International Women's Day 2023: Overcoming the Digital Divide to Improve Women’s Health
Patricio V Marquez and Lani Rice Marquez
The global community comes together on March 8th to celebrate International Women's Day, this year under the theme "DigitALL: Innovation and Technology for Gender Equality”.
This year’s theme is apt as the gender gap in digital access keeps women and girls from unlocking technology’s full potential, particularly in marginalized communities.
The Mobile Gender Gap Report 2022 showed that mobile is the primary way men and women access the internet in low- and middle-income countries (LMICs), accounting for 85 percent of broadband connections in 2021. The report estimated that more than 3.2 billion people now access the internet on a mobile phone in these countries. Across LMICs, however, women remain 7 percent less likely than men to own a mobile phone, and are 16 percent less likely to use mobile internet, with the widest gaps in South Asia (41%), Sub-Saharan Africa (37%), and the Middle East and North Africa (16%), compared to Latin America and the Caribbean (1%), East Asia and the Pacific (2%), and Europe and Central Asia (5%). This means that there are still 264 million fewer women than men accessing mobile internet.
While men and women face the same barriers that prevent them from adopting mobile internet, including lack of literacy, digital skills, affordability of internet-enabled devices, safety, and security, women are disproportionately impacted as they tend to belong to groups that are most likely to be unconnected, such as those who are unemployed or have low literacy levels, and are also often affected by restrictive social norms which make mobile ownership and use more difficult.
Ensuring that women and girls have equal access to and use of digital technologies — mobile phones, computers, and the internet — is central to their economic and social empowerment and inclusive economic development. This can be facilitated by the adoption in countries of practical solutions to increase access, affordability, and usage, such as intentional design measures that locate public internet access points in safe spaces (e.g., libraries and community centers), designing registration policies that prioritize women and other vulnerable groups to obtain identification and other legal documents that are required to access digital public platforms, measures that improve the affordability of devices and data plans, and tailored digital skills education and training programs for women.
Overcoming the Digital Gender Gap is Critical to Address Health Gender Gaps
While conditions for women are improving, some major gaps still remain, negatively impacting their well-being across the world. One significant gap is excess female mortality and ill health, which could be avoided with better access to essential health services. But, despite health care advances in the past few decades, wide gaps persist in research and treatment for conditions that are unique to women, such as maternal and menstrual health, as well as for conditions that present differently in women than men. These gaps can result in major disparities in treatment for conditions that are largely preventable.
The COVID-19 also impacted vulnerable populations–especially women and children. Shortages of health workers were exacerbated, as many of them were diverted to managing COVID-19 cases or hampered by lack of personal protective equipment or advised to discontinue service delivery. Local or national lockdowns, along with the consequences of physical distancing, travel restrictions, disruptions on the supply chain for contraceptive commodities, and the fear of contagion in health facilities among pregnant women undermined or reversed the progress made in the past decade to improve the access to and quality of sexual and reproductive health services and reduce unwanted teenage pregnancy and maternal mortality.
Indeed, as documented in a recent UN agencies report, “Trends in Maternal Mortality”, alarming setbacks for women’s health have taken place over recent years, as maternal deaths either increased or stagnated in nearly all regions of the world. And, as revealed in the report, in total numbers, maternal deaths continue to be largely concentrated in the poorest parts of the world and in countries affected by conflict (e.g., in 2020, about 70% of all maternal deaths were in sub-Saharan Africa, and in nine countries facing severe humanitarian crises, maternal mortality rates were more than double the world average (551 maternal deaths per 100 000 live births, compared to 223 globally). Even in high-income countries, women in minority and low-income population groups were at highest risk of maternal mortality. In the United States, for example, four out of five pregnancy-related deaths are preventable. Moreover, increases seen in maternal mortality rates from 2018 to 2020 for non-Hispanic Black women and Hispanic women were significantly higher than increases for non-Hispanic White women. Severe bleeding, high blood pressure, pregnancy-related infections, complications from unsafe abortion, and underlying conditions that can be aggravated by pregnancy (such as HIV/AIDS and malaria) are the leading causes of maternal deaths. These are all largely preventable and treatable with timely access to high-quality and respectful care.
The Digital Revolution Presents Unprecedented Opportunities for Improving Women’s Health
Digital health has the potential to reshape health care delivery, including for women’s health. As accelerated during the COVID-19 pandemic, digital tools are rapidly becoming a core part of health care delivery, with high acceptability by consumers. They offer alternative service delivery models that help overcome obstacles that hinder access to care, such as transportation barriers, stigma associated with visiting mental health clinics and enrolling in substance use disorders rehabilitation programs, personnel shortages, and high costs. These platforms, especially in mobile formats, can offer remote screening, diagnosis, monitoring, and treatment, facilitate remote training for non-specialist health care workers, and enhance online peer-to-peer support and self-care. They can also offer digital appointment and medicine intake and refill reminders.
Digital technology can also facilitate access to information on important, but often taboo areas, such as sexual and reproductive health and rights, that are critical for improving women’s health. As observed by Ayesha Amin, the founder of the youth- and women-led organization Baithak—Challenging Taboos, a Generation Equality Commitment Maker in Pakistan, “When women don't have access to information, they are not able to make informed decisions about their bodies.” On top of stigma, mobility restrictions and lack of resources prevent many women from accessing crucial health services, and the digital divide can limit women’s access to life-saving information.
Over the past decade, an increasing number of apps and high-tech services that specifically address women's needs have been developed, including digital fertility and menstruation tracking and digital solutions for pregnancy, postpartum, and menopause. Remote fetal monitoring in the home, low-cost hand-held ultrasounds and apps that provide access to on-the-go blood pressure measurements are game-changers for at-risk pregnancies and are empowering clinicians and communities around the world who face barriers to accessing health care.
A number of innovative biotech companies are also focusing on both prevention and management of associated conditions. For example, as reported by The Lancet, new technologies, such as artificial intelligence (AI) approaches to cancer diagnostics, have advanced at a rapid pace in recent years. Advancement in AI that use non-invasive ultrasound images to accurately detect ovarian cancer or detect signs of breast cancer that radiologists miss is beginning to deliver breakthroughs. AI technology is showing an impressive ability to spot cancer at least as well as human radiologists—a tangible sign of how AI can improve public health.
Improved access to health services can facilitate early detection and treatment of conditions such as cervical cancer and breast cancer, where approximately half of breast cancers develop in women who have no identifiable breast cancer risk factor other than gender (female) and age (over 40 years), and help increase survival rates, since many women are diagnosed only after the disease is in an advanced stage, leading to higher case fatality. Since the human papillomavirus (HPV) is the main cause of cervical cancer, vaccination among school-aged girls is another critical disease prevention intervention, whose uptake could be promoted via social media and other digital platforms.
Likewise, digital tools can deliver information, education, and communication about how untreated maternal illnesses and lifestyle behaviors can also affect children. For example, poor maternal nutrition before and during pregnancy, as well as tobacco and alcohol use during pregnancy, contribute to poor intrauterine growth, resulting in low birth weight (LBW), which in turn predisposes the child to metabolic disorders and risk of non-communicable chronic diseases (NCDs) later in life. These problems are compounded by HIV and malaria, as LBW and malnutrition are more frequent in HIV-infected children, and malaria infection during pregnancy is a common cause of anemia and LBW. Information, education, and communication via social media and other digital platforms can also help confront the “economics of manipulation and deception” by the tobacco industry that target young women and girls through social media influencers, special parties and events, and celebrity endorsements, to encourage the consumption of cigarettes and new tobacco products such as e-cigarettes.
The use of digital technology for women’s health can create a more continuous line of communication between patients and health care providers through features such as online messaging, video appointments, and digital access to specialists. Various technologies have been developed to help support women’s health during pregnancy, including apps and online platforms aimed at providing women with medical insight and emotional support throughout pregnancy and post-birth, addressing the often-neglected issue of post-partum depression. These technologies are of particular importance for scaling up and expanding access to mental health services, given the stigma and discrimination that are still attached to mental and substance use disorders. Research findings indicate that pregnancy is associated with substantial changes in women’s brain areas that are responsible for social cognition and the ability to understand the thoughts and intentions of others, which can cause functional impairment at a time when the mother is performing tasks vital to an infant’s growth and development. Depressive and anxiety disorders during pregnancy and the post-natal period are common and are associated with compromised parenting behavior, nonresponsive caregiving practices, and a lower likelihood or shorter duration of breastfeeding. And in some countries, suicide, which is frequently caused by mental and substance use disorders, is a leading cause of death among women of reproductive age.
Supporting access to effective interventions to promote good nutrition, prevent anemia, and deliver reproductive health and other essential health services, including effective contraception, pre-natal care, child delivery, and post-natal care, as well as mental health services, are not only important for ensuring women’s well-being but also for improving nutrition in the early years of children and as preventive measures for arresting the explosive growth of NCDs worldwide.
While digital technology can pose threats to the safety and well-being of adolescent girls and contribute to domestic violence by helping abusers to coerce and control victims, it can also protect, empower, and improve victims’ access to justice. This is of great importance as intimate partner violence (IPV), the most common form of violence against women, causes serious short- and long-term physical problems and profoundly impacts their mental health, increasing risks of depression, anxiety and other mental disorders. A report by the World Health Organization (WHO) found that worldwide, nearly 1 in 3, or 30 percent, of women have been subjected to physical and/or sexual violence by an intimate partner or non-partner sexual violence or both. The prevalence estimates of lifetime intimate partner violence range from 20 percent in the Western Pacific, 22 percent in high-income countries and Europe, and 25 percent in the Americas to 33 percent in the Africa region, 31 percent in the Eastern Mediterranean region, and 33 percent in the South-East Asia region. Globally, as many as 38 percent of all murders of women are committed by intimate partners, and 6 percent of women report having been sexually assaulted by someone other than a partner. And data from countries such as the UK, show that suicide as a result of domestic violence is a hidden toll in women’s lives.
Innovative uses of technology to tackle domestic violence include apps and websites that can link victims with service providers and support groups; technology that can give victims in remote areas access to services and allow victims to can stay connected with friends and family, combating abusers’ attempts to isolate them; and CCTV cameras and GPS tracking devices that can alert victims and authorities if an abuser is approaching and help victims and police record incidences of domestic violence. These tools, alongside combating victim-blaming attitudes and education directed at the community, are vital in preventing domestic violence.
Health and social policies and programs that target the needs of women across the life cycle, including via new digital technologies, are also important for ensuring and supporting “healthy” life expectancy (the average number of years that a person can expect to live in full health—that is, not hampered by disabling illnesses or injuries). For example, while women’s health is frequently considered synonymous with reproduction, a growing number of start-ups are working to address menopause health, a critical, yet often neglected stage of female health care, by providing comprehensive support for menopausal concerns including health assessments, access to telehealth providers trained in menopausal health, numerous innovative products to help manage the process of menopause, and a connected online community.
A life cycle approach to women’s health is also required as there are marked gender differences in health and mortality patterns in older ages as well. Indeed, the world has more women than men aged above 50. In the age group 90-94 years, women outnumber men by a ratio of 2-to-1, and among centenarians, by 4-to-1. As women live longer than men, they face a double burden: not only are they at higher risk of spending more of their lives in poor health as observed in European Union countries, developing dementia (women are 20-30 percent more likely than men to die from Alzheimer’s disease and other types of dementia), and of living alone (24 percent of women vs 12 percent of men aged 65 years and above live alone), but they are also more likely to be the main caregivers as partners, daughters, and daughters-in-law.
The way forward
As we reflect on International Women’s Day 2023, it should be clear that addressing the root causes of ill health, premature mortality, and disability among women and enhancing women’s voice and agency to deal with limiting, and in some cases, oppressive, social and cultural norms and gender-based violence should be a cross-sectoral development priority going forward.
Dedicated policies and sustainable investments, including those from multi-entity arrangements such as The Global Financing Facility in Support of Every Woman, Every Child (GFF), to effectively harness and facilitate greater access to and use of digital technologies, have an important role to play in eliminating disparities in women's health and in helping turn the tide against the feminization of poverty and toward enabling women to lead lives of economic advancement and self-reliance. At the same time, these measures stand to contribute to the improvement of physical health and mental wellbeing of future generations, to the development of critical human capital that underpins economic growth and prosperity, and to building more resilient societies in the post-pandemic era.
Let’s be clear: only by ensuring the rights of women and girls to good health and to human capacity development will we achieve justice and inclusion, economies that work for all, and sustainability for our shared environment, now and for future generations.