When 36-year-old Meenamma swallowed a small amount of herbicide after a fight with her husband, she did not expect it to kill her. “She just wanted me to realise how deeply she had been hurt,” recalled her husband, Venu. “She thought we would take her to a hospital and treat it.”

What neither Meenamma nor her family realised was that she had consumed paraquat dichloride, one of the world’s most toxic herbicides, banned in more than 70 countries and now at the centre of a growing debate in India. Paraquat has no antidote.

The family rushed her to a government health centre before transferring her nearly 100 kilometres to a tertiary hospital. For a brief period, there was hope. Then her kidneys began to fail, she developed breathing difficulties, and was moved to the intensive care unit. She died shortly afterwards.

For doctors, Meenamma’s story is tragically familiar. Even small quantities of paraquat can cause irreversible damage to the kidneys and lungs, and once symptoms begin to progress, treatment is largely supportive and survival is near impossible.

Meenamma’s death comes as the future of paraquat in India hangs in the balance. A committee of doctors and agricultural scientists has reportedly recommended a nationwide ban after reviewing evidence linking the herbicide to fatal poisoning, kidney failure, lung fibrosis and Parkinson’s disease. Industry groups, including CropLife India, however, have urged caution, arguing that a ban could increase cultivation costs and disrupt weed management, and instead favour stricter safeguards.

The debate raises a fundamental question: can a substance as hazardous as paraquat be made safe through regulation alone?

Regulations with regard to pesticides

In 2015, the Anupam Verma Committee reviewed pesticides banned or restricted elsewhere and recommended a regulatory approach for paraquat rather than a ban. Measures such as improved packaging, warning labels and training were expected to reduce harm while allowing farmers continued access to an effective herbicide.

On paper, the approach appears reasonable. In practice, however, the assumptions underlying it often break down.

Visits to pesticide retailers in Tamil Nadu revealed that paraquat products were labelled as “moderately hazardous”, despite the chemical’s well-documented lethality in cases of human exposure. Some products manufactured in northern India and sold in T.N. carried warnings only in Hindi and English, raising questions about whether safety information was accessible to all users.

Paraquat also remains available through online marketplaces and agricultural e-commerce platforms. In many cases, products can be purchased without any meaningful verification that the buyer is a trained applicator or even a farmer.

Even if every farmer received safety training, experts point out that many people exposed to paraquat are not the individuals who purchased it -- Meenamma, for instance, had not bought it. Family members may encounter improperly stored containers. Children may access bottles left within reach. Agricultural labourers hired for spraying may never see the original packaging or safety instructions.

This limitation becomes even more apparent in cases of accidental poisoning. Risk communication assumes that the person exposed to a chemical has received and understood safety information. Reality is often messier.

Across rural India, pesticides and herbicides are frequently sold in small quantities and repackaged into unlabelled bottles, plastic sachets or reused containers. In tropical climates, where temperatures routinely exceed safe limits for prolonged use of protective equipment, workers often spray chemicals without full personal protective gear. A report by Pesticide Action Network has documented how heat, cost and practicality, frequently undermine assumptions about safe pesticide use in low- and middle-income countries.

These realities have led some public health experts to question whether paraquat’s risks can ever be adequately managed outside controlled settings.

The costs we do not count

The stakes extend beyond fatal poisonings.

Paraquat’s immediate toxicity is well known. Less visible are its long-term consequences. Studies have linked exposure to chronic respiratory disease, progressive lung fibrosis, kidney injury and Parkinson’s disease, although many questions remain unanswered. Yet India has little data on the long-term health burden among agricultural workers repeatedly exposed to the herbicide.

Even the company Syngenta, who was the original manufacturer and patent holder has decided to stop making Paraquat soon because of its link to Parkinson’s disease.

This means discussions about paraquat often compare a known economic cost against an unknown health burden.

Industry groups argue that safer alternatives may increase cultivation costs, particularly for farmers facing labour shortages and rising wages. Yet the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) caution that decisions about highly hazardous pesticides should not be based solely on purchase price. A pesticide may appear inexpensive at the point of sale, but may impose costs through emergency medical care, disability, lost income, environmental contamination and the burdens borne by affected families and communities.

What would a ban do?

However, some countries have already phased it out. South Korea, which banned paraquat in 2011–12 after it became one of the country’s most common means of suicide, reported a substantial reduction (nearly half) in pesticide-related suicides. Researchers found that pesticide suicide mortality fell dramatically within two years while crop yields remained unaffected.

Similar reviews from Taiwan, China, Brazil and Thailand have found little evidence that paraquat bans resulted in the large-scale agricultural losses often predicted by opponents. A 2023 international review concluded that eliminating paraquat could save lives without reducing agricultural productivity.

These experiences raise an important question: if industry groups argue that India would face significant productivity losses or sharply increased cultivation costs after a ban, the responsibility should, arguably, be on them to demonstrate this with real-world evidence.

The politics of risk

The paraquat debate also illustrates what public health researchers describe as the commercial determinants of health—the ways commercial interests can shape how health risks are framed.

Industry representatives have argued that farmer suicides are primarily driven by debt, crop failures and agrarian distress, and that restricting pesticides will do little to address these underlying causes. Few would dispute the importance of these structural factors. However, evidence from suicide prevention research suggests that reducing access to highly lethal means can save lives even when the underlying causes of distress remain unchanged.

Addressing agrarian distress and restricting access to highly hazardous pesticides are therefore complementary interventions rather than competing ones.

The question before India

Paraquat’s continued popularity illustrates why the debate remains contentious.

On the outskirts of Vellore, farmer Kishore stood beside a field sprayed with paraquat two days earlier. The weeds that had covered the land were shrivelled and brown. “It works very well,” he said. “I just have to make sure it never falls on the crop itself, otherwise that will die too.”

For farmers, that effectiveness is precisely the attraction. For regulators, it is the challenge.

The question before the Centre is not whether paraquat works. Few dispute that it does. The question is whether a herbicide so toxic that a lidful can become a death sentence, so difficult to regulate in real-world conditions, and so widely available beyond the hands of trained users can ever be made safe enough to justify its continued use.

For families like Meenamma’s, where two children are now without a mother, the answer has already arrived.

(Those in distress may contact the Tele-MANAS helpline at 14416 or 1-800-891-4416 or the numbers listed here.)

(Dr. Christianez Ratna Kiruba is an internal medicine physician and a freelance health journalist based in Guwahati, Assam. christianezdennis@gmail.com; Bhawesh Jha is a project and policy officer with the University of Edinburgh. bhaweshk118@gmail.com)