October 2023: Gender Considerations in Digital Health

AS George et al, Gender Dynamics in Digital Health: overcoming blind spots and biases to seize opportunities and responsibilities for transformative health systems, Journal of Public Health, Volume 40, 2018

“A critical first step is to understand existing gender inequalities and the power relations that underpin them. Consulting marginalized women and understanding their social context and relationships is vital to ensure that digital health addresses their needs and does not further harm them.”

Key Takeaways: 

• Digital interventions that don’t address the underlying power relations in a community could further widen existing gender inequalities.
• Digital technologies have addressed gender inequalities, for instance, by supporting decision-making and communication between couples.
• It is imperative to consult marginalized populations as well as the gatekeepers when designing and delivering strategies to target structural changes.
• There is a need for ongoing monitoring, evaluation, and research on the intersection of digital health, gender, and other social factors to better understand their consequences.

Comment from the Center for Global Digital Health Innovation: 
Digital interventions present an opportunity to make health systems more equitable. For example, from a gendered perspective, digital health technologies can provide demand-side benefits by promoting health-seeking behavior among women, and they can foster supply-side improvements by training frontline healthcare and community workers. Looking ahead, digital health programs can be designed to transform the social context by including key populations during an intervention's planning stage when the intersectionality between gender and other social factors can be explored.  

C Figueroa et al, The Need for Feminist Intersectionality in Digital Health , Lancet Digital Health, Volume 3, 2021

“Using feminist intersectionality, we can understand how to design and disseminate digital health to achieve health equity. We are at the forefront of applauding digital health’s boom, but if we do not tackle digital health’s gender inequities, health apps might increase rather than eliminate them.”

Key Takeaways

• While women are often perceived as a homogenous group, ignoring intersecting racial and ethnic identities can result in poor health outcomes for minority populations.
• In the U.S., only 3% of commercial digital health venture capitalist funding since 2011 has focused on women’s health, resulting in very few interventions that address their health priorities.
• There is a lack of female leadership in digital health, with women making up only 12.2% of partners at venture capital funds, and only 10% of chief executive officer positions.
• The language used by health apps is often gendered and can exclude the people deemed to behave outside of gender norms, harming trans, intersex, and non-binary populations.
• Women, especially those from marginalized backgrounds, need to be included in the design and testing of apps to reduce software-related security risks as well as inherent bias in design and algorithms.

Comment from the Center for Global Digital Health Innovation:
It is imperative to address gender inequities in digital health by implementing transformative change at the strategic decision making level. Women professionals working in the digital health field need to be encouraged to serve in leadership roles and funding needs to focus on interventions that address women’s health priorities. We need to promote greater representation of women and other marginalized groups in digital health research. We also need to elevate these groups' needs at the intervention design stage, by designing interventions to be accessible to women and other marginalized groups as end users. The feminist intersectionality framework can help inform the approach for overcoming existing gender inequities, ultimately benefitting women's health.

A Labrique et al, Improving success of non-communicable diseases mobile phone surveys: Results of two randomized trials testing interviewer gender and message valence in Bangladesh and Uganda, PLOS ONE, 2023

“[The study] demonstrates the need for a better understanding of the impact of gendered voice and introductory message by cultural context on survey performance metrices. Further exploration of such nuances is crucial for not only improving survey participation in LMICs but also for reducing gendered data gaps in these survey modalities.”

Key Takeaways

• Researchers must carefully calibrate their strategy for data collection using mobile phones. This study discusses the findings of two randomized controlled micro-trials in Bangladesh and Uganda that assessed variables including the effect of the perceived gender of recorded voices in Interactive Voice Response (IVR) surveys in LMICs.
• The study showed a relatively better performance of using a female voice in Bangladesh, with the response rate for the female voice and introductory message being significantly higher than in surveys that used a male voice.
• Results in Uganda were different from the study in Bangladesh, which demonstrated a need for further research in understanding the effect of gendered voice and the cultural context on survey performance metrics.
• While gender roles are fairly traditional in both countries, the authors hypothesized that the gender gap in phone ownership and lower participation of women in the public workforce in Bangladesh could have influenced the findings of the study.

Comment from the Center for Global Digital Health Innovation:
Further research on the effect of gendered voice and the social context for IVR surveys is necessary in order to improve survey performance metrics and reduce the gender data gap. With rising levels of survey fatigue, spam messaging, and distrust of motivational messages, there is a greater need to explore factors that motivate survey respondents to participate in and complete mobile phone surveys.