The tiny nation of Suriname, on South America’s Atlantic coast, has one of the highest suicide rates in the world. A majority of those deaths involve a single substance: paraquat, a pesticide widely used for weed control that is lethal to humans in amounts as small as one swallow.
Pesticides are among the leading means of suicide in agricultural areas of developing nations, implicated in more than 100,000 deaths annually. Yet for years, their threat has been largely overlooked.
Now, a handful of researchers and philanthropists are pushing to change that, arguing that restricting access to the most lethal pesticides could be one of the simplest, most cost-effective ways to save lives.
Paraquat, one of the deadliest pesticides still on the market, is among their top targets. It is quickly absorbed by the body and has no antidote. Even a small dose causes multi-organ failure, though death may take hours or days.
That often leaves time for people who ingest it in a moment of despair to come to regret their decision, according to Dr. Esther Fong, an emergency physician at Suriname’s busiest hospital. “You see the death written on their foreheads,” she said, “but you cannot do anything about it.”
Paramedics, police officers and teachers see paraquat’s reach as inescapable.
“It’s very easy to find, and most every house has one bottle or more,” said Ashna Badrising, an English instructor at the E.H. Cabell School.
Last November, on the morning of Diwali, a holiday marking the triumph of light over darkness, one of her brightest students opened a bottle of the pesticide and took a swig. She died three days later.
“I see when someone is struggling or depressed,” Ms. Badrising said. “But I never expected this.”
Inexpensive, effective and dangerous
From the air, the buildings of Paramaribo, Suriname’s capital and largest city, are a confetti of reds, blues and browns on an endless blanket of green. In this tropical climate, vegetation has the upper hand.
To tame their prolific lawns and gardens, many residents use paraquat, which they dilute with water and spray on unwanted grass and weeds. Marketed as Gramoxone, it’s inexpensive and effective.
It’s also dangerous. Developed by the chemical company Syngenta, paraquat is now banned in the European Union and China, as well as scattered other countries around the world, but it is still in widespread use elsewhere. The United States permits its use in nonresidential settings, requiring that buyers be trained and certified. Research suggests that chronic exposure to even small amounts of the substance increases the risk of developing Parkinson’s disease, though Syngenta disputes that link.
There are other contributors to the suicide rate in Suriname, where many young people straddle a dizzying gulf between their traditional upbringing and the modernizing world.
But experts say the most decisive factor, here and elsewhere, is not why people try to harm themselves but how they choose to do it. Where the available means are more lethal, a higher share of attempts are fatal.
Pesticide poisoning deaths are most common in Nickerie, a rural district where a majority of the population is Javanese or East Indian and lanes of houses are backed by green ribbons of rice fields. Christina Bhulai, a soft-spoken 18-year-old, was recently discharged from the hospital there. Depressed and in a moment of dissociation, she had drunk half a cup of paraquat, but her father rushed her to medical care and she managed to survive. She urged young people struggling with similar feelings to share them with a teacher or family member. “Do not do this stupid thing,” she said.
When paraquat and other pesticides arrived in the poor agricultural regions of the world beginning in the mid-20th century, they received a hero’s welcome. Along with new strains of crops and farming techniques, they helped drive the Green Revolution, which boosted agricultural productivity and curbed hunger. But many households were unprepared to manage such powerful toxins, and for years the danger wasn’t recognized.
In 1995, Michael Eddleston, a young medical student with an interest in toxicology, went to Sri Lanka to study snakebites. But it was the dry season, and the snakes were lying low.
Idling around the hospital, he was struck by the number of patients treated for pesticide poisoning. Sri Lanka’s crop yields had surged after the introduction of modern fertilizers and pesticides in the 1960s, but, he learned, the suicide rate had increased fivefold as well.
Over the next three decades, Dr. Eddleston devoted himself to studying various strategies for preventing these deaths: providing chemical antidotes to people who have consumed pesticides, distributing storage containers for farmers to lock up their pesticides, training vendors to screen out suicidal customers. None proved to have a meaningful impact.
What worked was banning the most toxic compounds, a process Sri Lankan regulators began in earnest in the mid-1990s. Farmers responded by switching to other hazardous substitutes, which then had to be banned, too. Eventually, in 2014, the government outlawed paraquat. As lethal pesticides disappeared from circulation, Sri Lanka’s overall suicide rate fell more than 70 percent.
Sri Lanka’s success drew the interest of Open Philanthropy, a charity and research organization associated with the effective altruism movement, which seeks to direct donations to important, neglected and tractable causes.
Weighing the evidence from Sri Lanka and elsewhere — like South Korea, where restrictions and then a ban on paraquat cut suicide mortality in half — Open Philanthropy concluded that banning pesticides was a highly cost-effective way of saving lives, at about $2,000 per suicide averted.
But it was a strategy without a leader. “There wasn’t a single organization dedicated to it,” said James Snowden, who oversees Open Philanthropy’s global health programs.
So in a series of grants, Open Philanthropy gave Dr. Eddleston $20 million to start the Center for Pesticide Suicide Prevention and take his efforts worldwide.
To lobby the Surinamese government, the center employs Gamini Manuweera, a former Sri Lankan pesticide regulator who knows firsthand the challenges of restricting access to these substances.
Last year, he was instrumental in bringing the issue to the attention of Shemiem Modiwirijo, the head of the Agriculture Ministry’s pesticide division. “I knew that people are dying by suicide with paraquat, but I never thought about the numbers,” she said.
Some farmers fear a ban of the pesticide would hamstring their operations. Paraquat is widely used, with nearly 480,000 liters imported in 2023, according to government data. Ms. Modiwirijo fears that if farmers lack viable alternatives, they will find ways to circumvent restrictions.
Shiewa Nanhoe, an agronomist at a company that cultivates bananas and other tropical fruit on about 500 acres in Suriname, said its operation phased out paraquat in 2017, after more than a decade experimenting with various substitutes.
This allowed the company to earn an environmental certification, but she cautioned that eliminating pesticides makes farming more expensive. “You cannot compete with other producers who are using conventional products and expect to have a good cost-price,” she said.
Yves Diran, who leads the crop management program at the Anne van Dijk Rice Research Center in the fields of western Suriname, conducts research to improve farming practices and reduce agriculture’s impact on the environment and human health.
Speaking over the roar of a crop-duster passing overhead, he said farmers in the area typically spray paraquat at the borders of their fields and to clear overgrown ditches. He said the weeds could be mowed instead, but they grow back more slowly if they are poisoned.
He doesn’t spray his own fields, he said, but his neighbors do, despite his protests. Even his mother uses it. “I have a 1-year-old son now, and I don’t want him to be in an area where paraquat is being used a lot,” he said. “But I cannot force them.”
Ms. Modiwirijo wonders if there is a middle ground. “The biggest problem is that people are simply able to get it at every store right around the corner,” she said. “My mind-set is let’s try to severely regulate it first,” limiting access to commercial farmers while cutting off household use.
Based on his experience in Sri Lanka, which imposed such a half measure at first, Mr. Manuweera predicted it would not cut suicides. “If it’s on the market, you can’t stop people from accessing it.”
Continuing obstacles
The government has lagged in addressing the country’s elevated suicide rate. The Health Ministry’s 2016 national suicide prevention plan called for limiting pesticide access. But according to Eva Stroo, director of the nonprofit Mind Matters Foundation, the government never followed through on its recommendations, nor did it update the plan when it lapsed in 2020.
Ms. Stroo, a Dutch psychologist who moved to Suriname a decade ago, noted the scarcity of local mental health resources. Paramaribo’s Rotary Club supports her foundation’s campaign to raise awareness about suicide prevention, but she depends on funding from the Dutch government to operate a crisis line — which is, ironically, only for callers in the Netherlands. It’s cheaper to staff the line in Suriname, and the time difference from Europe makes it easier to cover overnight shifts.
Ms. Modiwirijo, the Agriculture Ministry official, said she was committed to addressing the problem, but was stretched thin. The pesticide division has broad oversight over pesticide imports and storage practices, but just four staff members. She stepped down from leading it in March, and a new director has not yet been selected.
Nonetheless, the ministry has initiated a study of alternative weed-control methods, and the suicide prevention center is working with local researchers to survey farmers about their current pesticide practices.
There is progress in other countries, where the stakes are even higher. In China, the suicide death rate fell 60 percent from 2006 to 2018 as it successively banned various pesticides; the country banned paraquat in 2020. In 2023, India banned monocrotophos, one of the most hazardous products still on the market, but paraquat is still allowed. Last December, Nepal banned paraquat and two other pesticides, and Dr. Eddleston expects Pakistan and Bangladesh to ban paraquat this year.
Multilateral organizations are jumping in, too: In 2023, a consortium of countries and companies established a Global Alliance on Highly Hazardous Pesticides, and the United Nations adopted a resolution urging member states to join.
There is more work to do, Dr. Eddleston says, particularly in Africa, where there’s little reliable data about suicide or the substances involved.
It is not lost on him that there are implications for countries where other lethal technologies are widely available. For example, about 35 percent of Americans live in a household with a consumer object that is far more dangerous than paraquat.
“Pesticides are a perfect model for guns,” he said. In 2023, a record 27,300 Americans shot and killed themselves.
“You need to remove them from people’s houses. That’s politically impossible, but that’s where you need to work.”
If you are having thoughts of suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources. Go here for resources outside the United States.
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