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!

Turns out, kidney disease is not just a ‘kidney’ problem anymore, it can, in fact, affect other organs, and could even be linked to other chronic conditions, revealed a recent study.

In the US, more than 1 in 7 adults are affected by chronic kidney disease or (CKD). This means that 35.5 million Americans are affected by it, and what makes it worse is that 9 out of 10 people do not even know they have CKD, says the Centers for Disease Control and Prevention (CDC). Amid all these numbers thrown on to, something more concerning lies. A recent Lancet study shows a link between the rise in CKD and other chronic diseases. We are talking about chronic conditions like diabetes, high blood pressure, and obesity.

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So, What Does The Study Say?

The researcher saw that 14 percent of adults who are over the age 20 or older, which makes 788 million Americans who had CKD in 2022. The biggest problem is not the disease itself, but the unawareness. Doctors, experts, and researchers from time and again have pointed out how kidney disease is often asymptomatic, this is why it is ignored until it becomes advanced. However, at that point the patients could already need dialysis or even an organ transplant. This gap in early diagnosis and treatment is what has made CKD the ninth leading reason of death, worldwide.

When you kidney functions naturally, it works as the powerhouse of filtration. A pair of healthy kidneys are able to filter and process more than 150 liters of fluid from the blood. These organs are also responsible for filtering out the waste and toxins through your urine. Not just that, but your kidneys also help in red blood cells production that keeps you healthy. When all of that does not happen, it can eventually impact every other organ in your body.

Like they say, everything is connected, and it surely is. For instance, somewhere around 20% of the blood that your heart pumps goes to your kidneys. If someone has diabetes and high blood pressure, it could damage the blood vessels and lead to protein in the urine and a slower filtration rate. It can then lead to other chronic infections, autoimmune disorders, and even genetic variants.

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Kidney-Body Relation

If you leave your kidney disease untreated, it could lead to kidney failure. This is when you would be more in need of dialysis or a transplant. Doctors have pointed out that most people do not die of chronic kidney disease, rather it impacts their quality of life, worsening their cardiovascular conditions. It can lead to complications like a heart attack, a stroke, or a heart failure.

How Does This Happen?

People who have kidney diseases are at an increased risk for high blood pressure. Due to hurdles in the process of filtration, plaque build ups and hardens the arteries. This in return increases stress on the heart. In fact, the American Heart Association also defined the link between kidney and heart as 'cardiovascular-kidney metabolic syndrome'. This defines a health disorder that is a condition of the overlap of obesity, chronic kidney disease and cardiovascular diseases.

The bleed out of CKD is not just limited to your heart. The National Institute of Health, US points out that along with heart complications and high blood pressure, CKD could also lead to anemia, mineral and bone disorder, metabolic acidosis, malnutrition, and electrolyte imbalances in the blood.

So, What Is The Best Way To Keep Yourself Safe?

The first way is to note any symptoms and get yourself diagnosed. Look for signs like loss of appetite, unexplained nausea or vomiting. Do you feel tired often? Are you having trouble concentrating? Is there any change in how often you go pee?

Other symptoms like a change in your urine color or texture, or feeling itchy or dry, muscle cramps, unexplained weight loss or skin conditions could also signal towards kidney diseases.

However, not always does CKD show symptoms, experts suggest that to be one step ahead, it is important to undergo regular health checkups, including blood culture. General guidelines usually point towards getting a blood test done every 3 to 6 months. For someone with high blood pressure, diabetes or any other disease, the current guidelines say that those people should get regular blood and urine tests to screen for kidney disease. But what really happens is that though these tests exist, they are still used far too little. Doctors point out that many patients skip them because collecting a urine sample feels inconvenient, and overall awareness about kidney disease remains low. As a result, research shows that only about 35 percent of people with diabetes, and just 4 percent of those with high blood pressure, actually end up getting the recommended urine screening.

A ray of hope is that there are now several effective tools to slow the progression of kidney disease. Along with traditional options like ACE inhibitors, newer classes of medications including certain heart failure drugs and GLP-1 drugs. These medicines have shown to help protect kidney function. Although these newer treatments are not widely used yet, their adoption is steadily increasing.

What is important to remember is to also always consult your GP to ensure all preventative measures are followed carefully.

In 2022, the National AIDS Control Organisation (NACO) of India published the National Technical Guidelines for PrEP pr the pre-exposure prophylaxis (PrEP), a medicine that reduces the risk of HIV infection. It has been four years since then and the access still remains limited. It was called a novel strategy to deal with HIV, however, there not has been public rollout and government too has not distributed it. This means awareness remain low and the cost is too high for everyone to afford it. PrEP is available for Rs 2,200 to Rs. 3,000 a month in private markets and at subsidized rates in just a few handful of non-profits that too in select cities.

HIV was first identified in 1986 in India, since then the country has made gradual progress in controlling the disease. As per the Sankalak, Status of National AIDS and STD Response Report 2024, released by NACO, HIV prevalence among adults, which is considered between 15 to 49 years was 0.20 per cent. This represented a 44 per cent decline since 2010.

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However, the prevalence and incidence remain high in vulnerable populations. While the incidence in general population was 0.05 per 1,000 uninfected persons in 2023, men who have sex with men (MSM) see an incidence of 1.55, Hijra/Transgender persons (HTG) have 2.76, and female sex workers (FSW) are at 3.33. This means that nearly a million of FSWs, 350,000 MSM and 96,000 HTGs have the disease. A report from India Spend notes that it is not an actual headcount, but an estimation, which represents that the real number could be more than that.

How Does PrEP Work?

HIV spreads in the human body by targeting and infecting T cells or the critical white blood cells of our immune system. PrEP blocks HIV from replicating inside T cells after exposure. It stops the infection from taking hold. PrEP has also come in form of oral pill which could reduce the chances of contracting HIV through sexual contact or injection drug use.

Studies have documented a sharp fall in HIV infections in communities where Pre-Exposure Prophylaxis (PrEP) is widely used. In Australia, a study involving more than 62,000 people found that government-subsidized oral PrEP helped reduce new HIV cases by 78% among men who took the medication for at least 60% of days between 2018 and 2023. PrEP works best when taken daily, lowering the risk of HIV transmission through sex by over 99% and by more than 74% through infected needles. It can be stopped when a person is no longer engaged in high-risk activities such as having multiple sexual partners or injecting drugs.

Last year, the United States Food and Drug Administration (FDA) approved twice-yearly injectable PrEP, lenacapavir. The World Health Organization recommended for a fast rollout. Maker Gilead Sciences signed agreements with generic manufacturers, including Dr Reddy’s Laboratories, to make the jab available in 120 low- and middle-income countries at lower cost.

Amid this, Zimbabwe become the first African country to roll out the breakthrough injection, while Japan approved the pill version made by Gilead Sciences - Truvada.

From childhood, many girls are taught to be agreeable, responsible and perfect in everything they do. They are praised for being obedient, hardworking and emotionally controlled. Over time, this expectation can shape behavior in ways that may quietly harm mental and physical health.

This pattern is often referred to as “Good Girl Syndrome”. While it is not a formal medical diagnosis, doctors say the effects of constantly trying to live up to expectations can be very real. The pressure to appear composed and capable all the time can lead to emotional suppression, chronic stress and eventually hormonal disturbances.

To understand how this pressure affects the body, NDTV Health spoke with Dr. Y. D. Meherprasad, Senior Consultant in Endocrinology and Preventive Healthcare at MGM Malar Hospital, Chennai, who says he has observed this pattern among many young women in his clinical practice.

The Hidden Stress Behind Perfection

Good Girl Syndrome describes a behavioral pattern where individuals, often women, feel compelled to meet expectations without showing weakness or stress. This can translate into people pleasing behaviour, fear of conflict and difficulty setting boundaries.

Dr. Meherprasad explains that constantly trying to maintain this image can create a persistent stress response in the body.

“Hormonal imbalances are being noticed in young Indian women associated with the Good Girl Syndrome, where women are always trying to meet expectations and are continuously successful, all without showing any signs of stress,” he told NDTV Health.

According to him, the problem arises when emotions are suppressed for long periods. “When women suppress emotions for long periods, the body remains in a state of constant stress response,” he said.

Emerging research in the field of psychoneuroendocrinology suggests that emotional stress can directly influence hormonal regulation in the body.

The Cortisol Connection

At the centre of this process is cortisol, the body’s main stress hormone. Normally, cortisol rises briefly during stressful situations and then returns to normal levels once the threat passes.

However, when stress becomes constant, cortisol levels can remain elevated for long periods.

Studies have shown that chronic high cortisol can disrupt reproductive hormones. One effect described in research is sometimes called “progesterone steal,” where the body prioritizes producing stress hormones instead of reproductive hormones.

Low progesterone levels can contribute to irregular menstrual cycles, acne and other hormonal symptoms that many young women experience.

Stress, Insulin Resistance And PCOS

Dr. Meherprasad says chronic stress may also contribute to metabolic changes. In some cases, it can mimic or worsen conditions such as Polycystic Ovary Syndrome (PCOS).

When cortisol levels remain high, the body releases more glucose into the bloodstream to provide energy for a perceived threat. If that energy is not used through physical activity, insulin levels rise to regulate blood sugar.

Over time, this can lead to insulin resistance, which is a key factor associated with PCOS. Women may experience abdominal weight gain, irregular ovulation and difficulty managing their weight.

Warning Signs The Body May Be Struggling

The effects of prolonged stress do not appear overnight. They often show up gradually through subtle changes in the body.

Dr. Meherprasad says menstrual irregularities are one of the early warning signs. Some women may experience delayed cycles or even a temporary halt in ovulation.

Sleep disturbances are also common. Many women report difficulty falling asleep because their minds remain constantly active, leading to fatigue the next day.

Other symptoms may include mood swings, persistent anxiety, brain fog and difficulty losing weight despite maintaining a careful diet.

Restoring Balance

Dr. Meherprasad says addressing these hormonal issues requires both medical evaluation and lifestyle changes.

Regular hormone screenings can help detect issues related to thyroid function, insulin levels and reproductive hormones such as LH and FSH. Early treatment is important if conditions such as PCOS or thyroid dysfunction are present.

Equally important is addressing the emotional component of chronic stress.

“Hormonal imbalance is not only physical but also closely linked to emotional health,” said the doctor.

He recommends prioritizing adequate sleep, regular physical activity and practices such as yoga that help calm the body’s stress response. Creating space for emotional expression through journaling or therapy can also help reduce long term stress.

In a culture that often rewards perfection, doctors say it may be time to rethink the idea of the “perfect girl”. Sometimes, protecting one’s health begins with allowing space for imperfection.