A report by Swachh Bharat Mission says that 74.5 per cent of public places are equipped with toilets. Another report by the Ministry of Jal Shakti states that there are 2.23 lakh Community Sanitary Complexes built across all States and UTs under the Swachh Bharat Mission (SBM) since October 2014. Over 92 lakh toilets have been constructed since the launch of SBM Gramin (SBM (G)) in April 2020.

While toilets are there, are they accessible? This is the question one should ask. The National Family Health Survey (NFHS) focuses on 131 health indicators, but not until the NFHS 5 survey did they include the question of accessibility of toilets in the survey. This happened after the inputs from the Department of Drinking Water and Sanitation (DDWS) and the Ministry of Health & Family Welfare questioned the accessibility.

One might ask, why is the question of accessibility so important? The answer is quite simple. Access to water, sanitation and hygiene is the most basic human need and is also included under the Sustainable Development Goals by the UN.

Are These Numbers Real?

This thought crossed my mind because back in 2021, I went on a solo trip, on a bus to Udaipur from Delhi. There, the bus made two stoppages. This was done so people could get a quick dinner and freshen up, relieve themselves and be prepared for the rest of the journey. This was a nightmare. The bus only stopped for 10 minutes. While some men used the washroom, others went to the bushes.

For the women, there were three cubicles. One of them was broken, and the other one did not have a light bulb, which meant only one was usable. There was a long queue for that cubicle, and time was short. There was no point in trying to find an isolated corner, because it was past midnight, in an unknown area.

I waited anxiously. When finally, my turn came, I saw an overused, dirty washroom. The toilet seat is in a horrible condition. I wanted to touch nothing there. But I had to pee. So, I used my mask to cover my nose from the odour, folded my pants so they did not touch the floor and squatted. It was quite a task to balance.

On my way back to Delhi, I made sure to not drink any water for over a 13-hour bus journey. I dehydrated myself so I did not have to use the washroom. When I did reach, I was severely dehydrated and was sick for three days.

I shared my experience with my friends only to realise that many women have faced the same. There are no washrooms for women.

A friend of mine told me that it is because these roads and dhabas are mainly designed to serve men. They are the ones who travel at night or are on the roads most of the time. As a result, the few women who do travel or are on the road suffer.

Health Risks Women Are Prone To

Well, it is true, but partially. While holding your pee for too long can lead to health risks, peeing on a dirty toilet seat cannot lead to infections unless your urethra is in contact with the bacteria present on that toilet seat. However, nobody wants to sit on a dirty toilet seat, even if you do not get an infection. A safe and hygienic toilet is a basic need.

One of the regular saleswomen, Usha, who visits my house shared her experience with me. “Being on the road constantly means I must use the dirty public washrooms. But I do not want to use them. So, sometimes I ask my regular customers to let me use their washrooms. Some say yes, and some say no. I understand they are also concerned about their safety and privacy,” she says. As a result, Usha spends most of her day not drinking enough water and holding her pee when she is at work. Due to this, she also suffered from a Urinary Tract Infection (UTI).

Her friend, Halima too faced similar problems and due to increased levels of uric acid in her body, she suffered from Hyperuricemia.

Other health risks are kidney stones and other kidney problems, headaches, dull skin, xerostomia or dry mouth, fatigue, and urinary incontinence, which means losing control over your pelvic floor muscles leading to uncontrolled leakage of urine, seizures and weakness.

What Can You Do?

Wear comfortable clothes and capris. Capri pants are comfortable and are short in length, which means this won’t touch the toilet floor when you squat or sit.

Carry Essentials

Even though you cannot get a UTI alone from sitting on a toilet seat, it is always safe to carry a toilet seat sanitiser. If nothing, it can help you get rid of the bad odour so you can use your stand and pee device inside the toilet. You can also use disposable toilet seat covers if your knees are weak, and you cannot squat. Always flush with your seat down.

Always keep disposable gloves, a portable bidet (fill it with water before use), a pocket liquid handwash, wet wipes, tissues and sanitiser handy. Do not forget to keep extra sanitary pads. It might sound a lot, but I promise that it all fits in one pouch. Use this travel-friendly pouch every time you are on the road, or using a public washroom.

What Can We Learn From Others?

However, in case we do not get these technologically advanced toilets here, you can always pack a travel-friendly toilet kit!

Amid the growing burden of hypertension and related heart disease in India, a team of experts has suggested switching to potassium-enriched low-sodium salt substitutes (LSSS).

In India, more than 1 in 4 people have hypertension, and cumulatively, more than 90 per cent of adults with hypertension are either undiagnosed, untreated, or treated but live with uncontrolled hypertension. This burden needs to be tackled on an urgent basis

In view of this, experts from clinical medicine, public health, and nutrition released a consensus statement recommending potassium-enriched LSSS as an effective intervention to reduce hypertension and cardiovascular disease in India.

Current estimates show that Indians consume between 8 and 11 grams of salt (equivalent to 3.2–4.4 grams of sodium) per day, nearly double the WHO’s recommended limit of 5 grams (2 grams of sodium).

High sodium intake is a key driver of elevated blood pressure. At the same time, potassium plays a complementary role by helping counteract sodium’s effects—yet potassium intake in India remains below optimal levels.

With nearly 80 per cent of sodium intake in India coming from salt added during cooking at the household level, experts emphasized that interventions focused on reducing salt use at home can have the greatest impact.

“High-quality research shows India’s high sodium and low potassium intake is a key driver of hypertension and cardiovascular disease. Low-sodium salt substitutes address both—cutting sodium and restoring potassium, which is key to lowering blood pressure. With no change in taste and appropriate safeguards, this is a safe, scalable solution for India’s NCD prevention strategy,” Prof. Vivekanand Jha, Executive Director of The George Institute for Global Health India.

What Is A Low-sodium Salt Substitute? How Can It Boost Heart Health?

The low-sodium salt substitutes are composed of approximately 70–75 per cent sodium chloride and 25–30 per cent potassium chloride. It reduces sodium intake while increasing potassium consumption, thereby helping to lower blood pressure and reduce cardiovascular risk.

The World Health Organization (WHO), in January 2025, released guidelines recommending potassium-enriched salt to combat hypertension and related heart risks.

The WHO's guideline suggests using K-salt or potassium chloride instead of regular table salt, rich in sodium. It may reduce noncommunicable diseases (NCDs) such as cardiovascular diseases (CVDs) and chronic kidney disease by lowering blood pressure.

Also read: Two Potassium-Rich Foods That Could Lower Blood Pressure Better Than Cutting Salt

It also lowers the risks of other conditions associated with high sodium intake, such as gastric cancer. As per the WHO, every year 80 Lakh people die due to poor diet. Of these, 19 lakh deaths are attributable to high sodium intake.

These alternative salts contain less sodium than regular salt and often include potassium chloride (KCl), with or without other agents, to achieve a flavor similar to regular salt.

Evidence shows potassium - enriched low-sodium salt substitutes are a practical, effective, and scalable solution. The new consensus also marks an important shift from evidence to action, aligned with the Government of India’s commitment to reduce population-level salt intake.

India has committed to a global goal of reducing the average population level sodium intake by 30 per cent by 2030 to help prevent and control non-communicable diseases (NCDs).

Is Potassium Salt Safe?

While the WHO guidelines urged people to partially replace table salt with potassium, concerns have been raised about the safety of LSSS that contain potassium, because too high a level of blood potassium (hyperkalemia) may be harmful, especially to individuals with impaired kidney function.

Experts noted that potassium is safe for most people, including many with early-stage kidney disease, but maintained that caution is primarily necessary for individuals with advanced stages of kidney disease or when potassium levels are already high.

"While we have enough scientific data supporting the benefits of Low-Sodium Salt Substitutes, the evidence-to-action gap must be closed by treating LSSS as a ' dietary vaccine' to treat hypertension. It is the 'low-hanging fruit' of cardiology, a passive intervention that provides 24/7 cardiovascular protection without requiring patients to actually sacrifice the taste of their traditional diet," said Prof. Ambuj Roy, Department of Cardiology, AIIMS, New Delhi.

Also read: Pink Salt vs White Salt: What Difference Does It Make?

Dr. Sandeep Mahajan, Professor, Nephrology, AIIMS, New Delhi, added, “The potential risks of low-sodium salt substitutes are often overstated relative to their population-level benefits. While a small subset of patients—particularly those with advanced kidney disease or on specific medications—require caution, this group is clearly identifiable and can be guided through simple screening and labelling measures".

The expert noted that "nearly 90 per cent of the population can safely benefit from this intervention".

The Consensus recommends priority actions such as:

• Policy integration: Include potassium-enriched LSSS in national sodium reduction strategies, hypertension and NCD guidelines, and update FSSAI standards to enable the safe, widespread use of potassium-enriched LSSS as edible salt.

• Focus on everyday use: Prioritise replacing regular salt with potassium-enriched LSSS in homes and in government nutrition programmes and institutional kitchens, while requiring food industry reformulation to use potassium-enriched LSSS in high salt packaged foods and restaurant meals.

Every month, millions of women endure painful periods and convince themselves that it is normal. However, the statistics tell a different story. Endometriosis affects about 247 million women worldwide, and nearly 42 million of those are in India alone. Yet, most of them suffer in silence for years before they get diagnosed.

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, on the ovaries, fallopian tubes, bowel, or nearby pelvic areas. India accounts for nearly 25% of the global burden of this condition. Even with this staggering number, it remains one of the most underdiagnosed issues in women’s health.

When Is Period Pain "Too Much"?

- Pain severe enough to disrupt daily activities, work, or school

- Cramping that starts days before your period and continues after it ends

- Pain during or after intercourse

- Painful bowel movements or urination around your cycle

- Heavy or irregular bleeding

- Unexplained fatigue, bloating, or lower back pain

These are your body's warnings, not signs of weakness or something to just endure.

The Cost of Waiting

The statistics on diagnostic delays are alarming. On average, there is a 7 to 9-year delay between the first symptoms and a confirmed endometriosis diagnosis worldwide. Endometriosis affects 10–15% of all women of reproductive age and up to 70% of women with chronic pelvic pain, yet many spend nearly a decade seeing multiple doctors before anyone identifies the true cause.

This delay leads to serious consequences. The monthly natural conception rate in women with endometriosis drops to just 2–10%, compared to 20% in women without the condition. Longer delays are directly linked to more severe disease, greater psychological distress, and tougher fertility challenges.

Listen to Your Body

Too many women come to me after years of being told their pain is normal. By the time they reach us, many are already dealing with advanced-stage disease.

Your pain is real, and it deserves a real answer. Do not wait, consult a specialist. Early diagnosis truly changes everything.

If your periods are affecting your quality of life, your body is asking you to listen. The sooner you seek help, the better your outcomes. Consult a specialist today. Take the first step towards a pain-free life.

India, which carries the world's second-largest population of hemophilia cases—a genetic blood disorder—must shift towards prophylaxis care for the bleeding disorder, said health experts today on the occasion of World Hemophilia Day.

World Hemophilia Day is observed every year on April 17 to raise global awareness of hemophilia and other inherited bleeding disorders.

This year’s theme of “Diagnosis: First step to care” highlights the critical importance of diagnosis—the essential first step in treatment and care.

According to the World Federation of Hemophilia (WFH), 75 percent of people suffer from hemophilia, without even knowing it, simply because they don’t have access to basic healthcare.

What Is Hemophilia?

Hemophilia is a rare bleeding disorder where blood does not clot properly, even for minor injuries. It is caused by an error in a specific gene on the X chromosome, leading to a deficiency or absence of clotting factors.

While the condition mainly affects males, women are the genetic carriers. In people with hemophilia, the blood lacks sufficient clotting factors -- which are proteins essential for stopping bleeding.

Whether the bleeding is external, such as cuts, or internal, such as bleeding into joints or muscles, the blood does not clot. So, it can be a very serious disorder.

Without consistent care, repeated bleeding into joints can lead to

• chronic pain,
• deformity,
• loss of mobility.

Hemophilia is mainly of three types:

• Hemophilia A: This is the most common type. People with this condition have low levels of clotting factor 8 (factor VIII).
• Hemophilia B: People with this type don’t have enough clotting factor 9 (factor IX).
• Hemophilia C: Also known as factor 11 (factor XI) deficiency. It’s the least common type of hemophilia.

The Burden Of Hemophilia In India

Hemophilia A, the most common type, affects about 1 in 5,000 male births, underscoring the urgent need for improved detection and awareness.

Hemophilia B, on the other hand, is an X-linked genetic disorder affecting 1 in approximately 25,000 male births.

India bears a significant burden from Hemophilia A. Estimates suggest around 136,000 individuals are affected, but only a small fraction are diagnosed and registered due to unequal access to essential care.

Dr. Varun Kaul, Professor, Dept of Pediatrics, Guru Gobind Singh Medical College & Hospital, Faridkot, told HealthandMe that in India, systemic gaps, ranging from limited diagnostic access to unevenly distributed treatment centers, continue to restrict access to RRT, especially beyond metro cities.

In contrast, more than 50 per cent of persons with hemophilia globally benefit from regular replacement therapy (RRT) as the standard of care.

Routine replacement therapy (RRT), commonly known as prophylactic care or prophylaxis, is the standard treatment for severe hemophilia.

It involves the regular intravenous (IV) infusion of clotting factor concentrates to maintain factor levels above 1 per cent to prevent spontaneous bleeding, particularly into joints and muscles.

Need For Prophylaxis Care For Hemophilia

Most Indian patients currently rely on reactive, on-demand therapy to manage bleeds after they happen.

Dr. Kaul said that although this may help prevent the immediate crisis, it fails to stop the cumulative joint damage that often results in permanent disability.

“Providing regular, scheduled infusions to maintain sufficient clotting factor levels can prevent bleeds entirely, reducing annual bleed rates by 90 per cent and enabling a life free from chronic pain and constant fear of the next bleed,” Dr. Kaul said.

Some progress is visible, as States like Karnataka, Kerala, Jammu and Kashmir, to name a few, have pioneered state-sponsored RRT programs.

“It is now imperative to transition from mere crisis management toward implementing preventive care as a National Health priority,” Dr Kaul added.

Hemophilia: The Need To Focus On Women

Dr Rahul Bhargava, Principal Director & Chief - Hematology, Hemato-Oncology & Bone Marrow Transplant, Fortis Memorial Research Institute, Gurugram, stressed the importance of focusing the treatment on females.

"Carrier testing in hemophilia remains largely focused on affected males, while women who may be carriers are often not included in routine screening,” Dr Bhargava told HealthandMe.

As an X-linked inherited disorder, hemophilia can present in women with low clotting factor levels, leading to

• prolonged bleeding,
• heavy menstrual cycles,
• complications during surgery and childbirth.

Most of the cases remain undiagnosed until a clinical event occurs.

"Identifying carriers through timely testing enables appropriate counselling and informed reproductive decisions. It also supports early diagnosis in families and reduces the risk of severe bleeding complications in future generations,” the doctor said.

How To Manage Hemophilia?

Dr Tulika Seth, Professor of Haematology at All India Institute of Medical Sciences (AIIMS) in New Delhi, in a post on social media platform X, stressed the importance of testing for hemophilia.

"If a child gets prolonged bleeding from a minor cut or injury, or if there are spontaneous painful swellings in the joints after minor falls, or sometimes even by somebody holding the baby, or there's a lot of bruising, people should get the baby tested or the adult tested for hemophilia," Dr. Seth said.

She noted that in mild cases of hemophilia, sometimes a person may not be aware that they have a deficiency, and then when they go for a tooth extraction or any surgery, they may have a problem.

"So, it's important to know your family history, and if you've had any prolonged bleeding after any pain, then you should tell your doctor and get tested," the doctor said.

Dr Bhargava also called for a broader approach that includes women in screening programs to help strengthen prevention and long-term management of hemophilia across families.

Hemophilia management requires attention beyond hospital care to prevent long-term complications.

To reduce bleeding episodes, it is important to:

• regularly follow up,
• adhere to treatment,
• maintain joint health.

Other measures include

• safe physical activity,
• balanced nutrition,
• avoiding trauma

"Integrating medical treatment with lifestyle practices supports functional independence and improves overall disease control,” Dr. Bhargava told HealthandMe.