The digital revolution: Opportunities and challenges for SRHR

After the close of the Dialogue’s first day, Heiko Warnken, Head of the Division for Health, Social Security and Population Policy at Germany’s Federal Ministry for Economic Cooperation and Development (BMZ) welcomed delegates to the BMZ building for a public panel discussion on the digital opportunities and challenges facing SRHR. He pointed out that the Cairo Programme of Action still very much guides German development cooperation, but 25 years ago, nobody could have imagined the transformative digital world we live in today. Digital technology, said Mr. Warnken, needs to be harnessed in order to push forward the SRHR agenda.

There followed a stimulating public panel discussion moderated by Sumangali Somaskanda from Deutsche Welle TV, which considered the potential application of digital approaches to the promotion and provision of SRHR. All the panellists recognised both the huge advantages and the considerable potential risks of digital technology when it comes to SRHR.

Tanzila Khan, Manager of the Entrepreneurship Development Programme for the Hashoo Foundation in Pakistan, reminded delegates that the assumption that this technology is available to all is a ‘risk in itself’: In her country Pakistan, power outages mean that even the few who do have access to mobile technology, still do not have consistent access. She pointed out that she had been inspired to set up the ‘GirlyThings’ App in Pakistan by the barriers she faced obtaining essential sanitary supplies as a wheelchair user. ‘I was angry that I couldn’t access the shop to buy sanitary pads because there were steps outside. I started thinking about other barriers women faced, such as financial dependency on their husbands or embarrassment about such a taboo issue.’

Hermen Ormel, Senior Adviser on SRHR for the Royal Tropical Institute (KIT) in the Netherlands spoke about the huge potential of digitalisation for targeting information and supply chain improvements. He cited the example of the Cell-life initiative in South Africa, which helps people to manage HIV and encourages women to seek medical assistance after unsafe abortions. Despite such innovations, he said, there is still a huge challenge to ensure that the poorest are not left behind in the rush to find digital solutions. There are often big digital divides between urban and rural areas and between men and women, and people share phones, so confidentiality can also be an issue. ‘MHealth should not be seen a magic bullet,’ he concluded, ‘but as a tool, and as part of a bigger picture.’

Leon Swartz, Director of Population Development Research in South Africa’s Department of Social Development, said that in his country access to Wi-Fi remains very unequal, but digital tools and information and communication technologies are nevertheless proving very useful for improving access to information and ensuring better service delivery. He cited several examples, including the National Population Unit’s use of GPS-satellite technology to map existing adolescent SRHR and HIV service delivery points in eight districts in KwaZulu-Natal and the Eastern Cape. Another ground-breaking, national mobile phone-based health service called MomConnect is targeted at all pregnant women and mothers of children under one in South Africa, whilst another government initiative addresses gender-based violence by offering telephone and WhatsApp advice from qualified social workers.

Dr. Magnus von Knebel-Döberitz, Director of the Department of Applied Tumour Biology at Heidelberg University Hospital, Germany, highlighted what he called a ‘game changing’ initiative in Africa using mobile technology for cervical cancer screening in remote and under-resourced areas (read more here). ‘As many people are dying from cervical cancer in Africa as from road accidents,’ he said. ‘It is a hidden but horrifying nightmare.’ Using mobile technology, women can self-test and the samples can be analysed by high-tech diagnostic machines with results transmitted via a Cloud back to health workers, making timely treatment possible and avoid countless preventable deaths. The technology could also be used for more accurate diagnoses of biopsies (up to 50 per cent of which, he said, were currently incorrect). Trials have been conducted in Kenya and are beginning in Ethiopia. However, data security is a key concern, and this needs robust legal frameworks that have not yet been fully developed in many countries.

Caroline Kent, Deputy Director of the Tactical Technology Collective in Germany, said whilst the digital world is now a much smaller place and technology can be used as an equaliser to address gender imbalances and promote SRHR, it is important remember that this technology is never neutral. Any use of digital technology - and particularly where sensitive issues of SRHR are concerned - should always be mindful of how appropriate that technology is, who developed it and how it is used. She gave an example of security forces in Egypt using Grindr (dating app for LBGTIQ* people) to entrap gay men and said that the growing incidence of hate speech against women in the digital space can lead to a silencing of women’s voices. ‘It is important to understand, she concluded, ‘that a lot of this technology can also be used against us. We should all be aware of how our data is used, and whom it is developed by. The biases we see in our analogue world are often replicated in the digital world.’