Highways of Inequality

When I finally finished the photoshoot for my exhibition in the village near Jalalabad, the sun was already in the mid of the sky. It was end of the May. The summer of the northern India was in full swing as the outside temperature touched 48-degree Celsius. Me and my co-traveller from the organising partner of the exhibition, a young lady in her mid-twenties, started early morning from Lucknow to reach the destination on time. The village was about 200 kilometers away from Lucknow, near Jalalabad. As soon as we finished the shoot, we started off immediately to catch our return flight to Delhi from Lucknow in the evening. In between, to combat with the dehydration in the scorching heat, we kept drinking water to keep us hydrated. And unfortunately, it was filling up the urinary bladder slowly and gradually. The moment we reached Aligarh – Kanpur Road, I asked the chauffeur to stop the car somewhere near a roadside public toilet, so that I could relieve the pressure in my lower abdomen. He stopped the car in front of a gas station, where I found three open urinals under the sky. The urinals were stinking with strong smell of ammonia and devoid of water supply, though the provision was there. Born as an Indian male, I managed to void and with a much-relieved mental & physical state I came back to the car to embark. I was about to board, when the young lady asked, “did you find any toilet space for us? I am also under pressure.” That moment I felt that I had done a criminal offence in my life. I was guilty that I felt never before. I asked the staffs of the gas station and as expected there was none. We did not find a single functional toilet in the entire expressway that can be used by women. The few options available in the roadside restaurants or dhabas, were not at all in a condition to use. She travelled for next three and half hours sitting beside a guilty soul. She was having definite abdominal discomfort, prominent in her face and body language. 

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Holding urine for a long time, like my traveling partner, allows bacteria to multiply within the urinary tract, resulting in cystitis[1] – the representing phenomena of (lower) Urinary Tract Infection (UTI) other than pyelonephritis. It is advised and encouraged to drink plenty of fluids and to urinate frequently to help flush bacteria from the bladder. Unfortunatelyan advice is not enough till the solution is not there.

UTI is the single most common bacterial infection among Indian females, mainly caused by the Escherichia coli.[2] An estimated 50% of women experience at least one episode of UTI at some point of their lifetime and between 20% and 40% of women can have recurrent episodes[3]. It is also known to be one of the most common medical complications during pregnancies. It remains a major public health problem in terms of morbidity and financial cost with an estimated 150 million cases per annum worldwide, costing global economy in excess of US$6 billion[4]. The introduction of antimicrobial therapy has contributed significantly to the management of UTIs. In almost all cases of community-acquired UTI, empirical antimicrobial treatment is initiated before the laboratory results of urine culture are available; thus, resistance may increase in uropathogens due to frequent misuse of antimicrobials[5]

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In recently times, India is in the global discussion point about three major things. 

First, the Women empowerment. The national policy[6] states that, “The Constitution not only grants equality to women, but also empowers the State to adopt measures of positive discrimination in favors of women.” Section 6.8 of the policy states that “Special attention will be given to the needs of women in the provision of safe drinking water, sewage disposal, toilet facilities and sanitation within accessible reach of households, especially in rural areas and urban slums.” 

Second, the Clean India Mission where the government provided subsidy of about US$27M for construction of nearly 110 million toilets in rural India between 2014 and 2019. The campaign has been promoted and advertised to combat open defecation

And finally, the antimicrobial resistance in India. The World Health Organisation stated, “The emergence of antimicrobial resistance (AMR) is creating ‘superbugs’ that make treating basic infections difficult (and in some cases impossible) […] And though the emergence of resistance in microorganisms is a continuous phenomenon, its amplification and spread are the result of one thing: human behavior. […] The (South-East Asia) Region is likely the most at-risk part of the world. Not only does AMR affect the health and well-being of people across South-East Asia, but it also has ramifications for public health and well-being more broadly.” 

Now-a-days, women are also traveling outside their home, both in urban & rural areas. I have seen the female frontline workers, who are traveling on a daily basis to reach the far-flung villages from the towns, are holding their urine for a long time. Hence, toilet facilities and sanitation should be there not only within accessible reach of households, but also in the roadsides, including 142,126 kilometers of Highways across the country. The word equality probably set the idea that anatomy & physiology of women are equal to men, and women can void their filled urinary bladder in the open space or in soiled urinals like men. And finally, in a health burdened country where 67.78% of total expenditure on health was paid out of pocket & 7% of Indians fall below the poverty line just because of indebtedness due to health expenditure[7], the focus should be there to PREVENTcommonest burden of the bacterial infectious disease like UTI, instead of emphasizing expenditures on treatment protocol. The recurrence of UTI causes forced repetition of antibiotics, mostly of irrational choice, which becomes a recurrent financial burden to the families and many times that leads to procure the irrelevant antibiotics over the counter (OTC).

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The whole idea & effort of empowerment becomes null & void, if the country has a population, who are burdened with the recurrence of infectious disease like UTI. We should understand the holistic health of a female’s mind & body, that functions differently from a male. The fact is often completely ignored that both rural & urban women are also traveling like men. It is the high time to introspect the policies by accepting the fact that more than males, clean & functional toilets are essential for females for certain anatomical reason – not only at home but also outside home. 


[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749018/

[2] https://www.semanticscholar.org/paper/A-Study-on-Reoccurrence-of-UTI-in-Indian-Women-Thakur/9fff69afaccbbc040de0d0b8e0cd95ae24f302e1?p2df

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663160/

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663160/

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663160/

[6] https://wcd.nic.in/womendevelopment/national-policy-women-empowerment#:~:text=The%20Constitution%20not%20only%20grants,discrimination%20in%20favour%20of%20women.&text=1.3%20India%20has%20also%20ratified,secure%20equal%20rights%20of%20women.

[7] https://www.downtoearth.org.in/dte-infographics/india_s_health_crisis/index.html#:~:text=This%20is%20in%20contrast%20to,of%20the%20total%20health%20expenditure.&text=Mizoram’s%20per%20capita%20health%20expenditure,GDP%20on%20health%20in%202015.

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