Does having a mobile phone matter? Linking phone access among women to health in India: An exploratory analysis of the National Family Health Survey

Background The disruptive potential of mobile phones in catalyzing development is increasingly being recognized. However, numerous gaps remain in access to phones and their influence on health care utilization. In this cross-sectional study from India, we assess the gaps in women's access to phones, their influencing factors, and their influence on health care utilization. Methods Data drawn from the 2015 National Family Health Survey (NFHS) in India included a national sample of 45,231 women with data on phone access. Survey design weighted estimates of household phone ownership and women's access among different population sub-groups are presented. Multilevel logistic models explored the association of phone access with a wide range of maternal and child health indicators. Blinder-Oaxaca (BO) decomposition is used to decompose the gaps between women with and without phone access in health care utilization into components explained by background characteristics influencing phone access (endowments) and unexplained components (coefficients), potentially attributable to phone access itself. Findings Phone ownership at the household level was 92 center dot 8% (95% CI: 92 center dot 6-93 center dot 0%), with rural ownership at 91 center dot 1% (90 center dot 8-91 center dot 4%) and urban at 97.1% (96 center dot 7-97 center dot 3%). Women's access to phones was 47 center dot 8% (46 center dot 7-48 center dot 8%); 41 center dot 6% in rural areas (40 center dot 5-42 center dot 6%) and 62 center dot 7% (60 center dot 4-64 center dot 8%) in urban. Phone access in urban areas was positively associated with skilled birth attendance, postnatal care and use of modern contraceptives and negatively associated with early antenatal care. Phone access was not associated with improvements in utilization indicators in rural settings. Phone access (coefficient components) explained large gaps in the use of modern contraceptives, moderate gaps in postnatal care and early antenatal care, and smaller differences in the use of skilled birth attendance and immunization. For full antenatal car, phone access was associated with reducing gaps in utilization. Interpretation Women of reproductive age have significantly lower phone access use than the households they belong to and marginalized women have the least phone access. Existing phone access for rural women did not improve their health care utilization but was associated with greater utilization for urban women. Without addressing these biases, digital health programs may be at risk of worsening existing health inequities.