Introduction
By 2020, there will be an estimated 7.26 billion mobile phone users worldwide—a figure just short of the global population of 7.58 billion people.1 This has transformed phone connectivity and also access to the internet. In low-income and middle-income countries, mobile phones are the primary means of internet access and nearly half of women access the internet using mobile phones.2 Increasing access to mobile phones therefore makes digital interventions for health particularly enticing and strategic; to increase access to health information and also to support communication between patients and healthcare providers, and improve the uptake, content and quality of health services. Yet significant gaps persist between men and women’s ownership, access to, and usage of phones which may exacerbate existing inequalities and limit the potential reach and effectiveness of technology use for health improvement.3
Women’s phone access, in particular, is highlighted for its transformative and emancipatory potential to accelerate social and economic development.4–6 Given existing gender inequalities in many low-income and middle-income countries, mobile phones can be an equaliser—allowing men and women to access the same information.7 Mobile phones can help to empower women; connecting them to family, friends, information and services.2 8 In doing so, women’s access to mobile phones can challenge power relations and social norms, increasing women’s awareness and autonomy.9 In some settings, this may inadvertently increase risk to women; making them targets for backlash in contexts where conservative gender ideologies dominate.9
In the health domain, mobile phones are also increasingly becoming a modality for facilitating women’s access to health information and engagement with the health system. While evidence directly linking women’s phone ownership to changes in changes in reproductive maternal newborn and child health (RMNCH) outcomes is limited, secondary analyses of data from Burkina Faso suggest that women’s phone ownership may be associated with improvements in reported modern contraceptive use.10 Similar analyses carried out in India suggest women’s phone ownership in urban areas was positively associated with skilled birth attendance, postnatal care and use of modern contraceptives.
Indirectly, women’s phone ownership and access may influence participation in digital health programmes, including mobile health (mHealth) programmes which have been shown to increase women’s decision-making, social status and access to health resources, as well as influence gender relations in positive ways; providing new modalities for health communication and cooperation, and enabling greater male participation in health areas typically targeting women.6 11 Mobile phones are also increasingly being used in other ways that give women a voice in the health system, whether through feedback on the content and quality of health services,12–15 or through participation in phone surveys used to generate evidence on disease burden16 17 or on women’s experiences with the health system.18
Despite their immense potential, underlying inequities in women’s phone ownership, access and use may inadvertently drive inequities in women’s access to health information and services and in the adoption of practices linked to improved health outcomes, particularly among mothers and children.9 19 20 In this analysis, we argue that addressing the gap between men and women’s phone ownership (hereafter referred to as the gender gap) and increasing women’s access to and use of mobile phones has great potential for improving RMNCH health, particularly for populations most left behind tracked by Countdown 2030. In our conceptual framework, we map the relationship between women’s characteristics and social norms on access to phones. With access to a phone, women may have increased exposure to health information including health-related advice, appointment reminders, and/or provider interaction and engagement (figure 1). This, in turn, may yield changes in attitudes and knowledge which drive demand for health services and leads to changes in care-seeking and practices for RMNCH.
Drawing on data available on phone ownership in Demographic and Health Surveys (DHS), analyses will demonstrate that (1) gender gaps in mobile phone ownership vary, but they can be substantial, with less than half of women owning mobile phones in several countries; (2) the gender gap in phone ownership is larger for rural and poorer women; (3) women’s phone ownership is generally associated with better RMNCH indicators; (4) among women phone owners, utilisation of RMNCH care-seeking and practices differs based on their income status; and (5) more could be done to unleash the potential of mobile phones on women’s health if data gaps and varied metrics are addressed. Methods underpinning analyses are described in online supplementary file section 1.