{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:23:59Z","timestamp":1788395039691,"version":"build-2803163510"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In the state of Maharashtra in India, a pilgrimage called \u201cPandharpur Wari\u201d attracts half a million pilgrims annually. Orthodox Hindu culture is generally resistant to allowing women to participate in religious functions during their menstruation. With a significant female presence, ensuring adequate Water Sanitation and Hygiene (WASH) facilities and Menstrual Health and Hygiene (MHH) is crucial. Due to scant reliable quantitative data, a qualitative study was conducted to investigate first-hand accounts of experiences of WASH facilities and MHH practices of women pilgrims during 2023 pilgrimage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study employed a qualitative design with convenience sampling, selecting 100 women pilgrims (aged 18-45\u2009years) from the pilgrimage across 3 sites. Data were collected through semi-structured interviews. Descriptive and thematic analyses were conducted to examine experiences, challenges, and suggestions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Over half (53%) were aged 32 to 41\u2009years while (18%) were between 22 and 31\u2009years. Most had studied up to secondary level (77%) and were married (95%). Thirty-four percent were farmers and a few had some other day job (7%). A large majority (97%) faced difficulties accessing toilets and bathing facilities, with some resorting to open defecation (36%). About (2%) used oral contraceptive to delay periods and (7%) experienced menstruation during pilgrimage. Lack of facilities for bathing and toilets along the pilgrimage route was one prominent challenge. Other challenges were, needing to bathe in the open, lack of gender-segregated facilities, and scanty sanitary facilities along the route. Women were found to be resilient in managing menstruation amidst systemic gaps. It was also found that cultural beliefs shaped pilgrimage participation while in menses and how it was hard to manage menstruation during pilgrimage without adequate infrastructure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The pilgrimage poses logistical, sanitation challenges for the pilgrims. Strategic planning, including mobile toilets, private bathing, menstrual hygiene support can improve the experience.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501319251359136","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T09:17:02Z","timestamp":1753089422000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Sanitation and Menstrual Health Challenges Among Pandharpur Women Pilgrims: An Exploratory Study With Recommendations"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4558-1983","authenticated-orcid":false,"given":"Manisha","family":"Gore","sequence":"first","affiliation":[{"name":"Symbiosis International (Deemed) University Lavale, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5101-6809","authenticated-orcid":false,"given":"Avinash","family":"Patwardhan","sequence":"additional","affiliation":[{"name":"George Mason University, Fairfax, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"Britannica. 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Accessed March 26 2025. https:\/\/sdgs.un.org\/goals\/goal6"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-022-01398-7"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.12697\/poa.2023.32.2.02"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.4103\/2249-4863.154627"},{"key":"e_1_3_4_10_2","unstructured":"Aid W. Integrating gender equality into water sanitation and hygiene projects. 2022. Accessed May 27 2025. https:\/\/washmatters.wateraid.org\/sites\/g\/files\/jkxoof256\/files\/integrating-gender-equality-into-water-sanitation-and-hygiene-projects\u2014guidance-for-ngos-and-implementing-partners.pdf."},{"key":"e_1_3_4_11_2","unstructured":"Hindustan Times. How 10L Warkaris make Pandharpur a fertile hunting ground for politicians. 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Accessed June 2 2024. https:\/\/www.who.int\/news-room\/questions-and-answers\/item\/what-is-who-s-role-in-mass-gatherings#:~:text=A%20mass%20gathering%20is%20a examples%20of%20a%20mass%20gathering"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2014.11.021"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/13563890211067542"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1371\/currents.outbreaks.50dfc803f07c5c0fc20d927d8f472d8b"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","unstructured":"Balsari S Greenough PG Kazi D Heerboth A. Water sanitation and hygiene at the world\u2019s largest mass gathering. Curr Infect Dis Rep. 2015;17(2):461. doi:10.1007\/s11908-015-0461-1. Accessed May 13 2025. https:\/\/www.researchgate.net\/publication\/273785683","DOI":"10.1007\/s11908-015-0461-1"},{"key":"e_1_3_4_18_2","unstructured":"Deseret News. How religious cooperation is leading to more toilets in India. 2016. . 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