1.      Mobiles can provide access to health information at scale using appropriate technology

Kilkari is one of the world’s largest mobile maternal messaging services and has reached 24.6 million subscribers across 17 states. Mobile Academy is the largest mobile-based training programme for health workers in the world and has reached over 235,000 frontline health workers across 16 states in India. Amid low levels of smartphone access and ownership among women in low-income and low-literate settings, both services use IVR (Interactive Voice Response) technology to help overcome these challenges.

2.      Timed and targeted information can improve modern contraceptive use and immunisation

When Dr Anita gave advice on condom use, people listened: Those who listened to Kilkari were associated with a 3.7% higher use of modern reversible contraceptives; the number rose to 7.3% among those who heard 50% or more of Kilkari content, compared to non-listeners – largely driven by increased condom use. Effects were even larger for families with a male child (9.9% increase), in the poorest socioeconomic strata (15.8% increase), and in disadvantaged castes (12.0% increase). The evaluation also found higher rates of immunisation among infants at 10 weeks (2.8%).

3.      A relatively small amount of the relevant content, delivered at the right time, is a cost-effective way of saving lives

Seven Kilkari calls on reversible contraceptive methods, totalling just over 10 minutes and delivered direct to families’ mobile phones, had an effect on those families’ practices. Peer-reviewed analysis of our randomised controlled trial showed that Kilkari has saved nearly 14,000 lives (96% child lives and 4% maternal) and has been declared a highly cost-effective intervention, with the cost per life saved ranging from USD $392 to $953 depending on the intervention year.

4.      Design mHealth solutions with an equity lens to reach the poorest communities with mobile phone access

It’s important to think about how communities are using mobile phones, and when. The poorest subscribers, educated to at least secondary level, appear to have had the biggest equity gains from exposure to Kilkari, thanks to design decisions like the ‘retry’ algorithm – which tried mobile phone numbers at different times of the day, to reach families when they had time to listen.

5.      Subscription-based business models are challenging in low-resource settings

In the initial years, Kilkari subscribers were charged a nominal fee – but this user-fee model failed to cover marketing costs. Kilkari became a toll-free service in 2016 with call costs covered by the Government of India, enabling greater reach and impact.

6.      Digital interventions must be informed by gender intentional design

The gender digital divide in India, and the offline and online norms that create this divide, necessitate a gender-intentional, research-driven approach to designing mHealth interventions. We needed to understand who is left behind by digital interventions - and how to reach and impact those groups through alternate communication channels and platforms.

7.      Digital direct-to-beneficiary communications need to be complemented by a mix of other interventions to shift social norms and change deeply entrenched behaviours.

Despite advice that covered a full range of infant and childcare, Kilkari was not found to have had measurable impact on infant and young child feeding practices. Our evaluators found that practices under ‘normative influence’ – where families do not need to engage with the health system, like complementary feeding - saw more positive associations when communication tools like Mobile Kunji were used, providing opportunity for further discussion.

 --

This article was first written in November 2022 and updated in March 2023.

Kilkari is one of only five mHealth services globally to reach over one million subscribers and won ‘Best mobile innovation for women in emerging markets' at GSMA Global Mobile Awards 2019. Learn more about Kilkari on our website, in the  (third-party site) and at the International SBCC Summit from December 2022. 

Calculations on lives saved and cost effectiveness appear by LeFevre, A.E. et al, ‘Are stage-based, direct-to-beneficiary mobile communication programmes cost-effective in improving reproductive and child health outcomes in India? Results from an individually randomised controlled trial of a national programme.’

We are grateful to Stanford University for analysis of our evaluation, and to Johns Hopkins University for conducting the randomised controlled trial.

Sara Chamberlain is currently on sabbatical as India Digital Director; Radharani Mitra is India Creative Director and Global Creative Advisor; and Anna Godfrey is Head of Evidence at Βι¶ΉΤΌΕΔ Media Action.

 

The war in Ukraine is the most recent and explosive example in a wider trend of backsliding of democracy that is taking a toll on women and their inherent rights.

Even before this conflict, speeches, statements, and media content that reinforce gender inequality had increasingly become a political tool used to gain popular support, further undermining women’s rights.

Newsrooms already reflected this power imbalance, and COVID-19 only exacerbated the problem.

Now, as the war grinds on, we know that female journalists are at higher risk – and often at even greater disadvantage in their newsrooms than before.

Surveys have shown that women in the newsroom, particularly those with child care responsibilities, were already at a greater disadvantage. They report unequal pay, unequal hiring and promotions processes, and discriminatory allocation of work.

War and displacement will only exacerbate and entrench these inequalities.

All journalists, but particularly women, may become targets of misinformation, online abuse and hacking. Violence can be indiscriminate, most journalists are working without protective equipment, and some journalists have been killed already in this conflict.

Deeply rooted gender norms mean that there is an expectation that women take on household and child-caring responsibilities. In many parts of the world, if women aim for a career in journalism, this is considered by their families and wider society as an “extra”. This was particularly evident during lockdowns. “If something has to give, the career of the woman had to be dropped first,” said one Ukrainian female journalist we worked with.

Today, many women working in media in Ukraine find themselves torn between risking their lives to stay and do their jobs, or take their families and flee. Men of fighting age are not legally permitted to leave Ukraine. The impact will be years of family separation, career disruption, higher rates of poverty and ill health.

Women who were professionals in Ukraine may find themselves in lower paid or more menial jobs outside their home country. We are hearing first-hand accounts of senior female journalists and editors having to leave their city or even their country with their children, alone – this will have a tremendous impact on both their futures, and on the quality and range of coverage their media houses are able to produce.

This threatens newsroom equality in the longer term. Even before the conflict, Ukrainian female journalists told us that sometimes they had to miss training if it required travel, due to their child-caring responsibilities, putting them at further disadvantage compared to their male colleagues. This becomes an even more critical issue if it means missing important physical and online safety briefings that could make all the difference to their security.

Media organisations at home and internationally should actively reach out to female journalists ensuring they do not miss out on opportunities to help ensure they can cover the news safely.

Female journalists’ perspectives matter, particularly during war time

Our research also tells us that female journalists were already often prevented from covering subjects considered the exclusive domain of male journalists – such as politics and, now, conflict. They may be pigeonholed in journalism roles, more often covering topics of a social nature or that are otherwise considered “feminine”. This is deeply problematic and leads to an absence of women’s voices and perspectives on issues that directly and indirectly influence their rights. How events affect women, and what information they need in order to respond, is a critical component of coverage in any crisis.

There is a need for both media organisations and donors to better protect and support women in their journalism careers - now and in the future.

There are few genuine due processes for recourse, if women are harassed or otherwise have their rights infringed in the workplace. An estimated half of female journalists in Ukraine have faced sexual harassment in the workplace, mostly perpetrated by their colleagues and contributors through sexual jokes and verbal sexual abuse. This can only be expected to increase in times of high pressure and real risk.

Female journalists say that gender equality is still often perceived as a donor requirement or tick-box exercise, rather than a pillar of achieving effective democratic governance and social equity.

Media representatives we work with say it can be difficult to engage women in leadership roles in the newsroom, and there is a lack of support and mentorship to help women to tackle challenges and discrimination. Many female media practitioners remain at a junior or editor level, with correspondingly lower pay grades. Progress was stunted by COVID-19, and will be more so by the current war, leaving staff with less time for conversations about career progression and how to address the gender gap.

In the long term, newsrooms and donors need to ensure they are creating an environment in which women can fully participate in the workforce and in public discourse.

Both male and female journalists and media practitioners can bring gender concerns and analysis into topics and stories they cover. Policies to support and help protect female journalists, and ensure they are treated fairly in the workplace, will enable women in the newsroom to thrive, to raise social concerns and bring their own perspective to issues.

First COVID-19, and now the current crisis, have put many women’s livelihoods and economic security at risk – in journalism as well as in other sectors. Restoring these livelihoods, empowering them to return to the workforce, and allowing their issues to be better represented in the media will all be essential.

How women are represented in media is also important. Content that is stereotypical, sensational, or lacking in professional and ethical standards can further restrict women’s freedoms and increase their sense of insecurity and vulnerability.

Now and in the longer term, donors should consider the following in support for independent media:

• Ensure female journalists are equally included in all safety briefings, actively reach out to them and ensure they have protective equipment to help them to cover the war safely;
• Support the creation of internal policies ensuring gender equality and protection achieving the highest possible standards of fairness, clarity, and transparency. This includes policies for sexual harassment, and the use of gender quotas in recruitment;
• Support the creation of gender policies aimed at improving balance and representation in content to help uphold the rights of women and girls during the conflict;
• Provide training, mentoring, and networking opportunities to female journalists and media practitioners, to help mitigate the disadvantages they face in accessing senior and decision making levels.
• Ensure efforts are made to reach out to, and understand caring responsibilities of, female journalists, and how they could be supported through funding and when organising workshops and training.
• Use a solidarity-based approach that positions men and women as agents of change, and include men in the debate.

Across all of our training and mentoring work with public interest media, Βι¶ΉΤΌΕΔ Media Action aims to improve the balance and participation of men and women. We mentor female journalists in senior positions at partner media outlets to enable them to successfully navigate change and reforms within their organisation. And a cross-cutting theme is ensuring that media content is inclusive, considering the need to tell the stories of those who are misrepresented or less represented in the media, and to uphold their rights.

With public interest media under threat around the world, we are committed to continuing our efforts to ensure that women’s voices are meaningfully represented - throughout media organisations, and in the content they produce – to properly reflect the audiences they serve.

--

Cases of online abuse against women and girls have spiked in recent years. However, the legal and policy initiatives to address it do not seem to delve deep enough into the grave and changing dynamics of online violence in Nepal, or how this perpetuates gender-based violence in the offline world.

The development in internet and communication technologies has connected people in a way that was unimaginable a few decades ago. On one hand, this has opened endless opportunities to exchange ideas, share information and stay in touch with loved ones; on the other, it has given birth to new dangers that humans have never faced before. One such danger is the rise in online violence. As found by , women and girls are the main victims of trolling, abuse and hate speech everywhere in the world.

This scenario is not different in Nepal, where the rates of digital adoption are high. With increasing internet and social media users, we are witnessing , which can take the form of physical threats, stalking, sex trolling, sexual harassment, and Zoom bombing. In January 2022, there were around (with Facebook being the primary reported platform) and social media penetration has .

Virtual victims – the physical and emotional effects.

Between 2016 and 2020, were reported to the Cyber Bureau of Nepal. The prevalence is estimated to be much higher than reported. We spoke with around 80 adolescent girls and boys about their experience of online abuse as part of our recent research study for a gender equality project, funded by Foreign, Commonwealth and Development Office (FCDO). We were surprised to find that quite a few adolescent girls that we spoke to either had experienced sexual harassment on different social media platforms themselves, or knew someone who had. While only few boys mentioned experiencing or knowing someone (either boy or a girl) who have experienced this.

"I have experienced online sexual abuse. At one time I was even asked to share a picture of my breasts. This incident made me feel uncomfortable," one of girls told us during a focus group discussion.

Regardless of the nature (online or offline), violence takes a toll on the physical and mental health of survivors. Violence against women and girls still remains a culturally accepted practice, deeply rooted in harmful gender stereotypes and attitudes stemming from the continued acceptance of patriarchal societal norms.

As digital technologies play an increasingly central role in our everyday lives, some research suggests that women are often blackmailed by their partners or former partners, especially when couples in relationships share their passwords.  is mostly conducted through photoshopping women’s images, where men misuse women’s pictures to create new accounts to trick other men.

Silencing girls’ voices.

In a society like ours, where women and girls are expected to act in a particular way, our research found they tried to cover up any sort of violence, as they feel they will get blamed for sharing their personal life on social media sites. They fear that sharing such incidents can have a devastating impact on their mental health, reputations, relationships, access to education and employment, or even expose them to physical violence. Most of the time, women are questioned about their online behaviours, and a huge burden is placed on them to accept that they were at fault for putting themselves in a vulnerable position.

From our conversations with adolescent girls during our research study, we found that often they did not share these incidents with anyone, not even with their friends. As a solution, they simply ignored and avoided the perpetrators by blocking or unfriending them on their social media platforms. We discovered that these girls feared the consequences of sharing with their families and friends. They did not trust their friends to keep their secrets, and they thought they would be blamed for the incident if they shared it with their family members. This is also why many cases of violence against women and girls go unreported in Nepal.

"No. There is no way we will share such things with others because people we share such things (cyberviolence incidents) will not keep it to themselves. I have experienced a similar scenario previously, where I shared something with one of my friends, and she shared it with others too. So, we cannot trust anyone to keep our secrets," says a girl from our focus group discussion.

As part of our research, we also spoke with government officials, women rights activists and representatives from non-governmental organisations working on women and girls' rights. Many of the participants raised concerns such as the increasing use of social media to connect to the potential victims of human trafficking. Previously, traffickers used to travel to villages to connect with their potential victims. But these days they can connect and befriend potential victims through a simple friend request on social media platforms, liking or commenting on a post, before they meet in person.

What have we learned?

The key takeaway from our recent study was that adolescent girls using social media platforms are more at risk of experiencing online sexual abuse than boys, and for us, this highlights that their safeguarding should be a priority. We also identified an urgent need to engage with adolescent girls, and their friends and families, to help break through the barriers and fears associated with sharing their experiences.

Similarly, it is also very important to understand that internet platforms – while insecure - are not the only cause of such violence. Low levels of digital literacy contribute to the issue, and not least, the bad behaviour of people who hide behind online profiles and misuse these platforms. At last year’s UN Generation Equality Forum in Paris, four of the world’s largest tech companies – Facebook, Google, and – made bold commitments to tackle the abuse of women on their platforms and improve women’s safety.

Our findings point to the need to inform and empower women and girls in Nepal about the safe use of internet and digital media platforms, so that they can protect themselves from potential harm online.

Moving forward with holistic action

Considering the severe impact of online violence, Nepalese laws already have some provisions aiming at control of such activities. When a complaint is registered, Nepalese police are required to immediately search for the alleged perpetrator by tracking their IP address. Then, depending on the severity of the case, they either make the two parties compromise to resolve the issue, or file a case. However, there are many loopholes in the system. We feel that both legal changes and understanding the root causes are required to address this violence.

Actions must go beyond calling for improvements to the platforms’ own Community Standards, and their reporting systems and policies on removing content that breaks the rules. We also recognise this is an uphill struggle, particularly in non-English languages where the bots are not trained to recognise local languages, slang and dialects, and often end up removing legitimate content instead.

But we know that media and communication is in a unique position to challenge social norms and help address the root causes of why these cases go undiscussed and therefore unreported. In India, Myanmar, Tanzania, Zambia – using media and communication - we’ve seen positive changes for women and girls by engaging, informing, and sparking conversations on taboo topics both online and offline.

Our innovative Sexual and Reproductive Health Rights project in Myanmar called Ma Shet Ne (Don’t be shy!) was designed to help open discussions and break down barriers. We found that sharing interviews with female celebrities who spoke openly about the issues they had faced, and equal representation in content, helped to challenge the gender divide that had previously stopped women speaking out. Audiences were significantly more confident than non-audiences to talk about relationships and sexual health offline with medical professionals, friends and partners – a key achievement.

In Nepal, we recognise that creating safer environments like this, where women and adolescent girls can confidently share their experiences with friends and families without fearing the consequences, is vital. So far, we have supported local radio stations to produce digital content on various gender-based violence issues through training, editorial guidance and support to build the capacity of our local partner stations. But much more needs to be done.

Addressing online violence requires collective efforts. Broad-based, multi-sectoral partnerships need to be established to reach out to families and communities at scale. It is also important to bring systematic changes in mentality where it requires social institutions such as education, media, religion, the judiciary and political systems to be gender sensitive. With the advancement of digitalisation, it is crucial that women and girls are well informed. Sharing positive stories of those who have used formal support mechanisms and found help - and not suffered social discrimination as a result - is necessary to enable this shift.

We believe that collective efforts including stronger cybersecurity, media to support gender equality, changing attitudes and changes to legalisation all need to happen to address this problem.

--

Learn more about:
Our work in Nepal and with women and girls
Our new promise on Equity, Diversity and Inclusion

Limits on progress

However, there are constraints on the transformative potential of women’s collectives in India:

• Geographically isolated groups have few opportunities to engage beyond their immediate circle with the wider collective;
• Women have limited channels to request and receive targeted information, resources, and services from the wider collective;
• Grassroots members have limited opportunities to make their voices heard in the wider collective;
• The lack of access to high quality, standardised, flexible learning opportunities;
• Members tend to be older and less educated, and younger women are under-represented;
• There are limited opportunities for consultative decision-making, and leadership may not be transparent.

Digital technology could be a game changer

Chat applications and social media platforms, as social networking tools, could help women’s collectives overcome many of the constraints they face – for example, by:

• Reducing geographical isolation, enabling women to interact more regularly with their wider collectives.
• Improving internal information dissemination and consultative decision making by collective leadership.
• Improving the bottom-up flow of information from grassroots members to collective leadership to transnational partners, amplifying marginalised voices.  
• Diversifying group membership by attracting younger women.
• Helping collectives trying to scale to overcome challenges of transparency and leadership ossification by offering new growth pathways to young and emergent leaders.

Collectives could also use digital technologies to accelerate the accumulation of human capital by providing flexible, personalised digital learning to members, and the accumulation of financial capital by providing greater access to government entitlements and markets for their products and services.

Low tech digital solutions have delivered results

There are already examples of low-tech digital solutions achieving some of these goals for disadvantaged women in India, including for women in collectives. For example:

• , an Interactive Voice Response (IVR) social media platform for rural communities in India, enables women in self help groups to call a number to record an audio message about their community, or to listen to messages left by others. Over 100,000 unique users have been calling Mobile Vaani every month in the states of Bihar and Jharkhand, discussing a wide range of issues and sharing information, including health information during the COVID-19 pandemic.
•  equips women in self help groups who already own smartphones with an application to support claims for government entitlements, helping 600,000 people claim entitlements in 22 Indian states.
• Βι¶ΉΤΌΕΔ Media Action has used IVR to deliver impactful, cost-effective audio learning to rural, low-income women at scale in India for almost a decade – for example, delivering free health information to over 10 million families, and successfully training 200,000 frontline health workers in 13 Indian states in collaboration with the Indian government, .
• During the pandemic, Βι¶ΉΤΌΕΔ Media Action began collaborating with capacity building organisations - for instance,  to provide IVR-based learning in agricultural best practices to marginalised women farmers in self help groups in the state of Bihar, and with to support digital adoption and digital literacy in self help groups in Madhya Pradesh.  

The gender digital divide

However, the transformative potential of digital to support women’s empowerment in India is constrained by the gender digital divide, including on social media. In 2018, LIRNEasia estimated that only 9% of women aged 15–65 were using social media in India, compared with 22% of men. In addition, although India is now globally the largest market for platforms such as Facebook, Instagram, and YouTube, these are still heavily skewed towards male users. For example, according to estimates from publicly available advertising data, only 8% of Twitter users and 24% of Facebook users in India were women, as of January 2021. Even though more women began using the mobile internet during the pandemic, with usage increasing from 21% in 2019 to 30% in 2021, social media use did not reflect this: Facebook usage among women increased by just 1% during the pandemic, and Twitter usage among women fell by 6%.

Social media users in India tend to be younger, better educated, wealthier and urban

Wealth and education are the strongest determinants of access to and use of mobile phones in India, but age and geography also matter. In 2018, a study by LIRNEasia found that only 5% of social media users in India had only a primary school education or had never been to school, and only 11% lived in rural areas. The same study found that only 10% of 36–45-year-olds had used social media in 2018. Although social media use among adolescents in India has increased since then, the gender gap is the most extreme in this age group. For example, a survey by the Population Council in Bihar and Uttar Pradesh in 2018–2019 found that 33% of 15–19-year-old girls who had completed fifth grade or higher had used social media, compared with 70% of boys in the same age group.

Women and men also behave differently on social media in India. Men tend to be more active participants in digital groups than women, with the most active users being men with other forms of social privilege. Most women (92%) use social media to stay in touch with existing friends and family, rather than to make new friends (38%), which could limit their access to new ideas, opportunities and ways of doing things – the accumulation of bridging social capital. 

The role of gender norms

Gender norms - offline and online – are another constraint. Women’s use of mobile phones and the internet are often supervised and monitored by men, which limits the agency and freedom that digital technology could provide women. Technology-facilitated gender-based violence is rife in India, and nearly always against women. Research suggests that over 58% of women internet users have faced online sexual harassment of some form, most commonly on social media. While India has legislation on cyberbullying, cyber-stalking and online sexual harassment, victims of online gender-based violence do not usually seek legal recourse. Social media platforms have been grappling with the issue of online violence since their inception. However, despite best efforts, online violence and harassment remain pervasive issues.

Implications for designing social media interventions for women

The gender digital divide on social media platforms in India, and the offline and online norms that create the divide, necessitate a gender-intentional, research driven approach to designing social media interventions for women’s empowerment. 

• We need to begin with a gender analysis of who has access to digital technology and why, and who is excluded and why.
• We also need to understand women’s level of digital skill among the population we aim to serve, as well as their usage habits and the factors shaping their use, including the implications of shared and supervised mobile phone use for privacy and data protection.
• We need to design differentiated digital strategies, using appropriate digital channels and tools, to meet a diversity of needs.
• We need to use women-centred design methodologies to co-create solutions with women who represent different segments of the target population, to improve accessibility, usability and relevance.
• We must remember that face-to-face communication remains key to women in the target population who don’t own, or have meaningful access to, mobile phones – or the skills or permission to use one.
• We require processes to respond to online harassment and violence that may be triggered by your intervention.
• And we need to be patient. Test and re-test because there is the potential to do as much harm as good.

 

--

The third paper in our learning series offers more insights: 

Learn more about our Digital Women's Economic Empowerment learning and research agenda here. The project is funded by the Bill and Melinda Gates Foundation and includes partners at Chaitanya WISE, PRADAN, the University of Southern California at Los Angeles, and the University of Denver, Colorado.