Community risk perceptions and recommendations for drowning prevention: A qualitative study across West Bengal, India

Drowning is a leading cause of injury-related mortality worldwide, with disproportionate impacts on low- and middle-income countries. West Bengal, India, is characterized by extensive exposure to natural water bodies and marked regional and urban-rural heterogeneity. There is limited research on community risk perceptions and contextual drivers of drowning in this area, which constrains the design of effective prevention strategies. This qualitative study applied a phenomenological approach and conducted 46 focus group discussions involving a total of 339 participants from urban and rural communities across all 23 districts of West Bengal. Districts were selected based on recent drowning incidents. Adult residents were purposively sampled with support from local humanitarian organization. Data collection combined semi-structured interviews in local language, audio recording, and thematic analysis, iteratively coded to saturation using NVivo software. Four major themes emerged: (1) infrastructure and risk varies between urban and rural regions for instance differences in use and type of water sources, healthcare access and community connectedness; (2) Community awareness of population vulnerability, environmental risks, and other contextual exposures to drowning were identified where children, elderly, domestic migrant workers and non-swimmers were found to be vulnerable; (3) Adaptive response to threat through prevention, accessibility and rescue methods included informal rescue, reliance on traditional beliefs and expressions of fatalism; (4) Community recommendations based on lived experiences and risk perception of drowning were focused on fencing water bodies, enhancing childcare programs, strengthening medical infrastructure and providing swimming instruction. Infrastructure gaps and climate variability further heighten drowning risks in particularly exposed regions and households. Community risk perceptions underscore urgent priorities for drowning prevention in West Bengal. While findings are consistent across districts, intervention priorities vary according to regional needs.Strategies should strengthen supervision, physical barriers, childcare, water safety education, and access to critical care, informed by local perceptions and practices.