementing the right to adequate food and health requires proactive measures to eliminate harmful pesticides. Many policy-makers and regulators assume that mitigation measures are in place to adequately manage the risks to human health and the environment from pesticides. But these studies clearly show that, in many LMICs, under “real-life” conditions of use, even the most basic risk mitigation measures are not widely adopted. In the absence of this assumed protection, the most effective way to protect human health and the environment is to ban HHPs and only allow the use of those pesticides which do not require extra mitigation measures. Alternative, low risk and effective pest management approaches are available, but

coordinated action is needed to harness the resources and will of stakeholders at all levels to achieve a significant shift away from HHPs and towards agroecological farming methods. This includes global actors and frameworks, national authorities, the agricultural research community, the private sector, civil society and rural communities themselves.

Photo: The conditions of use and sale of pesticides in Armenia, often repacked and sold in non-original containers. Credit: PAN UK