In our previous blog, we put forth that public health programs are crucial for health outcomes in low- and middle-income countries (LMICs), and identified what makes some succeed while others fail. One dimension we touched upon – particularly in the context of community demand – is information. In this blog, we hone in on this aspect of public health programs, and why it is especially relevant for women.
Women’s information disadvantage
Women in LMICs tend to have less health knowledge than men – simply because they are less likely to receive it. For instance, a systematic review of HIV knowledge among youth in LMICs finds that boys consistently score higher than girls on measures of HIV transmission and prevention (Chory et al. 2023). Factors such as lower educational attainment and lesser exposure to media, act as barriers to the access of health-relevant information by women (Vlassoff 2007, Klugman et al. 2014). Further, women in these settings are less likely than men to use mobile internet (GSMA, 2025); among adolescents and youth aged 15-24 in low-income countries, 90% of females are ‘offline’ as compared to 78% of males (UNICEF, 2023) – with gaps persisting even within wealthier sections of society (Atalay et al. 2024). Across 32 countries and territories, for every 100 male youth who have digital skills, only 65 female youth do (UNICEF, 2023).
Figure 1. Gender gaps in digital access in LMICs
Source: GSMA, 2025.
Notes: (i) Mobile ownership gap has remained relatively stable and narrow, hovering around 8-10%. (ii) The mobile internet gap, which started out being the highest at 25% in 2017, saw a sharp decline until 2020, before rising again until 2022. (iii) Smartphone ownership gap has remained persistently wide at around 14-18% and notably converged with the mobile internet gap by 2024 – both at approximately 14%. (iv) Overall, while more women may own basic mobile phones, significant barriers to smartphone ownership and internet use persist, limiting their ability to access digital health information and services.
Figure 2. Gender parity ratio of basic digital skills among youth aged 15-24, selected countries/territories
Source: UNICEF, 2023.
Notes: i) Gender parity ratio equal to 1 indicates that male and female youth have equal digital skills. ii) On average, only 65 female youth have digital skills for every 100 male youth who do.
Where formal channels are thin, people learn about health through their networks – and here too, women are disadvantaged. Social networks influence health behaviors in LMICs, from contraceptive adoption in Kenya (Behrman, Kohler and Watkins 2002) to vaccination take-up in rural Nigeria (Sato and Takasaki 2019). However, women’s networks tend to be smaller and more constrained, with social norms restricting their mobility and outside interactions including workforce participation (Jayachandran 2021).
Information dimension of public health programs
Public health programs may exclusively take the form of information campaigns on health matters, or provide specific goods, services, or financial support in the health domain. Across contexts, the spread of information and awareness tends to make them more effective in serving their objectives.
Conducting an experiment in Kenya, Dupas (2011) shows that when teenagers are informed about the relative risk of HIV infection by partner’s age, there is a 28% decrease in teen pregnancy, which is an objective proxy for the incidence of unprotected sex. Analyzing the role of financial incentives for mothers and healthcare workers in the use of maternal and child health (MCH) services, Debnath (2019) finds that there are stronger effects for women who are relatively more knowledgeable about other government programs.With regard to public health insurance, Dupas and Jain (2023) demonstrate that giving phone-based information to patients about the program enables them to bargain at public hospitals for their entitlements, driving bottom-up accountability. In the context of India’s subsidized LPG cooking fuel programme, Afridi, Debnath, and Somanathan (2021) find that health information alone was insufficient to shift behaviour — only when paired with information about the existing financial subsidy did households show a modest increase in clean fuel uptake, suggesting that information interventions must address the barriers that are actually binding.
Leveraging mobile technologies
As the use of mobile phones and internet in LMICs expands, there is an opportunity to disseminate public health information through this medium across geographies. Yet, given the gender inequalities in mobile access and digital literacy, caution ought to be exercised such that these initiatives improve gender relations with respect to health, rather than inadvertently reinforcing disparities. While mobile phone programs can have positive effects in the form of fostering emotional support and communication between spouses and enhancing women’s autonomy in seeking healthcare, these may also result in “upholding men as gatekeepers of information and sole decision-makers” (Kirkwood et al. 2022).
In the context of mobile health (mHealth)1 and women, the focus is primarily on MCH – with the most prominent uses being education and behavior-change communication (Labrique et al. 2013). Based on a scoping review of 63 studies on mHealth and MCH in rural areas of LMICs, Adusei-Mensah et al. (2025) note that these interventions surged after 2020, linked to the Covid-19 pandemic. The literature demonstrates that digital health interventions can improve outcomes such as antenatal care attendance, health literacy, breastfeeding practices, dietary adherence, and so on, in under-served communities. At the same time, there are challenges in the form of lack of contextual adaptation, with several interventions failing to consider the cultural and social realities of the target populations. Besides, scalability is limited by low access to mobile technology, digital literacy, and infrastructure. The authors advocate for greater engagement and partnership with communities, including in the design of digital health tools. According to Small et al. (2024), the mode(s) of delivering information via mobile phones may matter: while one-way SMS communication is most common, there is a need to evaluate multimodal interventions including phone calls, group communication, visuals like videos and photos, on-demand access to information or counselling, etc.
One reason why patients lack adequate information is the paucity of health professionals and short doctor-patient interactions. Add to this women’s limited agency and social constraints in accessing healthcare. In such a context, popular messaging apps like Whatsapp may have a role to play. Yadav et al. (2022) study an initiative by an NGO in rural North India wherein stage-based support is provided to expectant and new mothers via Whatsapp groups. Women in the group obtain access to health education, professionals, and peer women. The researchers found that the groups created an open public space for communities and health professionals to connect, and was a convenient source for women to have their unmet healthcare needs addressed. The type of support ranged from explanation of test results, to reassurance and counselling.
On the non-MCH front, Zhang et al. (2020) synthesize research on the impact of mHealth on health behaviors pertaining to cervical cancer screening. While cervical cancer is a largely preventable disease, related screening remains limited in LMICs. Since there are techniques available for detection of precancerous cells or risk factors, programs that increase knowledge and awareness may help improve outcomes. An insight drawn from the literature is that a mobile text message can raise the uptake of cervical cancer screening to a greater extent as compared to traditional methods such as postal mail. However, evidence regarding the effect of mHealth tools on awareness regarding the disease is found to be inconclusive.
A recurring theme in these reviews is the need for greater rigor in research. Based on a review of similar studies, mostly from sub-Saharan Africa (SSA), Rossman et al. (2021) echo that there is limited, rigorous evidence on the effectiveness of digital health technologies for cervical cancer, and that further investigation can help in the design of optimal interventions. For example, in perinatal mHealth studies, there is dominance of pre-post study designs, which may exaggerate intervention impacts. This can be addressed by conducting high-quality randomized controlled trials (RCTs) and having longer follow-up periods. With regard to cervical cancer, some of the covered studies suffer from ‘selection bias’, that is, they have enrolled only teachers, only married women, or only women with prior screening history – limiting the generalizability of the findings (Zhang et al. 2020).
Role of community groups
Prost et al. (2013) undertook a systematic review and meta analysis of RCTs from Bangladesh, India, Malawi, and Nepal, to assess the impact of women’s groups practising learning and action – relative to routine care – on birth outcomes. The thinking is that empowered groups can give women the understanding, confidence, and support to choose a healthy diet and seek advice or care outside the home. Further, health education is more empowering if it involves dialogue and problem-solving rather than message giving. The researchers find that these groups lead to an increase in care-seeking and self-care among pregnant women, which in turn reduces neonatal and maternal mortality in rural, low-resource settings. For significant effects, there should be participation of at least one-third of pregnant women and population coverage of 450-750 per group.
More broadly, social capital – that is, social relations that may provide individuals and groups with access to resources and support in their community networks – is gaining importance in public health. Mengesha et al. (2021) synthesize quantitative and qualitative literature on social capital and the uptake of MCH services in LMICs. Women in communities with higher membership in groups, were more likely to utilize antenatal care services. These positive effects are obtained because women receive emotional and instrumental support from the network, with sociocultural factors and receiving information from trusted persons playing a role.
Yet, there may be constraints on women’s access to and benefits from social networks in contexts of patrilocality, that is, living with or close to the husband’s family after marriage. Based on a primary survey in the Indian state of Uttar Pradesh, Anukriti et al. (2000) demonstrate that co-residence with the mother-in-law (MIL) is strongly negatively associated with the daughter-in-law’s mobility and ability to form close social connections outside the household – particularly those pertaining to health, fertility, and family planning. Women with a high number of close peers are more likely to visit a family planning clinic, accompanied by a friend, and to use modern contraceptive methods. Given the gatekeeping role of MILs, the researchers suggest involving them in strategies to promote family planning and use of reproductive health services.
Simply put, knowledge is power – certainly when it comes to women and their health.
In our next blog at the end of April, we will shift focus to the issue of health insurance.
FOOTNOTES
1According to the World Health Organization (WHO) (2011), mHealth is medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.
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