Freedom within a cage: how patriarchal gender norms limit women's use of mobile phones in rural central India.

INTRODUCTION: India has one of the highest gender gaps in mobile phone access in the world. As employment opportunities, health messaging (mHealth), access to government entitlements, banking, civic participation and social engagement increasingly take place in the digital sphere, this gender gap risks further exacerbating women's disadvantage in Indian society. This study identifies the factors driving women's unequal use of phones in rural Madhya Pradesh, India. METHODS: We interviewed mothers of 1-year-old children (n=29) who reported that they had at least some access to a mobile phone. Whenever possible, we also spoke to their husbands (n=23) and extended family members (n=34) through interviews or family group discussions about the use of phones in their households, as well as their perspectives on gender and phone use more broadly. Our analysis involved comparing wife-husband pairs to assess differences in phone access and use, and thematic coding on the determinants of women's phone use using an iteratively developed conceptual framework. RESULTS: While respondents reported that women could use the phone without needing permission, this apparent 'freedom' existed in a context that severely constrained women's actual use, most directly through: (1) narrow expectations and desires around how women would use phones, (2) women's dependence on men for phone ownership and lower proximity to phones, (3) the poorer functionality of women's phones; (4) women's limited digital skills, and (5) time allocation constraints, wherein women had less leisure time and were subject to social norms that discouraged using a phone for leisure. CONCLUSION: Our framework, presenting the distal and proximate determinants of women's phone use, enables more nuanced understanding of India's digital divide. Addressing these determinants is vital to shift from re-entrenching unequal gender relations to transforming them through digital technology.

Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India.

INTRODUCTION: Kilkari is one of the world's largest mobile phone-based health messaging programmes. Developed by BBC Media Action, it provides weekly stage-based information to pregnant and postpartum women and their families, including on infant and young child feeding (IYCF) and family planning, to compliment the efforts of frontline health workers. The quantitative component of a randomised controlled trial (RCT) in the Indian state of Madhya Pradesh found that exposure to Kilkari increased modern contraceptive uptake but did not change IYCF practices. This qualitative research complements the RCT to explore why these findings may have emerged. METHODS: We used system generated data to identify households within the RCT with very high to medium Kilkari listenership. Mothers (n=29), as well as husbands and extended family members (n=25 interviews/family group discussions) were interviewed about IYCF and family planning, including their reactions to Kilkari's calls on these topics. Analysis was informed by the theory of reciprocal determinism, which positions behaviour change within the interacting domains of individual attributes, social and environmental determinants, and existing practices. RESULTS: While women who owned and controlled their own phones were the Kilkari listeners, among women who did not own their own phones, it was often their husbands who listened. Spouses did not discuss Kilkari messages. Respondents retained and appreciated Kilkari messages that aligned with their pre-existing worldviews, social norms, and existing practices. However, they overlooked or de-emphasised content that did not. In this way, they reported agreeing with and trusting Kilkari while persisting with practices that went against Kilkari's recommendations, particularly non-exclusive breastfeeding and inappropriate complementary feeding. CONCLUSION: To deepen impact, digital direct to beneficiary services need to be complimented by wider communication efforts (e.g., sustained face-to-face, media, community engagement) to change social norms, taking into account the role of socio-environmental, behavioural, and individual determinants.