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!

Pregnancy is often something women prepare for months in advance. They discuss nutrition, exercise, supplements, medical check-ups and what to expect as their bodies change. Menopause, however, rarely receives the same attention. It is often treated as a stage that women will simply reach one day and somehow manage along the way.

But menopause is also a major transition in a woman’s life, and being prepared for it can help make the experience easier to understand and manage.

Menopause itself is defined as the point when a woman has gone 12 consecutive months without a menstrual period. However, the transition usually begins earlier, during perimenopause, when changing hormone levels can lead to irregular periods, hot flashes, night sweats, sleep problems, mood changes and other symptoms. These changes can begin several years before menopause itself.

Preparation does not mean trying to prevent menopause or “balance” hormones before it happens. Most healthy women do not need supplements or hormones simply because menopause is approaching. Instead, preparation is about understanding what is happening and building a strong foundation for health.

What can women do before menopause?

Also read: At 58, She Mistook Memory Lapses For Menopause Brain Fog, But Tests Revealed Alzheimer’s Risk

Regular physical activity is one of the most useful habits to establish. Weight-bearing and resistance exercises can help maintain bone strength and muscle mass, which become increasingly important in midlife and beyond. Exercises that improve balance, coordination and proprioception, or the body’s awareness of its position and movement, can also support mobility and help reduce the risk of falls as women age.

Nutrition is equally important. A well-balanced diet should provide adequate protein along with essential vitamins and minerals. Calcium and vitamin D are particularly important for bone health, while a varied diet rich in vegetables, fruits, whole grains, pulses, nuts and other nutrient-dense foods can support overall health. Maintaining a healthy weight is also beneficial during this transition.

It is equally important to pay attention to cardiovascular and metabolic health. Regular checks of blood pressure, cholesterol and blood sugar can help identify common non-communicable diseases early. Avoiding smoking, staying physically active and maintaining healthy lifestyle habits can also support long-term health.

Preventive healthcare should not be overlooked either. As women enter midlife, keeping up with age-appropriate cancer screenings and routine health check-ups becomes an important part of looking after their health. The appropriate screening schedule can vary depending on age, family history, personal risk factors and local guidelines, so these should be discussed with a healthcare provider.

Just as importantly, women should become familiar with their own symptoms. Changes in periods, sleep, mood, body temperature, sexual health or concentration should not automatically be dismissed as “just ageing.” Keeping track of symptoms can help women recognise patterns and have more productive conversations with their healthcare provider.

Medical support is also an important part of preparation. Not every woman will experience menopause in the same way, and treatment is not automatically necessary. However, when symptoms begin to interfere with sleep, work, relationships or everyday life, hormonal and non-hormonal treatment options can be discussed with a doctor.

Perhaps the biggest change we need is in how we talk about menopause. It is not an illness, nor is it something women should simply suffer through in silence. It is a natural stage of life, but that does not mean its symptoms or its wider effects on health should be ignored.

Preparing for menopause is ultimately less about predicting exactly what will happen and more about entering this stage with knowledge, healthy habits and access to the right medical support. Women spend years preparing for major changes in their bodies. Menopause deserves that same attention.

By Dr Ponny M S, Consultant - Gynaecologist & Laparoscopic Surgeon, Apollo Adlux Hospital, Keralam

Delhi's air quality deteriorated sharply after Diwali celebrations, with several monitoring stations recording 'Severe' pollution levels on Monday, November 9. As firecracker emissions added to the city's existing pollution burden, concerns are mounting over the impact of toxic air on children's respiratory health.

For children, prolonged exposure to polluted air can be particularly concerning. What may initially appear to be a seasonal cough or minor throat irritation could become more serious if coughing persists or is accompanied by wheezing and breathlessness. Children with asthma or other respiratory conditions may be especially vulnerable, as poor air quality can aggravate their existing symptoms.

But how can parents distinguish a routine cough from a warning sign of respiratory distress? When should they seek medical attention, and what precautions can help protect children? HealthandMe spoke to pulmonologists to understand the symptoms parents should watch for and when to worry.

How Should Parents Respond If A Child Develops Coughing Or Wheezing?

Also read: Delhi AQI Crosses 2,000 Mark After Diwali: What Happens To Your Body Within Hours Of Exposure?

If a child develops a cough or wheezing, the first step is to minimise further exposure to polluted air.

Dr Nikhil Rajvanshi, Consultant – Pediatric Pulmonologist, Allergy and Sleep Specialist at Rainbow Children's Hospital, Delhi, advises parents to avoid outdoor play, running and strenuous physical activity when AQI levels are high.

Parents should also keep windows closed during peak pollution periods, use a HEPA air purifier if available, and ensure children wear a well-fitted N95 mask if they are old enough to tolerate it safely.

For children with diagnosed respiratory conditions such as asthma, following their prescribed treatment plan is important.

"If the child has a diagnosed respiratory condition such as asthma, parents should follow the prescribed action plan and administer inhalers or nebulisation only as advised by their doctor. Inhaled medication should never be started or discontinued without medical guidance," Dr Rajvanshi told HealthandMe.

He also cautioned against routinely giving children antibiotics or over-the-counter cough and cold medicines without consulting a paediatrician.

Warning Signs Of Breathing Trouble Parents Should Not Ignore

A cough does not always indicate a serious respiratory problem, but certain symptoms need prompt medical assessment.

Dr Rajvanshi said parents should watch for:

• Rapid or laboured breathing.
• Visible pulling in of the chest or ribs while breathing.
• Flaring of the nostrils.
• Persistent wheezing.
• Difficulty speaking or feeding because of breathlessness.
• Unusual drowsiness.
• Bluish or grey discolouration of the lips or tongue.

A child who is struggling to breathe, has pauses in breathing or develops bluish lips needs emergency medical care. Infants below three months with a temperature of 38°C or higher also require prompt medical assessment.

Read More: Delhi Becomes World's Most Polluted City Ahead Of Diwali, Says Swiss Agency: Experts Recommend Precautions

Coughing Or Wheezing: How Can Parents Tell The Difference?

One important distinction parents should understand is that wheezing is not simply another form of coughing.

Dr Rajvanshi explained that wheezing is a whistling sound, usually heard while breathing out, and may indicate narrowing of the airways.

Recurrent wheezing, night-time coughing or coughing that worsens during physical activity should be evaluated by a paediatrician rather than dismissed as a seasonal cough.

He also emphasised that good nutrition can support a child's general immunity but cannot replace appropriate respiratory treatment. Reducing pollution exposure, recognising symptoms early and seeking timely medical attention remain important.

How Can Families Protect Themselves From Poor Air Quality?

Dr Kuldeep Kumar Grover, Associate Director – Pulmonology and Critical Care at CK Birla Hospital, Gurgaon, said an appropriately fitted N95 or FFP2 respirator offers better protection against fine particulate matter than a cloth or surgical mask.

However, the mask must fit snugly around the nose and mouth, without gaps.

He advised people to avoid outdoor running, brisk walking, cycling and strenuous exercise during periods of high pollution, as increased breathing rates can lead to greater inhalation of pollutants.

Children, older adults, pregnant women and people with asthma, COPD or heart disease should be particularly cautious and minimise prolonged outdoor exposure.

At home, families should keep windows and doors closed when outdoor pollution is high, use a HEPA air purifier where possible, and maintain good indoor ventilation when outdoor air quality improves.

People with asthma or other chronic respiratory conditions should continue their prescribed medication and keep their rescue inhalers accessible.

"Anyone experiencing severe breathing difficulty or chest pain should seek immediate medical attention," Dr Grover told HealthandMe.

He added that air pollution can affect even healthy individuals, so precautions should not be limited to those with pre-existing respiratory conditions.

"The objective is not to stop stepping outdoors altogether, but to make informed decisions about when, where and how long we expose ourselves to polluted air," he said.

Delhi's air quality took a nosedive after Diwali celebrations on Sunday. Smoke from firecrackers contributed to the already soaring pollution across the national capital.

Some real-time air-quality platforms reported readings above 1,000, while some claims of levels crossing 2,000 also surfaced . Meanwhile, the city's official Central Pollution Control Board (CPCB) AQI reached the 'severe' category at several monitoring stations.

India's official AQI scale runs from 0 to 500. Anything above 400 is classified as severe. A reading above 2,000 was reported by independent real-time air quality platforms.

The staggering AQI has sparked numerous health concerns among those who are continuously exposed to the toxic air. Exposure to high concentrations of fine particulate matter like PM2.5 can trigger a number of health issues including respiratory and cardiovascular effects within a matter of hours. The effects may linger even after a person returns indoors.

What Happens Within The First Few Hours Of Exposure?

Also read: Delhi Becomes World's Most Polluted City Ahead Of Diwali, Says Swiss Agency: Experts Recommend Precautions

PM2.5 refers to particles measuring 2.5 micrometres or smaller. Because of their miniscule size, they can traverse deep into the lungs. Some particles can even enter the bloodstream.

According to the World Health Organization (WHO), these particles can affect multiple organs and increase the risk of respiratory and cardiovascular diseases. Within hours of exposure, people may experience:

• Irritation of the eyes, nose and throat
• Coughing, wheezing and shortness of breath
• Chest tightness or discomfort
• Worsening of asthma and other existing respiratory conditions

The UK's Department of Health and Social Care notes that symptoms of short-term air pollution exposure can start within hours or several days. People with asthma, chronic obstructive pulmonary disease (COPD) and heart conditions are vulnerable to such high concentrations of particulate matter.

The effects of polluted air are not restricted to the lungs. Fine particles can trigger oxidative stress and inflammation, potentially affecting blood vessel function and the cardiovascular system.

Experts say that that exposure to PM2.5 can affect heart rate regulation and blood vessel function within six hours.

Dr Viny Kantroo, Senior Consultant, Respiratory Medicine, Critical Care & Sleep Medicine Indraprastha Apollo Hospital, New Delhi, told HealthandMe, "Short-term exposure to high levels of particulate pollution can increase the risk of heart attacks and strokes. Fine particles can enter the bloodstream and contribute to inflammation, affect blood vessel function and increase the tendency for blood clots to form. The risk is higher in people with hypertension, diabetes or existing heart disease."

Effects Continue After You Return Home

Also read: Pregnant During Peak Pollution? A Trimester-Wise Guide to Safer Festive Celebrations

Inflammatory responses may continue even after exposure stops. It also depends on the pollution concentration, duration of exposure and an individual's underlying health.

Moving indoors reduces further exposure, but it does not instantly reverse the damages triggered by pollutants that you have already inhaled.

Airway inflammation and increased sensitivity can last for days, depending on the intensity and duration of exposure. People may continue to experience coughing, wheezing or breathing issues after leaving a polluted environment.

The US Environmental Protection Agency also notes that short-term particle pollution exposure can aggravate asthma and bronchitis and is also linked with cardiovascular events, including heart attacks and strokes, especially among people with existing heart disease.

How To Reduce Exposure After Diwali?

During severe pollution days, avoid outdoor exercise and avoid stepping out. If going outdoors is unavoidable, use a well-fitting N95 or N99 respirator rather than a cloth or surgical mask.

Dr Kantroo advised, "During severe pollution, they should avoid strenuous outdoor activity and continue their prescribed medicines."

At home, keep windows closed when outdoor pollution is high and use a properly sized HEPA air purifier, if available. Avoid adding to indoor pollution through incense, candles, mosquito coils or smoking.

People with asthma or other chronic conditions should follow their prescribed treatment plans. Seek medical attention for breathing difficulty, chest pain or worsening symptoms. Severe breathlessness or chest pain need urgent medical care.