We have known for over 30 years that, when women take the contraceptive “pill”, they urinate out the residues which do get through the sewage treatment system and end up in the rivers where, in one research study, male sticklebacks (a small fish) produced eggs.
It is relevant to note that much (maybe most or even all) sewage from hospitals is, quite legally (but questionably safely) put directly into the public sewer system and treated, along with general urban sewage, in conventional public sewage treatment works (STW’s) with the products released to water courses (some of which are later, down-river, extracted for human consumption) and farm fields. That sewage will certainly involve the technical issues involving drug and antibiotic residues, and significant pathogen levels.
I will, over the next couple of years, be looking at recycling hospital wastes, safely.
Bill Butterworth, Land Research Ltd, 17 October 2018