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!

A 43-year-old mother from Northern Ireland got diagnosed with an exceptionally rare cancer after months of pain, continual bleeding and abdominal swelling. She said that these symptoms were initially and inaccurately attributed to perimenopause, anxiety and constipation.

Nicola Crymble’s symptoms started in 2024 after she had a copper intrauterine device (IUD) inserted. The bleeding and pain became so severe that she had the device removed while she was in Kenya doing mission work. “I was constantly bleeding, there was so much pain,” Crymble said.

However, her symptoms persisted even after she returned home. She said doctors initially suggested that perimenopause and anxiety could explain what she was experiencing.

By December 2024, Crymble had noticed a lump in her abdomen. It continued to grow, making everyday activities challenging. She said people even thought she was pregnant because of the swelling. She eventually went to hospital and underwent scans, which revealed a mass near her cervix. Doctors initially thought it might be a cyst.

Crymble Got Diagnosed With FATWO, A Rare Cancer

Also read: Dr Rachna Shroff: Indian-American Cancer Researcher Who Turned Her Diagnosis Into Advocacy

Crymble underwent major surgery in February 2025 to remove the tumour. She also chose to have her ovaries and fallopian tubes removed during the procedure. A month later, she received the diagnosis that she had female adnexal tumour of probable Wolffian origin, commonly known as FATWO.

The tumour is believed to develop from remnants of the Wolffian duct, an embryonic structure involved in the development of the reproductive and urinary systems. Although these structures usually regress during female development, residual tissue can sometimes pave the way for tumour growth.

FATWO is an exceptionally rare form of cancer. There are only around 150 documented cases recorded worldwide. While many FATWO tumours do not metastatize, some can behave aggressively. In Crymble’s case, the cancer later spread to her liver and vaginal vault, the upper part of the vaginal canal.

She experienced intense pain beneath her ribs before a scan revealed that the cancer had spread. Further surgery was ruled out because the tumour growths were too close to other organs.

Chemotherapy As Surgery Was Not An Option

With surgery no longer an option, Crymble and her doctors decided to proceed with chemotherapy. She began treatment on October 13, 2026, and is expected to undergo six rounds, one every three weeks.

The family is also looking for specialist advice because there is limited information available about the rare disease and the best way to treat it. Her husband, Andrew Crymble, said doctors had little experience with the condition.

“They've never seen it before, they don't know how to treat it,” he said, explaining why the family decided to share her story publicly. They hope it will reach researchers or doctors who may have more information about FATWO.

Crymble has stopped working and has found it difficult to maintain her usual family routines while undergoing treatment. The family is also seeking financial support after discovering that their life insurance coverage will not cover the treatment.

Also read: Amgen & AstraZeneca's New Treatment Combination Cuts Advanced Lung Cancer Death Risk By 58% In Trial

Symptoms That Warrant Immediate Attention

Perimenopause can cause changes in menstrual patterns, like irregular periods. But unexplained bleeding, stubborn abdominal pain, lump or unusual swelling should not automatically be attributed to hormonal changes without seeking medical intervention.

These symptoms can occur due to many causes, and they do not necessarily indicate cancer. But worsening or unusual symptoms demand medical assessment, especially when they do not improve or when new symptoms develop.

The effects of heatwaves, air pollution, noise and overall climate change may extend beyond physical health. According to a new report by the Earth–Brain–Health Commission published in Nature Mental Health recently, they can have a significant impact on mood, cognitive function and overall psychological wellbeing.

The commission warns that environmental changes are altering the conditions in which people live. It also talks about consequences for brain health and mental wellbeing. It also calls for mental health to become a consideration in climate policy, urban planning and environmental decision making, rather than being treated only after symptoms develop.

The findings are relevant to low and middle-income countries, where exposure to environmental hazards can overlap with greater socioeconomic problems like poverty and limited access to healthcare.

“Heat and heatwaves, air and noise pollution, extreme weather and compound events, urbanization, and the loss of green and blue spaces are associated with depression, anxiety, cognitive decline, and impaired emotional and behavioral functioning,” the commission states.

Effects Of Environmental Conditions On Brain

Also read: Lancet Study Finds Air Pollution & Chemical Exposures Could Add To South Asia's Diabetes & Heart Disease Burden

From biological changes like neuroinflammation, disruption of hormones and the body's internal clock to psychological stress and due to isolation and displacement, the commission identifies several ways through which environmental conditions may impact mental health.

Heat exposure is one of the gravest concerns in current times. Heatwaves can disrupt sleep and contribute to physiological stress, while air pollution can lead to cognitive decline. Noise pollution and stressful urban environments may fuel anxiety and depression.

These exposures are compounded by people’s standard of living. A person living in poorly ventilated housing, for example, may face heat, air pollution, financial hardship and limited access to healthcare at the same time. These combined problems can be difficult to measure by studying each exposure separately.

Who Is At Risk?

Also read: Rising AQI In Delhi-NCR: Doctors Warn Of Lung And Heart Risks As Pollution Builds

Children, older adults, people with disabilities and marginalised communities may face greater exposure to environmental hazards while having fewer resources and help to cope with them.

The commission also highlights low and middle-income countries and small island developing states. These populations may face significant environmental risks but remain underrepresented in research on climate change and mental health.

Dr Vivek Benegal, senior professor of psychiatry and former head of department at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, is among the commission's members. He said NIMHANS has been examining how climate change affects the human brain.

Benegal also pointed to a 2023 study conducted by researchers from NIMHANS and King's College London. The study found that even low levels of arsenic exposure, below World Health Organization thresholds, were associated with changes in brain structure and impaired cognitive abilities among children, adolescents and young adults.

Commission's Recommendations

The report recommends that governments should incorporate brain and mental health measures into environmental policies. Its recommendations include monitoring environmental exposures, identifying risks early in life, and designing healthier urban environments.

“The principal obstacles to action are organisational and financial rather than evidential,” the commission observes, noting that research cohorts, Earth-observation systems and environmental governance tools already exist but are often maintained separately.

COVID-19 vaccines were rolled out during the pandemic, so questions about their safety, how long they protect against infection and whether mRNA technology was tested for long enough continue to dominate public debate.

Dr Paul Offit, paediatrician and director of the Vaccine Education Center at Children’s Hospital of Philadelphia and former member of the CDC’s Advisory Committee on Immunization Practices, says many concerns overlook the the evidence collected before and after the vaccines were introduced.

In an interview with HealthandMe, Offit discussed how long COVID vaccine protection lasts, what scientists have learnt about rare side effects and why the technology behind mRNA vaccines was not as new as many people thought.

“I think it is probably the best studied vaccine in human history,” Offit said. He pointed to the large number of people who received them and the safety-monitoring systems used to look for adverse effects.

Why Are People Still Getting COVID After Vaccination?

Also read: EXCLUSIVE: Ex-CDC Vaccine Advisor Says Measles Outbreak Bigger Than Reported, Slams RFK Jr’s ‘No-See Evil’ Approach

The circulation of SARS-CoV-2, the virus that causes COVID-19, is sometimes used to argue that the vaccines do not work. Offit said this misunderstands the type of infection the virus causes and the protection vaccination offers.

“It’s a short incubation period mucosal infection,” he said. “So, vaccination or natural infection will protect you for about four to six months from mild to moderate disease, should protect you for longer against severe disease.”

He compared the future of COVID to influenza, saying that infections will continue even as vaccines help protect against serious illness.

“Even if everybody in the world were vaccinated every year, that virus would still circulate,” he said. “This virus is now with us forever.”

Offit said the goal of COVID vaccination is not necessarily to prevent every infection. It is to reduce the risk of hospitalisation and death, particularly among people most likely to develop severe disease.

“The goal of the vaccine is to keep you out of the hospital and to keep you from dying,” he said.

He said that people over 75, those with chronic heart or lung disease, pregnant women and people with weakened immune systems are at higher risk of developing severe complications from COVID. He said these groups should receive a vaccine every year.

Dr Paul Offit On COVID Vaccine’s Side Effects

Also read: American COVID Drives Cases And Deaths In UK: Unusual XFG Symptoms To Watch For

When COVID vaccines were first authorised in December 2020, the clinical trials involved approximately 35,000 participants across the Pfizer-BioNTech and Moderna studies, Offit said. Some rare side effects of the vaccine became apparent only after the vaccines were administered to much larger populations.

One such side effect was myocarditis, an inflammation of the heart muscle, and, less commonly, pericarditis, which affects the lining around the heart.

“Very quickly, it was found to be a rare cause, roughly 1 in 50,000 myocarditis,” Offit said, referring to mRNA COVID vaccines. He said cases were seen primarily in males aged 16 to 29 and were generally short-lived.

Current evidence confirms that myocarditis and pericarditis are rare but recognised risks associated with mRNA COVID vaccines. The risk has been observed most often in adolescent and young adult males, particularly within seven days after a second dose.

In June 2025, the US Food and Drug Administration required updated safety warnings for the Pfizer-BioNTech and Moderna vaccines. The FDA also noted that some patients in follow-up studies continued to show signs of heart muscle injury on MRI scans, with improvement in some cases. The long-term significance of these findings remains under investigation.

Offit also cited the example of Johnson & Johnson COVID vaccine, which was associated with a rare but serious condition involving blood clots and low platelet counts. The vaccine was no longer available in the US by May 2023.

“You're always looking and trying to find any rare side effect that's associated with the vaccine,” he said.

He added that concerns about stillbirths and pregnancy outcomes had circulated despite research examining vaccination during pregnancy.

Offit said there was “no evidence of congenital malformations, no evidence of premature birth or spontaneous abortion” in the studies he was referring to.

How Long Were mRNA COVID Vaccines Tested?

Another common concern is that mRNA COVID vaccines were developed too quickly and that the technology had not been studied for long enough. Offit disagreed, saying that the technology was not entirely new.

“I think it was studied for a long time,” he said. He pointed to research into mRNA as a vaccine platform that began decades before the COVID-19 pandemic.

“Drew Weissman and Katie Carrico met in 1997 and started working on mRNA as a vaccine platform, for which they won the 2023 Nobel Prize in Medicine,” Offit said.

He also referred to efforts to develop mRNA vaccines against SARS, the coronavirus that caused an outbreak in 2002 and 2003.

“But we really had, really since 1997, information about this vaccine, so like more than 20 years of studies of that vaccine,” he said. “People think it was a new vaccine, but it really wasn't that new.”

The technology had been studied before COVID-19, although the pandemic vaccines themselves still required clinical trials to establish their safety and effectiveness. After their introduction, researchers continued monitoring them to identify rare adverse events.

Do Benefits Of COVID Vaccines Still Outweigh The Risks?

Offit said the decision to vaccinate should take into account both the risk of side effects and the risk posed by COVID itself. “I'm an older person, so I'm going to get a COVID vaccine every year because I think that the benefits clearly outweigh the risks,” he said.

He argued that COVID continues to cause hospitalisations and deaths, making protection against severe disease an important consideration.

He said that the benefits outweigh the risks, particularly for people at higher risk of serious illness. Individual decisions should also take account of age, underlying health conditions, previous vaccination and current medical guidance.