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!

Multivitamins are essentially dietary supplements containing a combination of various vitamins and minerals, often used to bridge nutritional gaps in the diet, treat deficiencies caused by poor nutrition or illness and support overall health.

Designed to provide a broad range of nutrients in one daily dose, they are available in tablets, capsules, gummies or liquids and are widely recommended to adults of all ages and genders.

But which vitamins do women need and when should you be taking them?

Dr Yashica Gudesar, Director & Unit Head of Obstetrics & Gynecology, Max Super Speciality Hospital, Dwarka exclusively tells Healthandme: "A woman’s nutritional needs change at different stages of life, from adolescence to reproductive years, pregnancy, and menopause. While food should always be the primary source of nutrients, certain vitamins may be required as women age or depending on lifestyle, diet, and health conditions."

"There’s honestly no universal vitamin checklist that works for every woman. The needs change with age, lifestyle, stress, whether one is planning a pregnancy, and of course, what the blood reports actually show," Bhakti Samant, Chief Dietician, Kokilaben Dhirubhai Ambani Hospital further told this publication.

Here are the supplements you need to stock your medicine cabinet with:

1. Vitamin D

Vitamin D is a fat-soluble nutrient essential for strong bones, immune function, and calcium absorption, often synthesized when skin is exposed to sunlight or obtained via food and supplements.

Symptoms of Vitamin D deficiency include bone pain, muscle weakness, and depression. Deficiencies are common due to low sun exposure or poor diet, leading to rickets in children and osteomalacia or osteoporosis in adults.

However, this can be avoided by consuming a combination of calcium and Vitamin D supplements. Dr Ginni Kalra, Head Dietician, Aakash Healthcare explained to Healthandme: "One of the frequently deficient nutrients in women is vitamin D. It is very important in calcium absorption, bone density, immune homeostasis and mood balance. In most adult women, the amount needed is 600-800 IU (15-20 mcg) per day although deficient women can take 1000-2000 IU per day under the supervision.

"Calcium is necessary in bone density especially in women post-menopause who experience rapid bone loss owing to the diminishing estrogen. Adult women should take 1,000 mg per day that rises to 1200 mg past 50 years. Calcium supplements are most ideal in separated doses of 500-600 mg each time and preferably following meals. When combined with vitamin D, absorption will enhance much better."

"Calcium becomes especially important after the age of 30, and even more after menopause. It can be taken after meals, often divided into two doses for better absorption," Dr Gudesar added.

Moreover, Samant advised: "Vitamin D is best taken with a meal that has some fat. Calcium (around 1000–1200 mg daily) is better split into two doses and should not be taken with iron."

2. Iron

A vital mineral, iron plays a very crucial role in human functioning by helping create hemoglobin to transport oxygen throughout the body, essential for energy and muscle function. Low iron levels can result in decreased oxygen transport and leading to symptoms like extreme fatigue, weakness, pale skin, cold hands/feet and shortness of breath.

While an iron deficiency is usually caused by poor diet, blood loss due to menstrual periods, ulcers, cancer, or regular use of pain relievers like aspirin or malabsorption issues, it can be remedied through supplements.

Dr Kalra explains: "Iron is also essential especially in menstruating women because they lose blood monthly. It may result in an iron deficiency which causes fatigue, loss of hair, brittle nails, and poor concentration. The acceptable amount of iron that is recommended to be taken by women aged 19 to 50 is approximately 18 mg, but this reduces to 8 mg after menopause.

"Iron supplements are better absorbed on an empty stomach or when taken with vitamin C and not when they are taken with calcium, tea or coffee as they have been found to interfere with absorption. The intake in the morning is usually desirable, but in case of gastrointestinal discomfort, it should be avoided."

3. Vitamin C

Vitamin C is essential for the body because it serves as a powerful antioxidant, supports the immune system, and is crucial for the synthesis of collagen, which is vital for wound healing and the maintenance of healthy skin, bones, and blood vessels.

It also enhances the absorption of iron from plant-based foods and protects cells from damage caused by free radicals, potentially reducing the risk of chronic diseases like cancer and heart conditions.

While, foods such as oranges, lemons, red and green peppers, kiwifruit, broccoli, strawberries, and Brussels sprouts can provide help maintain Vitamin C levels, supplements can help boost absorption and maximize benefits.

Dr Kalra notes: "Vitamin C helps to maintain the immunity, collagen synthesis, and iron uptake. It should be taken in 75 mg daily by adult women. It is soluble in water and can be consumed together with breakfast."

Additionally, she also recommends intaking: "Vitamin E and vitamin A also help the skin, vision, and antioxidant defense, but overconsumption is not advisable because it may be toxic."

4. Omega 3

Omega-3 fatty acids are polyunsaturated fats known for their crucial role in brain function and overall mental health. Fish oil is particularly rich in EPA and DHA, which are vital components of cell membranes and have strong anti-inflammatory effects in the body.

These omega-3s play a critical role in human development, and they are primarily found in fatty fish and fish oil. Some popular sources of Omega-3 include:

• Salmon
• Cod Liver Oil
• Algae Oil
• Oysters
• Nuts and seeds, such as flaxseeds, chia seeds, and walnuts
• Plant oils, such as flaxseed oil, soybean oil, and canola oil
• Fortified foods, such as eggs, yogurt, juices, milk, etc.

But as many people do not consume enough fish, supplementation is often recommended to ensure adequate intake of these essential fatty acids.

Dr Kalra suggests: "Though not vitamins, omega-3 fatty acids are worth mentioning because of the cardiovascular, hormonal, and anti-inflammatory effects. About 250–500 mg of combined EPA and DHA a day may be helpful and is most often administered after meals."

5. Vitamin B12

Symptoms of a Vitamin B12 deficiency often appear slowly. You may not notice them at first, or may blame them on stress, lack of sleep or a busy schedule. However, if the deficiency continues for long, it could lead to serious health problems.

Dr Gudesar recommends: "Vitamin B12 supports nerve health and energy levels. Vegetarian women are more prone to deficiency. It is typically taken in the morning."

"Vitamin B12 is needed to promote nerve well-being, red blood cell building, and energy conversion. The chances of deficiency are increased in vegetarian women because B12 is mostly found in foods of animal origin. The suggested daily dose is 2.4 mcg, but the dosage can be raised in deficiency. It is preferable in the morning as it could increase alertness," Dr Kalra explained.

However, Dr Kalra also advises: "There should be individualization of supplement timing and dosage. Decisions should be based on routine blood tests, dietary assessment, age, lifestyle, and existing medical conditions.

"Excessive supplementation is detrimental, in particular, fat-soluble vitamins. The only safe and effective approach is nutritional adequacy by means of whole foods, and supplements are the supportive therapy only in cases where deficiencies are observed."

The digital revolution has transformed childhood. From online classes to gaming and entertainment, headphones and earphones have become constant companions for children. While technology has brought convenience and learning opportunities, it has also introduced a silent threat, damage to children’s hearing.

In my clinical practice as an ENT surgeon, I am witnessing an alarming increase in young patients presenting with symptoms such as ear discomfort, ringing in the ears (tinnitus), and reduced hearing ability. These issues, once uncommon in children, are now becoming increasingly frequent due to excessive and unsafe use of personal audio devices.

Understanding the Risk

What makes the situation more concerning is that children often do not recognize the early warning signs. By the time symptoms become noticeable, significant damage may have already occurred.

The 60/60 Rule: A Simple Preventive Measure

• Listen at no more than 60% of the maximum volume

• Limit usage to 60 minutes at a time, followed by a break

This simple guideline can significantly reduce the risk of hearing damage and should be strictly followed by children and adolescents.

Warning Signs Parents Must Watch For

• Frequently increasing the volume of devices

• Complaints of ringing, buzzing, or ear pain

• Difficulty in hearing conversations

• Speaking unusually loudly

If any of these symptoms are noticed, it is important to consult an ENT specialist promptly.

Promoting Safe Listening Habits

1. Limit Earphone Use: Encourage children to use speakers whenever possible instead of earphones.

2. Choose Safer Devices: Over-the-ear headphones are generally safer than in-ear earbuds as they reduce direct sound impact.

3. Ensure Quiet Environments: Avoid using headphones in noisy surroundings, as children tend to increase volume to compensate.

4. Take Regular Breaks: Continuous listening should be avoided. Short breaks help the ears recover.

5. Avoid Night-time Use: Using headphones before sleep can harm both hearing and sleep quality.

A Shared Responsibility

Routine hearing check-ups should also be encouraged, especially for children who frequently use headphones for study or entertainment.

The digital age is here to stay, and technology will continue to play a central role in children’s lives. However, safeguarding their health must remain a priority. Hearing is a precious sense that, once lost, cannot be restored.

By adopting simple precautions, spreading awareness, and encouraging responsible use of technology, we can ensure that our children enjoy the benefits of the digital world, without compromising their hearing health.

From virtual meetings and online calls to webinars, gaming, workouts, and long commutes, headphones and earphones have become nearly indispensable -- almost an extension of the human body. But the continuous exposure to sounds for long periods may be adversely affecting your hearing health, warned health experts on World Hearing Day.

World Hearing Day is observed on March 3 each year to raise awareness on how to prevent deafness and hearing loss and promote ear and hearing care across the world.

Hearing loss in an adult can impact day-to-day conversations, work-related activities, and social engagements, to name a few. According to the World Health Organization (WHO), more than one billion young adults are at risk of permanent, avoidable hearing loss due to unsafe listening practices.

“The repeated exposure to sound will directly impact the hairlike cells in the inner ear as they are damaged and run the risk of death, therefore resulting in Noise-Induced Hearing Loss (NIHL). This type of damage occurs and can be permanent, unlike the temporary ear fatigue that we all are likely to experience,” Dr. (Prof.) Anand Gupta, Regional Director & Head - ENT, Yatharth Super Speciality Hospital, Faridabad, told HealthandMe.

According to the US National Institutes of Health, NIHL can be immediate or take a long time to be noticeable. It can affect one ear or both ears.

Dr. Gupta noted that wearing headphones for long hours daily can make individuals more vulnerable to being harmed by NIHL.

Importantly, headphones with noise-cancellation abilities are at an even greater risk of causing NIHL, should the user have their volume set above 60 percent, Dr. Gupta said.

“Prolonged exposure to sound at any volume greater than 60 per cent creates further demands on the auditory system than normal, which can exaggerate symptoms associated with NIHL,” he added.

The most commonly experienced symptoms of NIHL include

• occasional headaches,
• ringing in the ears (tinnitus) or "buzzing" sounds,
• muffled hearing,
• difficulty understanding conversations,
• a feeling of fullness in the ears.

Annual Hearing Checkups

Individuals who routinely listen to headphones should also have their hearing checked regularly. Taking simple precautions at this time could help prevent permanent hearing loss in the future.

The experts advised detecting hearing loss early.

“If you are an adult and have concerns about your ability to hear, consult with your otolaryngologist as soon as possible," Dr. Sumit Mrig, Director & Unit Head, ENT (Ear, Nose & Throat) & Cochlear Implant, Max Smart Super Speciality Hospital, Saket, told HealthandMe.

Depending upon how severely impaired your hearing is, the appropriate interventions may include hearing aids or other means that can dramatically improve your ability to communicate as well as improve your overall life quality,” Dr. Mrig added.

Other ways to prevent hearing damage include

• taking listening breaks every 10-15 minutes;
• lowering background noise (i.e., not turning the headphones up soundwise);
• and/or making use of quality, fitted headphones.

"Extended headphones, when used at high volumes, can strain the delicate structures of the inner ear, potentially leading to noise-induced hearing loss, tinnitus, and ear fatigue as well. Working professionals should also follow the 60- 60 rule, not more than 60 percent volume for 60 minutes as a stretch, and take regular listening breaks as well," Dr. Ashwath Kasliwal, Senior Consultant - ENT, Head and Neck, Apollo Spectra Hospital, Jaipur, told HealthandMe.