The body of literature suggests that incorporating women into mobile health (mhealth) initiatives holds great potential for empowering women and reducing gender inequity while simultaneously improving access to health services.1,2 In spite of this, nobody seems to be investigating the barriers that women may face when participating in mhealth programs. There is a need to move beyond simply suggesting that women participate in these programs; we need to begin investigating and addressing the structural and societal barriers women face when seeking to participate in mhealth interventions.
This need became evident during my time in Guatemala, where I sought to document the scale-up of mhealth. Established in 2007, TulaSalud began a telehealth project with the goal of reducing maternal and infant mortality rates and improving access to health services in rural Guatemala, especially for indigenous populations. The pilot project has been extremely successful, demonstrating a statistically significant reduction in maternal mortality and saving a projected 80 lives in 2012.3 TulaSalud has hired many female community facilitators (CFs) and equipped them with basic medical supplies as well as a smartphone. Over a period of two weeks in June 2015, I travelled to various rural communities in the Department of Alta Verapaz in order to interview CFs and learn about some of the challenges they face in their everyday work. Interestingly, half of the female CFs identified their greatest challenge as a lack of trust from patients, families, and village leaders. In contrast, none of the male CFs interviewed identified this as one of the challenges in their work, which suggests this mistrust may be gendered. Although both male and female CFs underwent the same level of health training, only female CFs were perceived by community members as not adequately trained for the role.
Addressing this gender barrier to participation in mhealth is important because CFs hold a position of power within their community; mobile phones provide a platform on which to advocate change and participate in community affairs.4 This is especially relevant in Guatemala, where women experience “restrictions on…access to, participation and voice in the public and social spheres”.5 These restrictions on civil liberties have been linked to increased maternal mortality and unintended pregnancies, as well as gender-based violence.6 Including women as not only beneficiaries of mhealth interventions but as active participants, can therefore promote gender equity in Guatemala.
In conclusion, a more rigorous investigation into the intersection between gender and mhealth needs to be conducted in order to inform future interventions. TulaSalud’s work in Guatemala serves as a case study highlighting the importance of creating a gender strategy when implementing mhealth interventions. Further research is needed to develop guidelines and best practices for mhealth project implementers.
|David Hill holds a Master of Science in Global Health from McMaster University with a concentration in Global Health Management. He currently works as the Program Administrator in the Global Health office at McMaster University in Ontario, Canada.|
1) Research in Gender and Ethics: Building Stronger Health Systems. (2015). mHealth and gender: Making the connection. Retrieved from: http://resyst.lshtm.ac.uk/sites/resyst.lshtm.ac.uk/files/docs/reseources/RinGs%20Policy%20Brief%20-%20mHealth%20%26%20Gender.pdf
2) Jennings, L. &Gagliardi, L. (2013). Influence of mHealth interventions on gender relations in developing countries: a systematic literature review. International Journal for Equity in Health, 12(1), p.85.
3) Martínez-Fernández, A., Lobos-Medina, I., Díaz-Molina, C.A., Chen-Cruz, M.F., & Prieto Egido, I. (2015). TulaSalud: an m-health system for maternal and infant mortality reduction in Guatemala
4) Groupe Speciale Mobile Association. (2015). Bridging the gender gap: Mobile access and usage in low- and middle-income countries. Retrieved from http://www.gsma.com/connectedwomen/wp-content/uploads/2015/02/GSM0001_02252015_GSMAReport_FINAL-WEB-spreads.pdfOECD Development Centre, 2015
5) OECD Development Centre. (2015). Social institutions and gender index. Retrieved from http://genderindex.org/
6) Paruzzolo, S.,Menhra, R., Kes, A., & Ashbaugh, C. (2010). Targeting poverty and gender inequality to improve maternal health: Executive Summary. Retrieved from http://www.icrw.org/sites/default/files/publications/Targeting-Poverty-Gender-Inequality-Improve-Maternal-Health_0.pdf
Photo credits: TulaSalud