More Women's Mobile Phone Ownership & Less Digital Health Impact: Evidence from South Asia

Updated: Dec 17, 2021

Do Increases in Women's Mobile Phone Ownership Translate into Increased Personal Agency? What Happens to Industry-wide Gender Assumptions as Mobile Phone Markets Become More Affordable?


Quick Take

Ease of access to mobile phones and mobile phone ownership are common progress measures to assess digital gender gaps. Unlike general measures of access, mobile phone ownership is often equated with enabling greater control for women-- bypassing traditional gatekeepers and social hierarchies. In this sense, mobile phone ownership has been used as a proxy of women's agency- a precursor to meaningful shifts in health behavior. But, recent evidence from India and Bangladesh clarifies that women's mobile phone ownership is adapting to norms-- not transforming them. Notably, lower income women don't just benefit less, but differently-- suggesting that increased mobile phone ownership isn't the key metric nor the answer for more effective digital health at this advanced stage of mobile phone and digital markets. Rather, clarity on how gender norms are quietly shifting long-standing industry assumptions can yield more accurate information on distinct pathways to health action among lower income women.


Why Focus on South Asia?

South Asia is becoming a bellwether for next iterations of digital gender divides, with some of the most affordable mobile phone markets per capita income in the world. A growing South Asia mobile market bubble has led to a significant decline in economic barriers to mobile phone use for low income segments of communities.


Initially India but now with Bangladesh and Pakistan following similar trajectories, this increased affordability is attributed to government incentives to draw mobile phone manufacturing within their borders as well as intense market competition driving down digital data usage rates.[1]


Whether this affordability will remain in the long run is an unanswered question but what it has provided is a multi-year window to clarify what happens to digital gender divides when economic constraints are kept at bay for many communities. More specifically, it enables asking whether a conceptually-grounded understanding of mobile phone ownership as a proxy metric for women’s agency aligns with real world evidence from the health domain.


Evidence of Increased Mobile Phone Ownership Among Women & Digital Data Affordability

In 2020, the national gender gap in mobile phone ownership was 15% in India, 24% in Bangladesh and 34% in Pakistan, according to GSMA’s Global Mobile Gender Gap Report in 2021. At a regional level, increased affordability in these three countries, among other factors, may have helped move the needle on women's digital mobile phone ownership gaps.


In fact, compared to the rest of the world, South Asia is the only region to have demonstrated notable movement-- modestly shrinking the gender gap in mobile phone ownership from 26% in 2017 to a 19% gender gap in 2020.[2] In contrast, ownership rates among women in Sub-Saharan Africa and the Middle East have remained relatively static during the same period—reducing by 1%, and increasing by 1%, respectively.


Alongside competitive prices for digital data, these factors remove significant economic barriers for communities in lowest income categories. But, how gender may influence this shift is less clear from the commercial and usage data on mobile phone connectivity, where mobile phone usage is the end point. In contrast, digital health intervention data is providing preliminary insights on how mobile phones, as strategies, are operating within daily lives of women and communities.

Country

Digital Data Affordability in US Dollars

Maturing Mobile Phone Markets in South Asia & The Two Digital Health Gender Divides

Unsurprisingly, women in higher income strata are more likely to own their own mobile phones, more likely to benefit from digital health interventions.[3] [4] [5] For instance, data reporting on mobile health intervention outcomes in 13 Indian states—covering 10 million mobile phone subscribers—found nine out of eleven health indicators benefited women who report higher income.[6] A study among Bangladeshi women residing in slum neighborhoods reported higher income women had five times the odds of using mobile phones to access health services than women reporting lower incomes.[7] Evidence suggests this may be more nuanced than a matter of greater numbers of higher income women with mobile phones or higher income women navigating with greater digital skills.


Differences in which indicators benefit high versus low-income women

Among those that are being reached through digital health interventions, lower income women don’t just benefit less-- they benefit less and differently. These differential influences on findings suggest digital health outcomes may function through different pathways for high and low income women.


For instance, lower income women demonstrate digital health intervention benefits from women’s health indicators related to breastfeeding and sterilization. In contrast, higher income women benefit from digital strategies enabling access to antenatal care and modern contraceptive use compared to women in lower income strata, according to global data.[8] [9]


Lower-Income Women, Health Decision-Making & Missing Decolonial Digital Strategies

A closer examination among lower-income women suggest underlying gender power dynamics may continue to factor into women’s autonomy as affordability improves for lower-income communities. A 2018 study in 8 Dhaka slums among 800 women identified just over half the study sample as mobile phone owners (53.4%) and 73% reported mobile phone use to access health services.[10] Women who resided in female-headed households had 85% higher odds of using mobile phones for maternal and child health related issues, while women whose husbands had regular jobs had 46% higher odds of mobile phone use compared to husbands who were laborers.


Additional qualitative research lends weight to the suggestion that gender dynamics have shifted but not disappeared as technology scales across economic lines. Notably, recent qualitative evidence from rural India reported on husband support for women’s digital utilization and mobile phone ownership. But, in practice, this translated into a superficial definition of ownership, with the device controlled by the husband.[11] A similar gendered & local adaptation is demonstrated with women’s perceived autonomy & privacy issues and smartphone ownership. Young women reported accepting attitudes when it came to family members routinely monitoring smartphone activity-- dismissing autonomy as a right or need associated with smartphone use for them.[12]


The study author highlights the colonial dimension of the disconnect and indeed, this tension between commercial+Western constructs of autonomy and the lived experiences of women in South Asia are directly implicated in handicapping digital health strategy effectiveness. Consistent with this is evidence that a focus on mobile phone ownership may, in fact, be handicapping digital health strategies in reaching more vulnerable segments of women. An alternative is more explicit exploration of digital health pathways to optimize shared mobile phone use-- an important strategy for women in lower income brackets, regardless of education levels. For example, among participants who were rural and illiterate women in India, 85% reported mobile phone use that was largely shared mobile phone use & less reporting explicit ownership of mobile phone.[13]


Practical Implications for Digital Health Strategies in Maturing Mobile Phone Markets

Evidence from South Asia suggests that as affordability increases, narratives around women’s mobile phone ownership suggesting uniform effects on women via greater autonomy are increasingly inaccurate. In the context of digital health outcomes, this may be driving a deeper health divide between higher and lower income women.


Furthermore, the potential for different digital health pathways to health action for high and low income women means that a continued focus on increasing access to the same digital health strategies will likely continue to disproportionately benefit women with more resources.


While additional research is clearly needed, there is ample proof of concept to acknowledge a disconnect between earlier and more mature stages of mobile phone markets in regard to autonomy afforded by mobile phones and real world evidence among women in South Asia. The next stage of digital health requires more precise clarity to inform course correction. For this, re-framing planning, monitoring and evaluation for digital health include acknowledgement of two macro level shifts in digital gender & health narratives.


First, as the South Asian mobile phone markets mature, digital gender gaps are creating within gender gaps between women in high and low-income strata.


Lower-income women are less likely to be reached. Even when low-income women are reached, current digital health strategies disproportionately benefit higher-income women rather than lower-income women.


Second, technology is adapting to social norms instead of technology transforming social norms.


Real world digital health evidence from India & Bangladesh provides a counterpoint to current commercial definitions reflecting mobile phones as a democratizing force in the context of health. Seemingly uncontroversial assumptions (e.g., ownership) are adapting to local gender norms as opposed to transforming them.


Finally, these implications translate into concrete actions for digital health intervention planners. In the context of gender and increasing affordability of digital devices and data, this includes:

  1. Metrics to capture relative versus absolute mobile phone ownership

  2. Metrics to capture gendered attitudes towards mobile phone ownership and autonomy related to health behavior and health decision-making that are defined by localized gender context

  3. Collection of data disaggregated by both gender and income is to inform effective digital health strategies responsive to low-income women



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References
[1] Ahmed, Y. The driving forces behind the high-growth South Asian smartphone markets. [2] GSMA. Connected Women- The Mobile Gender Gap Report 2021.
[3] Mistry SK, Akter F, Yadav UN, et al. Factors associated with mobile phone usage to access maternal and child healthcare among women of urban slums in Dhaka, Bangladesh: a cross-sectional study. BMJ Open 2021;11:e043933. doi: 10.1136/bmjopen-2020-043933
[4] Mohan D, Scott K, Shah N, et al. Can health information through mobile phones close the divide in health behaviours among the marginalised? An equity analysis of Kilkari in Madhya Pradesh, India. BMJ Global Health 2021;6:e005512. [5] LeFevre AE, Shah N, Bashingwa JJH, et al. Does women’s mobile phone ownership matter for health? Evidence from 15 countries. BMJ Global Health 2020; 5: e002524. [6] Mohan, D., Bashingwa, J. J. H., Tiffin, N., Dhar, D., Mulder, N., George, A., & LeFevre, A. E. (2020). Does having a mobile phone matter? Linking phone access among women to health in India: An exploratory analysis of the National Family Health Survey. PloS one, 15(7), e0236078. [7] Mistry SK, Akter F, Yadav UN, et alFactors associated with mobile phone usage to access maternal and child healthcare among women of urban slums in Dhaka, Bangladesh: a cross-sectional studyBMJ Open 2021;11:e043933. doi: 10.1136/bmjopen-2020-043933 [8] LeFevre AE, Shah N, Bashingwa JJH, et al. Does women’s mobile phone ownership matter for health? Evidence from 15 countries. BMJ Global Health 2020; 5: e002524. [9] Greenleaf, A. R., Ahmed, S., Moreau, C., Guiella, G., & Choi, Y. (2019). Cell phone ownership and modern contraceptive use in Burkina Faso: implications for research and interventions using mobile technology. Contraception, 99(3), 170-174. [10] Mistry SK, Akter F, Yadav UN, et alFactors associated with mobile phone usage to access maternal and child healthcare among women of urban slums in Dhaka, Bangladesh: a cross-sectional studyBMJ Open 2021;11:e043933. doi: 10.1136/bmjopen-2020-043933 [11] Scott, K., Shinde, A., Ummer, O., Yadav, S., Sharma, M., Purty, N., ... & LeFevre, A. E. (2021). Freedom within a cage: how patriarchal gender norms limit women’s use of mobile phones in rural central India. BMJ global health, 6(Suppl 5), e005596. [12] Iqbal, R. (2021). Gendering of Smartphone Ownership and Autonomy among Youth: Narratives from Rural India. arXiv preprint arXiv:2108.09788. [13] Garg, C. (2021). Is Mobile Phone Use Invading Multiple Boundaries? A Study of Rural Illiterate Women in India. Indian Journal of Gender Studies, 28(1), 29-45.