Closing The Gender Digital Divide: How Digital Health Innovations Are Improving Health Care For Mothers And Saving Lives

Closing The Gender Digital Divide: How Digital Health Innovations Are Improving Health Care For Mothers And Saving Lives

By Mark Allen, MSD for Mothers*

Mothers shepherd most of us through the first years of our lives, nurturing and protecting us, as we take our first steps in the world. Their pregnancy journey also determines how healthy we are as we begin our life’s adventure. Supporting maternal health is therefore critical to improving the quality of life for everyone, and ensuring people across the planet have the best possible launching point for their lives.

However, for mothers to be able to access the best possible health care, they also must be digitally empowered.

Mobile internet access and use are growing rapidly in many low-and middle-income countries, particularly in sub-Saharan Africa, creating many opportunities in health care – as a way to expand access to services and to support remote medicine, a key consideration in this age of COVID.

Mrs Ibrahim, pictured above with her newborn son, had a safe and healthy delivery thanks to timely interventions by her health provider — facilitated by the mDoc CompleteHealth digital platform — to address her hypertension, a pregnancy complication that if left untreated can be very dangerous for both mother and baby. An onboarding process that focused on building digital literacy, combined with personalized health coaching, were key to ensuring Ibrahim’s participation and effective use of the tool — and made all the difference when it came time for her to deliver.

Sadly, as this digital health market explodes, many women may be left behindGSMA data shows that low-income women, women in rural areas and other vulnerable groups are still less likely than men to use mobile phones to access the internet. Common barriers for women include poverty, gender inequity, cultural norms and a lack of digital literacy. Access to services and affordability are longstanding issues.

Digital health innovators are figuring out how to overcome these barriers and reach these women – women who stand to benefit the most from what the tools offer. Three solutions – mDoc, Together for Her and Nivi – show that with the right approach, it is possible to close the gender digital divide and connect women to quality maternal and reproductive health services. And in doing so, they are helping to reduce inequality in health care and health outcomes.

Approach #1: Build digital literacy, build trust

Mrs. Ibrahim, of Northern Nigeria, was 26 weeks pregnant with her third child when she was introduced to the most CompleteHealth digital platform on a routine antenatal care visit. She learned how to navigate the online hub, access health-education messages, chat with her assigned health coach and input key health metrics for her personal dashboard. Mrs Ibrahim continued to check in and update her profile from home. When Mrs. Ibrahim’s blood pressure became elevated – a symptom of preeclampsia, a complication that can turn deadly if left untreated – her healthcare provider was able to quickly detect and manage her condition, and danger was averted. Mrs. Ibrahim says follow-up counseling and support through the platform empowered her to practice self-care for the remainder of her pregnancy, by keeping up with her medications and blood-pressure checks. She later delivered a healthy baby boy.

Mrs Ibrahim is a typical mDoc user, in that she’s not wealthy, and despite having access to a smartphone, she wasn’t using it as a health tool – until mDoc. The platform’s thorough onboarding approach includes reaching women both online and offline through community “NudgeHubs”, peer-based workshops and “Tele-education” classes, is seen by the platform’s implementers as one of the keys to mDoc’s success. By proactively addressing women’s doubts and concerns – about their own abilities to engage, the value of doing so, the perceived risks around sharing private information and other fears – they were able to build trust1. The more confident and comfortable the women were in using the technology, the team found, the more fruitful the engagement. The typical mDoc user is low-income; most live on less than $3 per day, slightly above the country’s poverty line. Notably, among this group, almost three quarters have smartphones. The mDoc team concluded, based on project experience, that for mDoc users, access to technology is not the challenge – it’s about finding innovations that speak to them.

Mark Allen, Director of Strategic Partnerships and Global Programs at MSD

Approach #2: Prioritise relevant, user-driven content

Incorporating the user’s perspective into the design of a consumer-facing digital platform is also critical. The developers of Together for Her (TFH), an interactive digital-health platform for pregnant women in India, had users test the service, then adapted the interface and other features based on their feedback. They made navigation more intuitive and content more relevant – adding a way to track healthy weight gain, providing tips for wellness practices and lifestyle choices and other information pregnant women said they were looking for and valued as part of their experience with the platform.

The team’s findings from its internal analysis of the platform showed that the most important adjustments to retain middle and lower-middle income users – their target groups, who together comprise 44 percent of the TFH user base – included partnerships with community groups and local health-care providers, as well as the development of content to build health literacy. When adjustments were made, engagement improved. Even seemingly minor changes made a big difference. Early on, the platform asked new users to input a specific delivery date. Only about a third would answer the question; even fewer (13 percent) were completing the registration process. Once the question was changed, allowing women to note their delivery month instead, completion rates tripled.

Approach #3: Provide multiple options for access

Nivi, an interactive platform that provides maternal and reproductive health information and service referrals in India, Kenya, Nigeria and South Africa, engages women via WhatsApp and Facebook Messenger, reaching them where they already “live” in the digital space. According to a recent user survey, cost is the chief concern among users seeking family planning, and a quarter of Nivi users live in rural areas, which are disproportionately low-income – all signs that Nivi is reaching underserved populations.

In Kaduna State, Nigeria, in particular – one of the country’s poorer areas, and one with particularly high maternal mortality and morbidity rates – interest in the platform is growing fast. Nearly 500 new users have registered since June – 300 of them since September – to receive reminders about upcoming antenatal care appointments and other alerts.

Offering different language options is also helping Nivi to boost engagement. In India, the platform’s chatbot feature is available in both Hindi and English, which has helped expand Nivi’s user base significantly, including among lower-income women with fewer years of education. A version in Hausa, the popular tongue in many parts of rural Nigeria, is in the works to further broaden reach among marginalised groups.

Digital health is the future of health

The COVID-19 pandemic sharply accelerated the demand for digital health technologies. Patients, providers and health systems are demanding more telehealth, remote monitoring, AI and other digital health tools to improve COVID-19 and non-COVID-19 health-care services. Governments and the private sector are investing heavily in digital infrastructure, expanding mobile telecommunications networks and broadband to previously underserved areas. The total number of mobile subscribers is expected to swell by another half a billion between 2020 and 2025, according to the GSMA – nearly two-thirds of them from Sub-Saharan Africa and the Asia Pacific region. It is critical that we continue to support efforts by digital innovators to make it easier to adopt these services – to facilitate digital literacy training for women, to make it clear that these tools are relevant to women’s lives, and to involve women in solution design.

Digital innovation is helping to ensure that mothers have healthy births and can give their children the best possible start in life. Closing the gender digital divide is thus a key part of improving health care for mothers and saving lives. At MSD for Mothers, we are committed to working to ensure that no woman is left behind.

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