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!

America's falling birth rate is often reported with concerns like shortage of labour, a growing aging population, and slower population growth. But another major consequence is unfolding within the healthcare system that is going unnoticed.

As fewer women have children and more delay pregnancy, women's healthcare is evolving beyond maternity care to address changing health needs.

The U.S. Birth Rate Is Declining

According to the latest data from the U.S. Centers for Disease Control and Prevention (CDC), 3.63 million babies were born in the United States in 2024, a slight increase from 2023.

However, the general fertility rate fell to a record-low 53.8 births per 1,000 women aged 15 to 44, marking the lowest level ever recorded.

Women’s Healthcare Is Evolving In The US

One of the biggest changes is maternity care. With fewer births being reported, hospitals, particularly in rural communities, are struggling to keep labour and delivery departments financially viable.

The problem has contributed to the rise of a maternity care challenge where pregnant women have limited or no access to obstetric services.

The 2024 March of Dimes Maternity Care Deserts Report found that more than one in three U.S. counties lack a single obstetric clinician or birthing facility, leaving millions of women with reduced access to prenatal and delivery care.

Women living in these areas are more likely to receive inadequate prenatal care and experience higher rates of preterm birth.

Also read: Beyond The Bump: Why Preconceptions And Antenatal Care Are Key To A Healthy Pregnancy

Healthcare Focus Beyond Pregnancy

At the same time, healthcare providers are broadening their focus beyond pregnancy. Women today are delaying childbirth, having fewer children, or choosing not to become parents altogether.

As life expectancy increases, demand is growing for services related to menopause, cardiovascular disease, osteoporosis, pelvic floor disorders, mental health, and healthy aging.

The shift also explains why fertility care is expanding despite declining birth rates. As more Americans postpone parenthood into their late 30s and 40s, many require fertility evaluations, egg freezing, or in vitro fertilization (IVF).

Rather than indicating more births, the growing use of assisted reproductive technology reflects changing reproductive timelines.

Management Of Chronic Lifestyle Disorders

An aging female population is also changing healthcare priorities. Older women face a higher risk of chronic diseases such as heart disease, diabetes, osteoporosis, and dementia, increasing the need for preventive care and long-term disease management.

Health systems are investing more in menopause clinics, wellness programs, and other women's health services.

America's falling birth rate is therefore reshaping far more than population statistics. It is redefining women's healthcare, shifting the focus from pregnancy-related care to comprehensive support throughout every stage of life.

On World Population Day, the conversation is not just about how many babies are being born. It is also about ensuring that healthcare evolves to meet the changing needs of women, whether or not they choose to become mothers.

Chai and pakoras are practically non-negotiable once the rains set in. For a large number of Indians, though, monsoon comes with something less welcome: a blocked nose, itchy eyes, and a "cold" that just won't quit.

Most people write this off as a seasonal cold. It's often not. A large share of the patients I see in July aren't fighting a fresh infection. They're dealing with allergic rhinitis that's been present for months at a manageable level, and monsoon has simply pushed it past a threshold they can no longer ignore.

A Bigger Problem Than It Looks

The scale of this is easy to underestimate. A national study under the Global Asthma Network, which surveyed more than 1.27 lakh children, adolescents, and adults across India, found that close to a quarter of Indian adolescents aged 13 to 14 live with allergic rhinitis. Roughly one in ten adults does too.

Other Indian research puts the overall incidence of allergic rhinitis anywhere between 20 and 30 percent of the population. This isn't a niche complaint. It's one of the more common chronic conditions walking through general practice doors, most of which are simply unnamed.

Mostly Undiagnosed, Rarely Treated Right

The same national study found something more concerning: nearly three out of four people who met the clinical criteria for allergic rhinitis had never actually been diagnosed with it. Many had lived with recurring congestion, sneezing, and disturbed sleep for years without anyone connecting the dots.

A separate survey of over 1,600 physicians across India found that while a large share see allergic rhinitis routinely in practice, more than half had never used immunotherapy, one of the few treatments that changes the course of the disease rather than just quieting it temporarily.

Why Monsoon Makes It Worse

Indian allergen-testing data show a clear rotation of triggers through the year: dust mites dominate winter, pollens dominate summer, and fungal and insect allergens rise sharply once the rains set in.

The reason is straightforward. Once relative humidity in a city climbs past 70 percent, which happens routinely through the monsoon, fungal spores and dust mites both multiply fast. Waterlogging pushes fungal spore counts up further. A damp curtain or a mattress that never quite dries between showers becomes a long-term allergen source that outlasts any single rainy day.

It Rarely Comes Alone

Allergic skin and eye conditions tend to flare with the same seasonal humidity and allergen load as allergic rhinitis, and in practice, they rarely show up in isolation. A patient with monsoon-triggered nasal symptoms is worth a closer look for coexisting asthma, eczema, or conjunctivitis, simply because in the Indian patient population, these conditions travel together more often than not.

What Actually Helps

For anyone with a known allergic condition, a few habits make a real difference once the rains arrive:

• Start early. Begin or review your antihistamine or inhaled treatment before the monsoon sets in, not after symptoms flare. Allergic inflammation is far easier to control early than to bring down once it's escalated.
• Keep the fabric genuinely dry. Bedding, curtains, and upholstery that stay even slightly damp become breeding grounds for the mold and dust mites driving most flares. Check for indoor allergens rather than just blaming obvious outdoor ones.
• Ventilate or dehumidify. Especially in bedrooms, where hours of overnight exposure do the most damage.
• Keep rescue medication accessible through the season, not just on bad days.
• Don't wait out a flare that lasts beyond a week. That's usually the point where a proper allergy workup is overdue.
• If it happens every single monsoon, that pattern itself is a diagnosis worth acting on, not just enduring.

Monsoon doesn't create new allergy patients. It reveals how well the existing ones are actually being looked after.

“Let knowledge be your shield against the changing seasons."

Even a mild case of COVID-19 may trigger long-lasting eye problems, with new research revealing that persistent inflammation and nerve damage could be responsible for symptoms that standard eye tests often fail to detect.

The study, led by researchers at Linköping University in Sweden and published in Nature Communications, sheds light on why some COVID-19 survivors continue to experience debilitating vision issues months or even years after infection.

The research began after people who had recovered from mild COVID-19 sought medical help for persistent eye complaints. Many reported:

• Severe eye pain
• Light sensitivity (photophobia)
• Difficulty reading and focusing
• Extreme eye fatigue

Many participants said the condition significantly disrupted their daily lives, preventing them from working or continuing their education.

What the Study Found

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Researchers evaluated 100 people who developed eye problems after mild COVID-19 but had never been hospitalized. Their symptoms had persisted anywhere from three months to three years.

The findings were compared with those of 32 people who had recovered from mild COVID-19 without developing eye symptoms.

Using advanced imaging and laboratory techniques, researchers identified several abnormalities that conventional eye exams failed to detect.

Persistent Inflammation and Nerve Damage

The study found evidence of:

• Long-term inflammation in the eyes
• Damage to nerves controlling multiple eye functions
• Abnormal immune activity involving T cells
• Changes in proteins found in tear fluid

Lead author Petros Moustardas, senior research associate at Linköping University, said the findings indicate that COVID-19 may trigger a severe immune reaction in the eyes, resulting in chronic inflammation and nerve dysfunction.

Why Light Sensitivity Happens

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One of the most common complaints among participants was extreme sensitivity to light. Researchers found that their pupils were allowing too much light into the eyes because of impaired nerve control.

This abnormal pupil function was also associated with:

• Headaches
• Difficulty reading
• Trouble maintaining focus

An Unusual Eye Movement Disorder

The study also identified impaired coordination between the two eyes.

Some participants developed adult-onset strabismus—commonly known as crossed eyes—a condition that is rare in adults.

Researchers believe this occurred because COVID-19 affected the nerves responsible for controlling eye muscles.

A New Way to Diagnose COVID-Related Eye Problems

Because routine eye tests often miss these abnormalities, the research team developed two diagnostic models.

The first relies on specialized ophthalmic tests available at advanced eye clinics, while the second combines these examinations with tear fluid protein analysis to improve diagnostic accuracy.

Researchers hope these models will help doctors recognize COVID-related eye syndrome earlier and pave the way for future treatments.

"We found that the problems experienced by those affected were not detectable by standard tests. We had to perform specialised examinations to detect deviations. The puzzle pieces then fell into place, and we found explanations for the symptoms," said Neil Lagali, professor of experimental ophthalmology at Linköping University.

He added that while the findings provide important clues about how COVID-19 affects the eyes, more research is needed to develop effective treatments for those living with persistent vision problems.