Using technology to boost reproductive health & rights in India

By Kezia Yonzon

Having a choice of one’s own and exerting the choices have inherent considerations. This discourse is fundamental to public health and more specifically in the domain of reproductive health. The role of technology, given its reach and affinity to individual’s choice, is one way of affirming demand generation and access to family planning services and in a comprehensive manner.

The information gathered through these technology-based platforms are as valuable as the services being provided from the provider’s lens and much driven by the demand per se. Technology makes it easier to identify the trends and patterns and align the targets, whether it be the contents endorsing family planning or making modern methods of contraception accessible. It helps bridge the gap between the demand and the supply and most importantly, provide need-based family planning services.

Ensuring only service delivery may not be enough

Several initiatives have been undertaken to revamp the health care system across the globe with technology as the key lever. India certainly does not lag behind in this advancement. The e-health division of Ministry of Health and Family Welfare (MoHFW) hosts several eHealth initiatives using various web and mobile-based platforms. A preliminary look at the 74 odd mobile health (mHealth) initiatives listed in National Health Portal suggests that the initiatives are aimed at bringing efficiency in service delivery. Technological advancement in health not only restricts itself to advancing the means of health care provision but also extends to regulation and continuum of care. The effect of mHealth to improve health care service delivery could be seen at different levels, including medical education, clinical diagnosis, and management, communication to or between health care providers as well as follow-up care (Free, et al., 2013). The contribution, hence, cannot be stifled when it comes to supply side of the health care provision. But are technological initiatives such as the mHealth models efficient in generating demand for health care and enable access to appropriate care? More so, do they provide the beneficiaries with the opportunities to deliberate on one’s own choice?

The state of demand and access

Drawing the attention of practitioners and policy makers alike, basic rights to reproduction is recognized as key to health and well-being and is deep-rooted in realizing the human rights principles of self-determination and freedom from coercion (Centre for Reproductive Rights , 2006). While treaties and advocacies gain ground, a large proportion of women are captives to a host of negative consequences including unwanted pregnancies, sexually transmitted diseases, ill maternal and delivery services and so on. Estimates provided by FP2020 progress report 2018, suggest that while there has been a 30% increase in the proportion of women and girls using modern methods of contraception in 69 FP2020 focus countries (Family Planning 2020, 2018) only 50% of the unmet need demand has been satisfied. Much remains to be done to reach the 75% demand satisfaction target set by the Sustainable Development Goals 2030. Similarly, the World Health Organization reports that globally almost one-third of the women experience forms of sexual and or physical violence. Further, women experiencing violence are twice likely to have an abortion or fall prey to sexually transmitted diseases (World Health Organization, 2013). The National Family Health Survey (NFHS) 2015-16 reports state that amongst the currently married women in India, 13% still have unmet need for Family Planning, only a 1 percentage point unmet need demand has been met since the last round of NFHS in 2005-06.  Hence, addressing these needs cannot have a one metric agenda. The focus is widespread, from creating opportunities and access to generating awareness and change in intrinsic behavior.

How can technology help?

Three specific ways in which technology will have the upper hand in demand generation would be; a) Reach, b) Customization and c) Retargeting. One example in this context is the m4RH initiative implemented in Tanzania and Kenya. This is an automated, interactive and on-demand text-based mHealth initiative, and its widespread reach has allowed people to have a secure platform to raise queries on issues of reproductive health. The information generated through the queries were able to delineate choice patterns of the individuals in terms of preferred clinic locations, preferred choice of family planning methods as well as reproductive health content providing a strategic way forward in family planning developmental agenda (Oslen, Plourde, Lasway, & Praag, 2018). This pioneering initiative could serve as a good learning model in the Low and Middle-Income Country (LMIC) context. Other innovative mobile-based tools in the LMIC context such as the Smart Client developed by John Hopkins Centre for Communication (implemented in in Nigeria and Cote d’Ivoire), global initiative of The Mobile Alliance for Maternal Action (MAMA), CycleTel a text-based services (implemented in India), Interactive Mobile Application for Contraceptive Choice (iMACC)  (implemented in Kenya) are effectively reaching out to users of all levels with vital information on family planning. They help to educate audience on a large scale and promote a rights-based approach to reproductive choices and leading towards informed decision making.

To sum up…

It is undeniable that the penetration of mobile technology has gained pace and is ever increasing. However, there are certain underlining pre-requisites confiding its appropriate utilization to inform the demand. People and their capacity to access and make use of the technology is undoubtedly the first. Second, designing a technology-based development initiative and at scale have explicit resource consideration. Customization not only in terms of content but ease of use, graphical presentation needs to be incorporated to optimize results. Third, use of platform such as these would require acceptability and uptake at the user-end, without which its usefulness cannot be realized. These pre-requisites, if addressed in a comprehensive manner, will enable initiatives such as mHealth to bring transformational change in healthcare.

Lastly, the ever-evolving technological advancement provides a space to recreate and realize mHealth potential. Government, the primary benefactor, along with like-minded development bodies can leverage technology to take proactive measures to health care solutions while learning from the beneficiaries. And what better way than starting with a renewed focus on reproductive health and family planning!

---

About Author: Kezia Yonzon is a social science professional, and she specializes in Public Health, Livelihoods and Climate Change. Her work involves designing monitoring frameworks as well as preparing tools and analytical frameworks, developing sampling strategy, conducting training workshops and data analysis. Kezia is currently a Regional Manager at Sambodhi Research and Communications Pvt. Ltd and looking after Sambodhi’s operation in South East Asia.

---

*The views expressed by the author are her own only.