research and Global health NOV 7

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 8

*** This sample was adapted from a Monroe College student’s final paper. ***

Discussion

Introduction to Discussion

Women’s reproductive health is in jeopardy specifically in relation to restrictions to

abortion and prenatal health services. These limitations continue to be an expanding issue for

pregnant and adolescent women, ultimately resulting in life long physical, emotional, and mental

health implications for both mothers and their children (Janighorban et al., 2021). Studies

(Janighorban et al., 2021; Pabayo et al., 2020) have shown there are implications for the children

born in areas with restrictive laws and limitations to sexual reproductive health services and

education, such as an increased risk of infant morbidity and mortality. The long-term impacts on

children in areas where abortion is completely banned impedes on socioeconomic status long-

term or indefinitely, and children born to teen and adolescent mothers were more likely to be

teen parents and less likely to seek higher education (Hajdu et al., 2021). Besides the bestowed

children under these conditions, the pregnant women giving birth have also been seen to have

lifelong implications such as physical health issues, defective life skills, mental health issues, and

behavioral issues (Hajdu et al., 2022).

Evidence-Based Recommendations

Recommendations from Literature Review

Access to maternal health care and prenatal services is vital component to successful

pregnancies and reducing mortality and morbidity for both the children and mothers (Carlson &

Neuberger, 2021). With new limitations on abortion, reducing teen pregnancy is imperative.

Future studies are needed to measure the impact of these restrictions (Pabayo et al., 2020), if

unwanted pregnancies are going to be inevitable, and leaders need to strengthen the current

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 9

*** This sample was adapted from a Monroe College student’s final paper. ***

systems in place. De Londras et al. (2022) recommended use of the WHO’s international

guidelines be enforced to maximize health outcomes, health system efficiency, and to ensure

human rights, while Hajdu and Hajdu (2021) focused on the consequences of access to abortion

and family planning and urged the importance of implementing abortion policies. Their results

(Hajdu & Hajdu, 2021) could be utilized in creating such policies. Like Hajdu and Hajdu (2021),

Janighorban et al. (2022) recommended developing comprehensive and practical programs

beyond legal and political purviews. They (Janighorban et al., 2022) argued the repercussions of

limited access to family planning and abortion could impact the health of adolescents in varying

societies.

Program Recommendation

As research (Hajdu & Hajdu, 2021; Janighorban et al., 2022) has suggested the

importance of future studies and creation of policies to protect access to family planning, one

existing program that could be expanded is Women, Infant, and Children (WIC), a program

instated in order to mitigate the discrepancies in access to nutritional care (FNS, 2013). This was

brought forth by the Food and Nutrition Services (FNS), an agency within the United State

Department of Agriculture (USDA). They implemented a nutrition assistance program for

pregnant women and mothers, infants up to six months, and children under the age of five. The

WIC program was designed for this population who are of low-income status; guidelines deem

this to be between 100-185% of the federal poverty line for eligibility, those experiencing

nutritional risk such as malnourishment, underweight, diabetes, high risk pregnancy, in addition

to others (FNS, 2013). This program provides supplemental nutrition, nutrition education,

breastfeeding support and referrals to prenatal and other health services.

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 10

*** This sample was adapted from a Monroe College student’s final paper. ***

Benefits of this programs has been linked to decreased infant morbidity and mortality

among women and infants (Carlson & Neuberger, 2021). WIC has been associated with longer

gestational periods, and higher birth weights (FNS, 2013). Children under two have been

documented to have improved rates of immunization and regular access to medical care within

the first year of life and associated with a higher likelihood of having a regular provider

throughout childhood (Carlson & Neuberger, 2021). Access to these services is also linked with

lower healthcare costs to mothers and families, making maternal health services more accessible

(FNS, 2013).

The present research recommends that WIC should be expanded to incorporate sex-

education. Only 21 states mandate lessons on contraception. The majority of the country teaches

only abstinence (Disi et al., 2022). If WIC were to expand access to more of the population by

providing in-depth sex education and more government funding, then public health professionals

could aid in significantly reducing the risks of pregnancy for both mother and child. If this

program were to expand to all women in need of contraception, sex education, prenatal care,

maternal healthcare services, access to these benefits would reduce risks associated with

pregnancy, as well as reduction of risks of teen pregnancy.

The Conclusion would go here,

introduced by a Level 1 Header and adhering to APA 7 Basics

– No page breaks between sections or extra spaces

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 1

The Impacts of Abortion Restrictions and Limited Maternal Health Services

Alyssa Strickland

Department of Public Health, Monroe College, King Graduate School

KG 604: Graduate Research & Critical Analysis

Professor Amanda Ramlochan

March 26, 2023

*** This sample was adapted from a Monroe College student’s final paper. ***

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 2

The Impacts of Abortion Restrictions and Limited Maternal Health Services

Introduction

Access to maternal health services is a fundamental component to achieving health

equity; it is estimated by the United Nations (2022) that 121 million pregnancies each year are

unintended, with 45% of all abortions deemed unsafe, causing 810 women to die each day, due

to preventable causes related to childbirth. Appropriate measures to ensure safe and reliable

maternal health services before and after birth is imperative and should be a fundamental right

for all women. An expansion of resources, increased funding, proper education on contraception,

and access to maternal and prenatal care is needed to ensure safety for all women and create a

sense of bodily autonomy (Carlson & Neuberger, 2021; Disi et al., 2022).

Literature Review

Introduction to Literature Review

Safe and available access to maternal health services while abortion restrictions and

stigmatization continues to pose issues for young pregnant women (Janighorban et al., 2022).

With abortion restrictions on the rise and limited access to providers, it is imperative to assess the

risk factors that this imposes on pregnant women and women’s reproductive rights. The literature

review included only peer-reviewed, research articles and literature regarding the factors of

limited access to sexual reproductive services and prenatal care for women long-term. Some of

these factors include socioeconomic status, defective life skills, and mental health issues were

analyzed. The databases used to conduct the literature review was ProQuest and Medline from

the Monroe College library. Keywords and phrases included in the search for the articles

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 3

documented in the literature review reflect the following: abortion, abortion access, impacts of

abortion restriction, and maternal health service limitations.

Review of Literature

Limited Access of Care

Janighorban et al. (2021) conducted a mixed-methods research study using semi-

structured interviews in order to explore the impediments to access when it concerns

reproductive and sexual health services. This study was conducting using 120 female participants

ages 14-19, and 22 key informants that worked as midwives, psychologists or social workers in

April 2019 to June 2020 in Iran, specifically Isfahan, Tehran and Mashhad. Through in-depth

semi-structured interviews, the study participants explained in depth their experiences of barriers

to sexual and reproductive/maternal health services among teenage girls. They found that the

ineffectiveness of key organizations in providing sexual and reproductive health services as well

as lacking in political, legal, and social support indicate that the sexual and reproductive health

of these girls is not a priority for Iranian society. They were able to conclude in their research

that the long-term effects of the severe limitations to sexual health services, specifically when it

concerns abortions and prenatal services in this age group, were family challenges, easily

succumbing to peer pressure, inability to make informed decisions when it pertains to sex, and

lack of knowledge in relation to sexual health threats, and psychological distress (Janighorban et

al., 2021).

Hadju et al. (2022) conducted secondary, quantitative research analysis in order to

identify the long-term consequences of restrictive access to abortion, specifically following the

change in abortions laws after 1974 in Hungary. The study was conducted through a secondary,

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 4

quantitative research methodology, using the 2011 census in Hungary. They were able to

conclude from their research that children born after the law change to women under the age of

35 were less likely to seek higher education. They also found that these children were also far

more likely to become teen parents themselves. The restrictive abortion policy in Hungary

ultimately resulted in negative impacts on the socioeconomic results in the lives of the children

born after the law was put in place. As a whole, they saw that children born after the law change

had worse educational outcomes, and the law change overall reflect an unwantedness effect

(Hadju et al., 2022).

Changing Stigma and Expansion of Research

Maxwell et al. (2021) conducted a qualitative research analysis in October of 2019.

Unlike the previous studies (Hadju et al., 2022; Janighorban et al., 2021), Maxwell et al. (2021)

conducted this research study in order to figure out how providers can help normalize abortion,

challenge the stigma, and challenge sociocultural narrative surrounding the topic. Everyday

discussion as it pertains to abortion is generally negative, instilling shame and distress around the

topic and discussion, even though it is a common gynecological procedure. They conducted the

research study using a qualitative research approach, and conducted 20 interviews using thematic

analysis. From their research, they were able to identify four interconnecting themes among the

providers interviewed: 1. Resistance to abortion from their colleagues 2. negative sociocultural

abortion accounts. 3. Aims to achieve positivity or neutrality around abortion procedures. 4.

presenting abortion as normal and a part of maternal, sexual, and gynecological healthcare.

Further, they explained that abortion should not be considered wrong or viewed as inherently

negative, and it can be presented as a routine component of sexual and reproductive healthcare.

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 5

Presenting abortion neutral and positive ways can help limit and resist negative framings of the

procedure (Maxwell et al., 2021).

Lastly, Pabayo et al. (2022) carried out a secondary, quantitative research analysis in

order to determine if there was a connection between infant mortality risk and limited abortion

services in the states with varying restrictions among abortion laws in different states in the

United States. The data used for this studied came from infants born from 2008-2010 and used

this data comparatively to infants born in different regions of the world in 2015 and 2017. The

data was collected in the United States, at varying academic institutes including University of

Alberta, located in Alabama, University of Nevada, University of Utah, Columbia University,

and Montclair State University. They looked for a causal relationship between restrictive

abortion laws and infant mortality, and pulled direct statistics and numbers from LBID and

NCHS in accordance, and assessed specific laws and drew their research from there. They were

able to conclude that Infants born to Black mothers, single mothers, and low-income mothers

have higher infant mortality rates compared to infants born to White mothers, married mothers,

and moderate/high-income mothers. They were unable to find a definitive causal relationship,

but when they tested the relationship between infant mortality and five different abortion

restrictive laws they chose, they were able to determine that there is an increase in risk of infant

mortality when the laws are more restrictive.

Analysis of Literature

Maxwell et al. Hajdu et al. (2021), Janighorban et. al (2022) and Pabayo et al. (2020) all

used qualitative research as component of the methodology used when conducting their research.

All four studies indicate that there are negative impacts on health outcomes and demonstrate a

violation to human and women’s reproductive rights when it comes to abortion access and

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 6

restrictive abortion laws. The more restrictive abortion laws overly complicate the provider-

patient relationships. They have been able to conclude that this specifically effects younger

women when it comes to reproductive health and shows negative impacts in the long run,

specifically to socioeconomic status, family planning, mental health implications, and fear and

avoidance associated with current healthcare systems. Comparatively, in Pabayo et al. (2020),

their research focuses more heavily on the risks of mortality among infants when abortions laws

are more restrictive, while Hadju et al. (2021) and Janighorban et al. (2022) focus more on the

implications to young mothers and their social and economic status following the inhibitions of

abortion access as opposed to discussing the morality implications are discussed in the former.

Meanwhile, Maxwell et al (2021) discuss the overall impacts to the healthcare system, and being

able to access a quality provider that has been trained and 1. Allowed to perform specific

procedures and 2. Properly trained to do so.

Discussion

Introduction to Discussion

Women’s reproductive health is in jeopardy specifically in relation to restrictions to

abortion and prenatal health services. These limitations continue to be an expanding issue for

pregnant and adolescent women, ultimately resulting in life long physical, emotional, and mental

health implications for both mothers and their children (Janighorban et al., 2021). Studies

(Janighorban et al., 2021; Pabayo et al., 2020) have shown there are implications for the children

born in areas with restrictive laws and limitations to sexual reproductive health services and

education, such as an increased risk of infant morbidity and mortality. The long-term impacts on

children in areas where abortion is completely banned impedes on socioeconomic status long-

term or indefinitely, and children born to teen and adolescent mothers were more likely to be

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 7

teen parents and less likely to seek higher education (Hajdu et al., 2021). Besides the bestowed

children under these conditions, the pregnant women giving birth have also been seen to have

lifelong implications such as physical health issues, defective life skills, mental health issues, and

behavioral issues (Hajdu et al., 2022).

Evidence-Based Recommendations

Recommendations from Literature Review

Access to maternal health care and prenatal services is vital component to successful

pregnancies and reducing mortality and morbidity for both the children and mothers (Carlson &

Neuberger, 2021). With new limitations on abortion, reducing teen pregnancy is imperative.

Future studies are needed to measure the impact of these restrictions (Pabayo et al., 2020), if

unwanted pregnancies are going to be inevitable, and leaders need to strengthen the current

systems in place. De Londras et al. (2022) recommended use of the WHO’s international

guidelines be enforced to maximize health outcomes, health system efficiency, and to ensure

human rights, while Hajdu and Hajdu (2021) focused on the consequences of access to abortion

and family planning and urged the importance of implementing abortion policies. Their results

(Hajdu & Hajdu, 2021) could be utilized in creating such policies. Like Hajdu and Hajdu (2021),

Janighorban et al. (2022) recommended developing comprehensive and practical programs

beyond legal and political purviews. They (Janighorban et al., 2022) argued the repercussions of

limited access to family planning and abortion could impact the health of adolescents in varying

societies.

Program Recommendation

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 8

As research (Hajdu & Hajdu, 2021; Janighorban et al., 2022) has suggested the

importance of future studies and creation of policies to protect access to family planning, one

existing program that could be expanded is Women, Infant, and Children (WIC), a program

instated in order to mitigate the discrepancies in access to nutritional care (FNS, 2013). This was

brought forth by the Food and Nutrition Services (FNS), an agency within the United State

Department of Agriculture (USDA). They implemented a nutrition assistance program for

pregnant women and mothers, infants up to six months, and children under the age of five. The

WIC program was designed for this population who are of low-income status; guidelines deem

this to be between 100-185% of the federal poverty line for eligibility, those experiencing

nutritional risk such as malnourishment, underweight, diabetes, high risk pregnancy, in addition

to others (FNS, 2013). This program provides supplemental nutrition, nutrition education,

breastfeeding support and referrals to prenatal and other health services.

Benefits of this programs has been linked to decreased infant morbidity and mortality

among women and infants (Carlson & Neuberger, 2021). WIC has been associated with longer

gestational periods, and higher birth weights (FNS, 2013). Children under two have been

documented to have improved rates of immunization and regular access to medical care within

the first year of life and associated with a higher likelihood of having a regular provider

throughout childhood (Carlson and Neuberger, 2021). Access to these services is also linked with

lower healthcare costs to mothers and families, making maternal health services more accessible

(FNS, 2013).

The present research recommends that WIC should be expanded to incorporate sex-

education. Only 21 states mandate lessons on contraception. The majority of the country teaches

only abstinence (Disi et al., 2022). If WIC were to expand access to more of the population by

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 9

providing in-depth sex education and more government funding, then public health professionals

could aid in significantly reducing the risks of pregnancy for both mother and child. If this

program were to expand to all women in need of contraception, sex education, prenatal care,

maternal healthcare services, access to these benefits would reduce risks associated with

pregnancy, as well as reduction of risks of teen pregnancy.

Conclusion

It is important to ensure that each person has access to health care resources especially

when the goal is health equity for all. These pre-existing inequities in reproductive healthcare

services are evident in our current healthcare system, and a greater, more targeted public health

response is needed to make meaningful change and foster positive outcomes for all women, girls

and children. Therefore, fostering other ways to cultivate change and provide easy access to

prenatal care, maternal healthcare services, and execute the right to bodily autonomy is of the

utmost importance.

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 10

References

Carlson, S. & Neuberger, Z. (2021, January 27). WIC Works: Addressing the nutrition and health

needs of low-income families for more than four decades. Center on Budget and Policy

Priorities. https://www.cbpp.org/research/food-assistance/wic-works-addressing-the-

nutrition-and-health-needs-of-low-income-

families#:~:text=Seminal%20USDA%20research%20early%20in,infants%2C%20and%2

0fewer%20infant%20deaths.

Food and Nutrition Services. (2013, October). About WIC: How WIC helps. U.S. Department of

Agriculture, Food and Nutrition Services. https://www.fns.usda.gov/wic/about-wic-how-

wic-helps

Hajdu, G., & Hajdu, T. (2021). The long-term impact of restricted access to abortion on

children’s socioeconomic outcomes. PLoS One, 16(3).

https://doi.org/10.1371/journal.pone.0248638

Janighorban, M., Boroumandfar, Z., Pourkazemi, R., & Mostafavi, F. (2022). Barriers to

vulnerable adolescent girls’ access to sexual and reproductive health. BMC Public

Health, 22, 1-16. https://doi.org/10.1186/s12889-022-14687-4

Maxwell, K. J., Hoggart, L., Bloomer, F., Rowlands, S., & Purcell, C. (2021). Normalising

abortion: What role can health professionals play? BMJ Sexual & Reproductive

Health, 47(1), 32-36. https://doi.org/10.1136/bmjsrh-2019-200480

Pabayo, R., Ehntholt, A., Cook, D. M., Reynolds, M., Muennig, P., & Liu, S. Y. (2020). Laws

restricting access to abortion services and infant mortality risk in the United

ABORTION RESTRICTIONS AND LIMITED MATERNAL HEALTH SERVICES 11

States. International Journal of Environmental Research and Public Health, 17(11),

3773. https://doi.org/10.3390/ijerph17113773

*** This sample was adapted from a Monroe College student’s final paper. ***

Welcome Back!

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 1

Effect of Ritualistic Bathing on Water Quality of Ganga River in India

Nayan Harshadkumar Patel

Department of Public Health, Monroe College, King Graduate School

PH690- Global Health

Professor Aditi Puri

October 15, 2023

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 2

Effect of Ritualistic Bathing on Water Quality of Ganga River in India

The issue being explored revolves around the pollution and contamination of water

bodies concerning the Ganga River. The river supports millions of people in India. As such, the

river's water quality bears significant implications for the well-being of the inhabitants and the

entire ecosystem. Pollution and contamination of the Ganga River mean people lack safe and

suitable water.

The main aspect that is involved in this case is the social element of Indian people. The

religious mass bathing events are the main reasons why the river is contaminated. The

contamination also comes about due to industrial wastes and the disposal of sewerage into the

river. The outstanding issue is that individuals suffer from health problems such as water-borne

diseases because of the pollution of the river. There have been higher incidences of diarrhoea,

cholera, pneumonia, typhoid and skin disease, especially among the fisher folk who heavily

depend on the river for water for consumption (UNEP, n.d). The diseases have remained quite

prevalent, especially because sewage treatment plants located on the Ganga have been expensive

to maintain and are ineffective during monsoons. They are unable to treat wastes such as heavy

metals, pharmaceutical products or personal care products, which can be directly traced to mass

bathing activities (UNEP, n.d).

The issue of pollution of the Ganga River must be addressed because of the fact that it

supports the basic needs of millions of people. One measure that can be useful in solving the

problem is raising awareness and educating people on the repercussions of mass bathing. Some

of the programs that have been successful in other areas have included establishing effective

sewerage treatment infrastructure and river-surface cleaning.

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 3

Literature Review

The Ganga River has immense cultural, heritage and religious significance and, as such,

has been heavily utilized for bathing rituals that have led to pollution and contamination of

water. The events tend to substantially lower water quality, making it unsuitable for use. Given

that there is significant dependence on the river for use in other aspects of life apart from the

religious factor, it is important that the problem is addressed. The Ganga River is one of the

biggest river systems worldwide, and as such, it serves numerous communities across its basin,

with 37% of India's population inhabiting the river's basin. It covers an ecosystem spanning 2525

km while covering 26.2% of the entire land mass in India. The basin is the fifth largest in the

world, with an area of 1,060,000 km2. (Dimri et al., 2021). The research uses five peer-reviewed

journals from databases that included ScienceDirect, Researchgate and Archives of Agriculture

and Environmental Science (AESA). The key searches were “Ganga River,” “Water pollution,”

“Contamination” and “Water quality.”

Review of Literature

Dimri et al. (2021) investigated the quality of water in the Ganga River using the water

quality index and multivariate techniques. The focus of their study was the upper Ganga basin

region of Uttarakhand, India. The purpose of the study was to assess the water quality of the

Ganga River. It looked to identify spatial and temporal deviation of water quality across 24

different sampling sites in the upper Ganga basin. The researchers also looked to determine the

water parameters which are associated with the variations and the impact of the pollution.

The water samples were collected from 24 different sites and were analyzed using

multivariate statistical techniques and the water quality index (WQI). The focus area of the study

was a region covering a stretch of 294km (Dimri et al., 2021). The researchers measured 19

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 4

physical and chemical parameters over the span of three seasons. The parameters, which

included EC, TDS, COD, Alkalinity, Hardness, MPN, Ca, and HCO3, indicated that there is a

high standard deviation, which is a result of the dispersion, and this translates to spatial variation

of the parameters. The study showed that the upper basin of the Ganga River is relatively

unpolluted because there is less interference by human beings and their activities (Dimri et al.,

2021). The majority of the parameters were deemed to be within permissible limits.

Aenab & Singh (2013) also evaluated the quality of water of the Ganga River. Their

choice of locale was Uttar Pradesh (UP). The purpose of the study was to evaluate several

monitoring stations along the river in UP state. Additionally, it was meant to create the river’s

specific water quality standards according to international standards and to provide a warning

system for users who are downstream in poor water conditions. The researchers evaluated 13

different monitoring stations using WQI analysis by the C++ program (Aenab & Singh, 2013).

Uttar Pradesh is one of the regions along the Ganga River which is faced with pollution.

Samples were collected in Uttar Pradesh, and relevant parameters were chosen to

establish consistent water quality measurements. The C++ program, also known as hybrid

language, helped evaluate the different parameters used in the research. The results indicated that

the standards of water along the river in the state of Uttar Pradesh are quite poor. The water was

regarded as being unsuitable for use. The recommendation was that individuals who live

downstream should be aware of the quality of water and its consequences, given that they rely on

Ganga River's water for their daily use.

The purpose of the study by Kumar et al. (2018) was likewise based on the assessment of

the quality of water in the Ganga River. The researchers studied the impact that religious

activities, particularly Kanwar Mela, have on the state of water in the river. The study featured

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 5

multiple sites which carry religious and cultural significance in Haridwar City. Kanwar Mela is a

religious celebration carried out annually in July and entails individuals taking baths and

conducting other religious activities in the river. In total, five sampling sites associated with the

festival during its peak days were involved in the research process (Kumar et al., 2018). The

samples were analyzed for several aspects, including physico-chemical, microbiological and

heavy metals viz., total solids (TS), electrical conductivity (EC), temperature and total dissolved

solids (TDS).

Analysis of data involved the use of analysis of variance (ANOVA) in determining the

difference between the parameters that were utilized with respect to pre and post-celebration.

Standard deviation was assessed through the use SPSS12.0, MS Excel 2016 and Sigma Plot,

2000 (Kumar et al., 2018). The study showed that the physico-chemical and microbiological

parameters of the river varied across the sampling sites. What was gathered from the results is

that the mas celebrations significantly altered the quality of water, as indicated by the before and

after measurements. The recommendation from the study is that there is a need for managing and

controlling the gatherings and activities that take place. It suggested raising awareness among

pilgrims about the concerns of water pollution.

The research by Sharma et al. (2012) was predicated on examining the impact of mass

bathing on the quality of water in the Ganga River. It investigated the effects that arise from the

rituals that are associated with religious activities. The researchers focused on one specific event

of mass bathing, the Maha Kumbh, which took place from January to April 2010. This event is

regarded as the biggest festival, which takes place every 12 years and is attended by millions of

people (Sharma et al., 2012). The emphasis of the study was on Royal Bathing dates.

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 6

Three different sites were incorporated into the research. Samples were collected from

the sites following the event. The key parameters involved in the study included Temperature,

pH, Conductivity, TDS, DO, Turbidity, BOD, Chloride, Hardness, TSS and TS. Some

parameters, such as temperature and pH, were analyzed on the spot, while others were analyzed

in the laboratory. The findings showed that overall, the environmental conditions significantly

worsened after the event (Sharma et al., 2012). Different sites were affected differently following

the celebrations. The Ghat area of Sapt Rishi Ashram was least affected as it was the least used

for mass bathing. At Har- ki- Pauri, all parameters were affected as it was the area that was most

used for bathing.

Srivastava et al. (2016) focused on assessing the level of water pollution in the Ganga

basin. The purpose was to comprehend the role that mass religious gatherings play in influencing

water pollution. Samples were collected from 60 different sites, and various parameters were

measured. These sites were based in Uttarakhand district, specifically the regions of Rishikesh,

Haridwar and Roorkee within the Ganga basin. These parameters included pH, electrical

conductivity, dissolved oxygen (DO) and turbidity. Apart from the samples which were assessed

in a laboratory for quantitative results, real-time (RT) sensing and crowd-sourced, qualitative,

sensing with a mobile application were also utilized (Srivastava et al., 2016).

The researchers assessed both upstream and downstream regions of the basin in order to

understand the effect of mas bathing. The main variations were at Haridwar, which has bathing

Ghats. The study outcomes showed clear connections between the religious ceremonies and a

rise in pollution of the Ganga River. Srivastava et al. (2016) recommended that other researchers

use data from their study to develop actionable insights and decision aids that can be applied in

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 7

more use cases. Other studies can also feature the collection of more data, which can contribute

to the platform.

Analysis of Literature

The main takeaway from the studies that were included in the literature review is that

religious activities that take place along the Ganga River are instrumental in enhancing the

pollution and contamination of river's water. The Ganga basin is large and supports hundreds of

millions of people in India. These persons depend on water from the river for day-to-day

activities. Millions more people visit during the festivities, with some of them happening

annually and others being occasional. The rituals which entail mass bathing substantially affect

the water mass, thus making the water unfit for human use.

The studies have provided different perspectives, with all of them leading to the same

conclusion. Dimri et al. (2021) showed how the upper basin, which is relatively unused for

rituals, is considerably less polluted. Aenab & Singh (2013) chose an area that is quite prominent

for the activities. Kumar et al. (2018) provided key insights through assessing water before and

after the events. Sharma et al. (2012) focused on the impact of the largest event, while Srivastava

et al. (2016) used different techniques to evaluate pollution along the river. The studies looked at

the problem in different ways, which helped in compounding the understanding of the problem.

The results of the studies complemented each other.

The major similarity between the studies is the outcomes. They all pointed out that

religious rituals are directly associated with the pollution of the river. All of the studies involved

the collection of water samples from different sites and testing for different parameters that

revealed the connection between mass bathing and contamination. Srivastava et al. (2016) went

the extra mile by using two more techniques to assess the quality of water in the river. All

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 8

regions featured in the study were located along the Ganga basin with Kumar et al. (2018),

Srivastava et al. (2016) and Dimri et al. (2021) evaluating sites that are located in the

Uttarakhand district.

The studies used different parameters in the research process, though a number of them,

such as pH, electrical conductivity dissolved oxygen (DO) and turbidity, were uniform across the

three studies. Only Sharma et al. (2012) and Dimri et al. (2021) utilized an extensive number of

parameters that also included TSS, TDS and measurement of hardness. The analytical methods

used also differed. Most of them featured multivariate analysis due to the consideration of

multiple variables. Kumar et al. (2018) used ANOVA, SPSS12.0, MS Excel 2016 and Sigma

Plot, 2000, while Aenab & Singh (2013) used a C++ program. There was not much focus on

providing recommendations among the resources. Srivastava et al. (2016) recommended that the

findings be used to inform subsequent studies and plan for future events. Kumar et al. (2018)

recommended that the activities be checked and controlled, while Sharma et al. (2012)

recommended that the findings apply in influencing efforts to improve the quality of water.

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 9

References

Aenab, A. M., & Singh, S. K. (2013). Evaluating water quality of Ganga river within Uttar

Pradesh state by water quality index analysis using C++ Program. Civil and

Environmental Research, 3(1), 57-65.

https://d1wqtxts1xzle7.cloudfront.net/30633097/Evaluating_Water_Quality_of_Ganga_R

iver_Within_Uttar_Pradesh-libre.pdf?1391832450=&response-content-disposition=inline

%3B+filename

%3DJanuary_edition_of_The_International_Ins.pdf&Expires=1697055549&Signature=S

jzcoNcSNl~MJ3cMrA9~d15y1HLPyg~kwyGOV0VvI4ZxOaYnsl~4lCgPZovckTIf3PAj

5e4HX9P2N1SvC1eHPPLuati8I4E0Q0TmlfhNUzy53x4J6vFlrDL0iB9uWFYoH7Fg8g~

mlC4MxTcvA7vB0JitGZ-vKQi6oD7LxEbLiIfJ-

UjGgmwYJquVjFT5siwZCZK5ID4Rx7Q3LEsdjMTimfesDKa5k2xSIp5Am1zweOcZ12

kHTjbZh6MH0ZXd0FOVpirG9S7IlAxTAQ7t6qqJQLI6cx9SJwMl1z5CesPDEoq2FP4A

jWXe~Aeid6d4Tcd73uh2etbHj-~~xvt9gbnZMg__&Key-Pair-

Id=APKAJLOHF5GGSLRBV4ZA

Dimri, D., Daverey, A., Kumar, A., & Sharma, A. (2021). Monitoring water quality of River

Ganga using multivariate techniques and WQI (Water Quality Index) in Western

Himalayan region of Uttarakhand, India. Environmental Nanotechnology, Monitoring &

Management, 15, 100375. https://doi.org/10.1016/j.enmm.2020.100375

Kumar, V., Kumar, S., Srivastava, S., Singh, J., & Kumar, P. (2018). Water quality of River

Ganga with reference to physico-chemical and microbiological characteristics during

Kanwar Mela 2017, at Haridwar, India: A case study. Archives of Agriculture and

Environmental Science, 3(1), 58-63. https://doi.org/10.26832/24566632.2018.030108

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 10

Sharma, V., Bhadula, S., & Joshi, B. D. (2012). Impact of mass bathing on water quality of

Ganga river during Maha Kumbh-2010. Nature and Science, 10(6), 1-5.

http://www.sciencepub.net/nature

Srivastava, B., Sandha, S., Raychoudhury, V., Randhawa, S., Kapoor, V., & Agrawal, A. (2016).

An open, multi-sensor dataset of water pollution of Ganga Basin and its application to

understand the impact of large religious gatherings. arXiv preprint arXiv:1612.05626.

https://doi.org/10.48550/arXiv.1612.05626

UNEP. (n.d). Better sewage treatment is critical for human health and ecosystems.

https://www.unep.org/news-and-stories/story/better-sewage-treatment-critical-human-

health-and-ecosystems

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 1

Effect of Ritualistic Bathing on Water Quality of Ganga River in India

Nayan Harshadkumar Patel

Department of Public Health, Monroe College, King Graduate School

PH690- Global Health

Professor Aditi Puri

October 15, 2023

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 2

Effect of Ritualistic Bathing on Water Quality of Ganga River in India

The issue being explored revolves around the pollution and contamination of water

bodies concerning the Ganga River. The river supports millions of people in India. As such, the

river's water quality bears significant implications for the well-being of the inhabitants and the

entire ecosystem. Pollution and contamination of the Ganga River mean people lack safe and

suitable water.

The main aspect that is involved in this case is the social element of Indian people. The

religious mass bathing events are the main reasons why the river is contaminated. The

contamination also comes about due to industrial wastes and the disposal of sewerage into the

river. The outstanding issue is that individuals suffer from health problems such as water-borne

diseases because of the pollution of the river. There have been higher incidences of diarrhoea,

cholera, pneumonia, typhoid and skin disease, especially among the fisher folk who heavily

depend on the river for water for consumption (UNEP, n.d). The diseases have remained quite

prevalent, especially because sewage treatment plants located on the Ganga have been expensive

to maintain and are ineffective during monsoons. They are unable to treat wastes such as heavy

metals, pharmaceutical products or personal care products, which can be directly traced to mass

bathing activities (UNEP, n.d).

The issue of pollution of the Ganga River must be addressed because of the fact that it

supports the basic needs of millions of people. One measure that can be useful in solving the

problem is raising awareness and educating people on the repercussions of mass bathing. Some

of the programs that have been successful in other areas have included establishing effective

sewerage treatment infrastructure and river-surface cleaning.

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 3

Literature Review

The Ganga River has immense cultural, heritage and religious significance and, as such,

has been heavily utilized for bathing rituals that have led to pollution and contamination of

water. The events tend to substantially lower water quality, making it unsuitable for use. Given

that there is significant dependence on the river for use in other aspects of life apart from the

religious factor, it is important that the problem is addressed. The Ganga River is one of the

biggest river systems worldwide, and as such, it serves numerous communities across its basin,

with 37% of India's population inhabiting the river's basin. It covers an ecosystem spanning 2525

km while covering 26.2% of the entire land mass in India. The basin is the fifth largest in the

world, with an area of 1,060,000 km2. (Dimri et al., 2021). The research uses five peer-reviewed

journals from databases that included ScienceDirect, Researchgate and Archives of Agriculture

and Environmental Science (AESA). The key searches were “Ganga River,” “Water pollution,”

“Contamination” and “Water quality.”

Review of Literature

Dimri et al. (2021) investigated the quality of water in the Ganga River using the water

quality index and multivariate techniques. The focus of their study was the upper Ganga basin

region of Uttarakhand, India. The purpose of the study was to assess the water quality of the

Ganga River. It looked to identify spatial and temporal deviation of water quality across 24

different sampling sites in the upper Ganga basin. The researchers also looked to determine the

water parameters which are associated with the variations and the impact of the pollution.

The water samples were collected from 24 different sites and were analyzed using

multivariate statistical techniques and the water quality index (WQI). The focus area of the study

was a region covering a stretch of 294km (Dimri et al., 2021). The researchers measured 19

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 4

physical and chemical parameters over the span of three seasons. The parameters, which

included EC, TDS, COD, Alkalinity, Hardness, MPN, Ca, and HCO3, indicated that there is a

high standard deviation, which is a result of the dispersion, and this translates to spatial variation

of the parameters. The study showed that the upper basin of the Ganga River is relatively

unpolluted because there is less interference by human beings and their activities (Dimri et al.,

2021). The majority of the parameters were deemed to be within permissible limits.

Aenab & Singh (2013) also evaluated the quality of water of the Ganga River. Their

choice of locale was Uttar Pradesh (UP). The purpose of the study was to evaluate several

monitoring stations along the river in UP state. Additionally, it was meant to create the river’s

specific water quality standards according to international standards and to provide a warning

system for users who are downstream in poor water conditions. The researchers evaluated 13

different monitoring stations using WQI analysis by the C++ program (Aenab & Singh, 2013).

Uttar Pradesh is one of the regions along the Ganga River which is faced with pollution.

Samples were collected in Uttar Pradesh, and relevant parameters were chosen to

establish consistent water quality measurements. The C++ program, also known as hybrid

language, helped evaluate the different parameters used in the research. The results indicated that

the standards of water along the river in the state of Uttar Pradesh are quite poor. The water was

regarded as being unsuitable for use. The recommendation was that individuals who live

downstream should be aware of the quality of water and its consequences, given that they rely on

Ganga River's water for their daily use.

The purpose of the study by Kumar et al. (2018) was likewise based on the assessment of

the quality of water in the Ganga River. The researchers studied the impact that religious

activities, particularly Kanwar Mela, have on the state of water in the river. The study featured

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 5

multiple sites which carry religious and cultural significance in Haridwar City. Kanwar Mela is a

religious celebration carried out annually in July and entails individuals taking baths and

conducting other religious activities in the river. In total, five sampling sites associated with the

festival during its peak days were involved in the research process (Kumar et al., 2018). The

samples were analyzed for several aspects, including physico-chemical, microbiological and

heavy metals viz., total solids (TS), electrical conductivity (EC), temperature and total dissolved

solids (TDS).

Analysis of data involved the use of analysis of variance (ANOVA) in determining the

difference between the parameters that were utilized with respect to pre and post-celebration.

Standard deviation was assessed through the use SPSS12.0, MS Excel 2016 and Sigma Plot,

2000 (Kumar et al., 2018). The study showed that the physico-chemical and microbiological

parameters of the river varied across the sampling sites. What was gathered from the results is

that the mas celebrations significantly altered the quality of water, as indicated by the before and

after measurements. The recommendation from the study is that there is a need for managing and

controlling the gatherings and activities that take place. It suggested raising awareness among

pilgrims about the concerns of water pollution.

The research by Sharma et al. (2012) was predicated on examining the impact of mass

bathing on the quality of water in the Ganga River. It investigated the effects that arise from the

rituals that are associated with religious activities. The researchers focused on one specific event

of mass bathing, the Maha Kumbh, which took place from January to April 2010. This event is

regarded as the biggest festival, which takes place every 12 years and is attended by millions of

people (Sharma et al., 2012). The emphasis of the study was on Royal Bathing dates.

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 6

Three different sites were incorporated into the research. Samples were collected from

the sites following the event. The key parameters involved in the study included Temperature,

pH, Conductivity, TDS, DO, Turbidity, BOD, Chloride, Hardness, TSS and TS. Some

parameters, such as temperature and pH, were analyzed on the spot, while others were analyzed

in the laboratory. The findings showed that overall, the environmental conditions significantly

worsened after the event (Sharma et al., 2012). Different sites were affected differently following

the celebrations. The Ghat area of Sapt Rishi Ashram was least affected as it was the least used

for mass bathing. At Har- ki- Pauri, all parameters were affected as it was the area that was most

used for bathing.

Srivastava et al. (2016) focused on assessing the level of water pollution in the Ganga

basin. The purpose was to comprehend the role that mass religious gatherings play in influencing

water pollution. Samples were collected from 60 different sites, and various parameters were

measured. These sites were based in Uttarakhand district, specifically the regions of Rishikesh,

Haridwar and Roorkee within the Ganga basin. These parameters included pH, electrical

conductivity, dissolved oxygen (DO) and turbidity. Apart from the samples which were assessed

in a laboratory for quantitative results, real-time (RT) sensing and crowd-sourced, qualitative,

sensing with a mobile application were also utilized (Srivastava et al., 2016).

The researchers assessed both upstream and downstream regions of the basin in order to

understand the effect of mas bathing. The main variations were at Haridwar, which has bathing

Ghats. The study outcomes showed clear connections between the religious ceremonies and a

rise in pollution of the Ganga River. Srivastava et al. (2016) recommended that other researchers

use data from their study to develop actionable insights and decision aids that can be applied in

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 7

more use cases. Other studies can also feature the collection of more data, which can contribute

to the platform.

Analysis of Literature

The main takeaway from the studies that were included in the literature review is that

religious activities that take place along the Ganga River are instrumental in enhancing the

pollution and contamination of river's water. The Ganga basin is large and supports hundreds of

millions of people in India. These persons depend on water from the river for day-to-day

activities. Millions more people visit during the festivities, with some of them happening

annually and others being occasional. The rituals which entail mass bathing substantially affect

the water mass, thus making the water unfit for human use.

The studies have provided different perspectives, with all of them leading to the same

conclusion. Dimri et al. (2021) showed how the upper basin, which is relatively unused for

rituals, is considerably less polluted. Aenab & Singh (2013) chose an area that is quite prominent

for the activities. Kumar et al. (2018) provided key insights through assessing water before and

after the events. Sharma et al. (2012) focused on the impact of the largest event, while Srivastava

et al. (2016) used different techniques to evaluate pollution along the river. The studies looked at

the problem in different ways, which helped in compounding the understanding of the problem.

The results of the studies complemented each other.

The major similarity between the studies is the outcomes. They all pointed out that

religious rituals are directly associated with the pollution of the river. All of the studies involved

the collection of water samples from different sites and testing for different parameters that

revealed the connection between mass bathing and contamination. Srivastava et al. (2016) went

the extra mile by using two more techniques to assess the quality of water in the river. All

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 8

regions featured in the study were located along the Ganga basin with Kumar et al. (2018),

Srivastava et al. (2016) and Dimri et al. (2021) evaluating sites that are located in the

Uttarakhand district.

The studies used different parameters in the research process, though a number of them,

such as pH, electrical conductivity dissolved oxygen (DO) and turbidity, were uniform across the

three studies. Only Sharma et al. (2012) and Dimri et al. (2021) utilized an extensive number of

parameters that also included TSS, TDS and measurement of hardness. The analytical methods

used also differed. Most of them featured multivariate analysis due to the consideration of

multiple variables. Kumar et al. (2018) used ANOVA, SPSS12.0, MS Excel 2016 and Sigma

Plot, 2000, while Aenab & Singh (2013) used a C++ program. There was not much focus on

providing recommendations among the resources. Srivastava et al. (2016) recommended that the

findings be used to inform subsequent studies and plan for future events. Kumar et al. (2018)

recommended that the activities be checked and controlled, while Sharma et al. (2012)

recommended that the findings apply in influencing efforts to improve the quality of water.

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 9

References

Aenab, A. M., & Singh, S. K. (2013). Evaluating water quality of Ganga river within Uttar

Pradesh state by water quality index analysis using C++ Program. Civil and

Environmental Research, 3(1), 57-65.

https://d1wqtxts1xzle7.cloudfront.net/30633097/Evaluating_Water_Quality_of_Ganga_R

iver_Within_Uttar_Pradesh-libre.pdf?1391832450=&response-content-disposition=inline

%3B+filename

%3DJanuary_edition_of_The_International_Ins.pdf&Expires=1697055549&Signature=S

jzcoNcSNl~MJ3cMrA9~d15y1HLPyg~kwyGOV0VvI4ZxOaYnsl~4lCgPZovckTIf3PAj

5e4HX9P2N1SvC1eHPPLuati8I4E0Q0TmlfhNUzy53x4J6vFlrDL0iB9uWFYoH7Fg8g~

mlC4MxTcvA7vB0JitGZ-vKQi6oD7LxEbLiIfJ-

UjGgmwYJquVjFT5siwZCZK5ID4Rx7Q3LEsdjMTimfesDKa5k2xSIp5Am1zweOcZ12

kHTjbZh6MH0ZXd0FOVpirG9S7IlAxTAQ7t6qqJQLI6cx9SJwMl1z5CesPDEoq2FP4A

jWXe~Aeid6d4Tcd73uh2etbHj-~~xvt9gbnZMg__&Key-Pair-

Id=APKAJLOHF5GGSLRBV4ZA

Dimri, D., Daverey, A., Kumar, A., & Sharma, A. (2021). Monitoring water quality of River

Ganga using multivariate techniques and WQI (Water Quality Index) in Western

Himalayan region of Uttarakhand, India. Environmental Nanotechnology, Monitoring &

Management, 15, 100375. https://doi.org/10.1016/j.enmm.2020.100375

Kumar, V., Kumar, S., Srivastava, S., Singh, J., & Kumar, P. (2018). Water quality of River

Ganga with reference to physico-chemical and microbiological characteristics during

Kanwar Mela 2017, at Haridwar, India: A case study. Archives of Agriculture and

Environmental Science, 3(1), 58-63. https://doi.org/10.26832/24566632.2018.030108

EFFECTS OF RITUALISTIC BATHING ON WATER QUALITY 10

Sharma, V., Bhadula, S., & Joshi, B. D. (2012). Impact of mass bathing on water quality of

Ganga river during Maha Kumbh-2010. Nature and Science, 10(6), 1-5.

http://www.sciencepub.net/nature

Srivastava, B., Sandha, S., Raychoudhury, V., Randhawa, S., Kapoor, V., & Agrawal, A. (2016).

An open, multi-sensor dataset of water pollution of Ganga Basin and its application to

understand the impact of large religious gatherings. arXiv preprint arXiv:1612.05626.

https://doi.org/10.48550/arXiv.1612.05626

UNEP. (n.d). Better sewage treatment is critical for human health and ecosystems.

https://www.unep.org/news-and-stories/story/better-sewage-treatment-critical-human-

health-and-ecosystems