Maternal Health in the Global South
A study to investigate the empowerment of mHealth initiatives
Author: Sara Falk
Bachelor thesis
LIST OF ABBREVIATIONS ... I ABSTRACT ... II
1. INTRODUCTION, RESEARCH PROBLEM, AND RELEVANCE ... 1
1.1. OBJECTIVE ... 3
1.2. RESEARCH QUESTIONS ... 3
2. LITERATURE REVIEW ... 4
3.METHODS ... 8
3.3.ANALYTICAL FRAMEWORK ... 9
3.1.ETHICAL CONSIDERATIONS ... 10
3.2.LIMITATIONS AND DELIMITATIONS ... 11
4. THEORIES ... 13
4.1.EMPOWERMENT THEORY ... 13
4.2.FEMINIST TECHNOSCIENCE ... 15
4.3.POSTCOLONIAL PERSPECTIVE ... 17
5.FINDINGS ... 20
5.1.MOTECH ... 23
5.2.GRAMEEN FOUNDATION’S LESSONS LEARNED ... 24
5.3. Do the women feel empowered? ... 26
5.4.NARRATIVE APPROACH ... 28
5.5. “Health at her fingertips.”... 29
5.6. Storytelling from Enkokidongoi ... 31
6. ANALYSIS & DISCUSSION ... 37
6.1.ANALYSIS ... 38
6.2. Gender and technology ... 38
6.3. Liberal or liberating empowerment? ... 40
6.4. Reproductive decisions ... 41
6.5.DISCUSSION ... 43
6.6 Unwilling and ignorant? ... 44
7.CONCLUSION ... 47
8.REFERENCES ... 49
APPENDIX ... 1
Interview 1 ... 1
Interview 2 ... 2
Interview 3 & 4 ... 3
LIST OF ABBREVIATIONS
ART Assisted Reproductive Technology
FINRRAGE Feminist International Network of Resistance to Reproductive and Genetic Engineering
GDI Gender Development Index
HDI Human Development Index
MAHILA Mobile Phone-Based Approach for Health Improvement, Literacy, & Adherence MAMA The Mobile Alliance for Maternal Action
MDG Millennium Development Goal
mHealth Mobile Health
MOTECH Mobile Technology for Community Health
NGO Non-Governmental Organization
SDG Sustainable Development Goal
SMS Short Message Service
STS Science and Technology Studies
WHO World Health Organization
WID Women in Development
Abstract
The fifth SDG aims to achieve gender equality and empower all women and girls. In this research, mHealth, as in mobile phones to improve maternal health outcomes, will be analyzed. In remote areas where healthcare may not provide care to the extent needed, these technological innovations may be of great importance. MOTECH, a mHealth initiative, promises empowerment, effectiveness, and cost-efficiency and will be analyzed further. The promise of empowerment will be the primary aim of this research and will be the center of attention, with the empowerment theory as a tool in the
investigation. Technoscience feminism with a postcolonial perspective will be additional analytical tools to comprehend mHealth and maternal health in the global South. Altogether, the lenses of observation will analyze how gender inequalities connect with technology depending on location.
Moreover, the research will contain a discussion of the concept of liberal empowerment and liberating empowerment. Cecília M.B. Sardenberg (2008) argues that liberal empowerment is conceptualized as a “gift” that can be
“donated.” The aforementioned does not work towards a process of group organizing and the building of self-esteem. Contradictions of empowerment are expressed through the debate between individual and collective
empowerment. The individual perspective emphasizes cognitive processes, focuses on independence and autonomy, and does not consider the power structures and everyday practices. Liberating empowerment brings sociopolitical dimensions to light but also the psychological processes at play. The sociopolitical and psychological dimensions further enable individuals to understand their personal problems’ political dimensions and act upon them (Sardenberg 2008:22-24). This research indicates that the project contributes to liberal empowerment and lacks feminist perspectives to satisfy the targeted group.
Keywords: Maternal health, Mobile Phones, Gender, Empowerment
1. Introduction, research problem, and relevance
Maternal health in developing countries is a challenge. Every year, upwards of 500,000 women die worldwide, with 99 % of those in developing nations (Prata et al. 2010). The SDG 5 argues for gender equality and empowerment for all women and girls (UN. n.d). In the same spirit, MDG 5 argued for reducing maternal mortality and achieving universal access to reproductive health (Ki-Moon 2015:6, 38). Say et al.’s (2014) analysis shows that the largest cause of maternal death worldwide are indirect causes and
hemorrhage (Say et al. 2016). To reach this SDG regarding gender equality and empower all women and girls, mHealth initiatives aim to improve health accessibility for women living in rural areas through mobile phones. As we all have experienced in the last decade, mobile phones have grown
exponentially, including the most low-resource regions. Developing countries struggle with insufficient infrastructure, shortage of healthcare workers, and lack of healthcare access (Eze et al. 2016:1024). mHealth is the expansion of mobile innovation used in various fields, and developers’
promises of overcoming these challenges. It is vital to research new technologies to reach the SDG and a comprehensive view when
implementing them. There are many studies provided for Western white women and their experience of reproductive health application. Thus, previous studies, made by and for the West, cannot be explicitly
implemented on women living in other circumstances with different cultures.
Furthermore, this research is essential due to the initial position to be as objective as possible and use feminist studies and local women’s own words in interviews to comprehend the topic.
Socioeconomic challenges seem to be the focus, and there have been several writings on maternal health and mHealth projects, both together and
separately. However, there appears to be little focus on women in these projects and using a feminist approach. The research gap will be examined and analyzed to contribute to the development of gender equality. Therefore, the research aims to use technoscience feminism (Wajcman 2004,2010, Weber 2006; Åsberg & Lykke 2010) and the Empowerment Theory
(Rappaport 1987, Friedmann 1992). To reach the SDG, it is essential to find sustainable solutions for health initiatives for women working correctly and by the women’s needs and circumstances. This research will complement the existing research on the subject. The documentation of the growing use of mHealth in developing countries needs more analysis to comprehend how to implement mHealth favorable for women who, from developers, are
promised emancipation and empowerment. Hopefully, this research can highlight existing failures in implementing healthcare apps without an investigation of the power relationship between funders and users. The postcolonial perspective and feminist analysis will be helpful when
observing power relations from different positions. The research within this subject is limited, and the understanding of mHealth and women’s issues needs further research in the future to reach the goals of the fifth SDG.
1.1. Objective
This research aims to broaden the understanding of maternal health, empowerment, and the usage of mHealth in developing countries with a gender-sensitive approach.
1.1.2 Research questions
• How does the connection between gender inequalities and technology appear in mHealth?
• Can mHealth initiatives be explained as liberal empowerment or liberating empowerment?
• How does mHealth enable women’s rights to reproductive decisions?
2. Literature review
The literature review focuses mainly on maternal health in the lens of mobile health programs, and due to the little evidence on the performance and willingness, there is a research gap. Still, the research gap in representation and involvement of females and a feminism approach to women´s issues is the primary intention of this research. There have been several writings on maternal health as well as mHealth projects, however when reviewing the existing literature, a possible research gap in the focusing on women, and instead, a focus on the low-resource aspect in implementing mHealth
projects in the South (Mburu & Oboko 2018) (Pankomera & Greunen 2018).
The existing research has focused on either mHealth in a technological sense or maternal health in a health perspective without a more in-depth analysis of the women. One exception is research done by Al Dahdah in 2017, which enabled women to speak freely and show fundamental problems that cannot be one-dimensional solved. To keep in mind as by Empowerment Theory (Rappaport 1987) and how empowerment is pervasive in American culture to be positive.
Further, in reviewing existing literature on the subject, the findings show that these mHealth projects are concerned with power relations from different ends (Al Dahdah et al. 2015, Al Dahdah 2017) (Ullah 2004) (Speciale &
Freytsis 2013). From the founders, developers, and caretakers from one end and the other end, there are existing traditions, culture, and central patriarchal systems that challenge the projects. As can be read in this document, NGOs have been successful in women’s decision-making regarding reproduction.
Still, they need more research and field studies to get more documentation on mHealth issues. Participation in which the people involved in the projects were the ones getting feedback from participators seems to be biased (Coleman et al. 2020), when compared to interviews done by researchers finding out how the projects received from a local perspective without being
the founder or developer of the application or initiative (Al Dahdah 2017) (Ullah 2004).
Al Dahdah (2017) has researched a specific project within mHealth, namely, MOTECH, a Ghana project. Their goal is to improve maternal, newborn, and child health in rural developing contexts. The project includes information and tracking of patients and giving women SMS alerts and voice messages.
MOTECH messages are, to some extent, prescribing actions that can be hard to implement for women. Al Dahdah (2017) critically describes that the messages, given by the geographical and financial difficulties, become symbolic violence for these women (Al Dahdah 2017:139-141). Similar projects have been developed, such as MAMA (Coleman et al. 2013,2020) and MAHILA (Reynolds et al. 2016).
The politics of technology needs to integrate into questions concerning gender power relations. In the lens of feminist technoscience, Judy Wajcman (2010) explains the difference between technoscience and technofeminism.
The relationship between social analysis and social transformations is the crucial difference separating the two concepts. Moreover, this research may show that there are possibilities in finding health gaps due to factors such as gender. Feminist researchers also show that technology is a “masculine culture” and grounded in patriarchal structures (Weber 2006:398). Feminist technoscience and STS emphasize the unavoidable link between science and technology (Åsberg & Lykke, 2010:299).
Meg Wirth et al. (2008) make a critical analysis of the policymaking process in reaching the MDGs concerning maternal health. Their key points were that measuring, and monitoring are possible in low-resource settings, using existing data. Secondly, there are health gaps between groups and not just rich and poor, and at last, the reduction of these gaps is key to maternal
health services to successful policymaking (Wirth et al. 2008). Further findings in the existing literature are from Delores James et al. (2016). which concluded their research regarding African American women’s
unwillingness to participate could have a variety of reasons such as financial incentives, clear information about privacy, and data concerns, tailored research to age-group and culture (James et al. 2016). James et al. opened an interest in investigating if and why there perhaps would be an unwillingness to use applications in a village that in the contemporary are not involved in a project in mHealth and have limited access to healthcare.
Thus, it is essential to consider how these projects’ recipients are
experiencing both challenges and limitations. Mobile technology enables a kind of “ecosystem.” Apps that are often on a mobile phone interact with internet-based services. The applications which have the most successful development have a lot of players involved, such as developers, device manufacturers, network operators, government, and users. NGOs are essential to customizing the applications to consider the local community’s needs (World Bank 2012:4). Ahsan Ullah (2004) also advocates for NGOs’
important role and how this empowers the women in their decisions in questions surrounding reproduction (Ullah 2004:1). Ullah (2004) concludes that NGOs aim to include more male counterparts in the programs to prevent domestic violence and take family members into account to balance women’s power in decision-making (Ullah 2004:8). Lastly, midwives need to play a unique role in this new way of mobile communication. Anna Maria Speciale and Maria Freytsis (2013) argue that the global community has turned its attention to midwifery and its healthcare role. They advocate integrating midwifery’s strengths in mHealth to reach the MDG related to maternal health (Speciale & Freytsis 2013:81).
Accordingly to the theories chosen, the literature review highlights the existing challenges on the subject. Also, there is a need to investigate further the promised empowerment for women using mHealth initiatives to decrease maternal morbidity and increase gender equality. The literature review showed the lack of focus on the women; instead, the focus pointed at economics and health as the observation target. Wirths (2008) finding that health gaps are not only between rich and poor supports the further
investigation of putting the women in the center of observation.
Technoscience feminism shows a new analysis of science and technology and adds social and historical implications. Further, the postcolonial perspective challenges western white values, and together it enables a fair investigation of mHealth. Empowerment embeds both fields and points to that empowerment theory is adequate to apply to this research. The sequent chapter will contain the methods and analytical tools to operationalize the observations made in this literature review.
3.Methods
In the search to answer these research questions, different perspectives, theories, and methods will function as tools due to the complexity. Each equally important to comprehend the social and historical implications, further introduced in chapters 3 and 4. Throughout the research, there will be secondary resources related to the subject to illustrate the topic; the following will be the basis of investigation.
- Case study of MOTECH in 5.1.
- Metanalysis of Marine Al Dahdah ´s (2017) contribution in 5.3 and the included existing interviews in 5.5.
- Additional interviews 5.6.
The methodological approach in this research is a qualitative study. The research will gather data mostly from secondary resources and some primary sources received from semi-structured digital interviews. MOTECH will work as a case study and tool to exemplify a mHealth initiative. The digital semi-structured interviews are from Enkokidongoi, Kenya, and have been conducted for this research to comprehend women’s lives in rural regions and contexts. Moreover, a meta-analysis of existing interviews by Al Dahdah (2017) from Ghana and India will further illustrate women’s lives and
present women who have been participants of mHealth initiatives. The choice of women’s narrative approach from different regions and contexts is to listen on how to change empowerment to favor the least advantaged.
The semi-structured approach enables the avoidance of interviews being too constrained and focused like on a structured interview. The questions can, in this way, be more open-ended and allow a discussion with the interviewees.
Alan Bryman (2016) argues for semi-structured interviews as prominent data
gathering methods within the feminist research framework. In-depth face-to- face interviews have become the “feminist method” (Bryman 2016:488). The interviews were collected by snowball sampling, which means an initial contact with a person, which enabled connections with others relevant to the research (Bryman 2016:188). The initial contact was found by family
networking and relationships that had been in projects surrounding education in Kenya. Neither of the involved stakeholders had connections with or had heard of the author before this study. Still, through family networking, the village was known beforehand and made it easier to connect.
The validity increased due to the stories similarity in the existing data (Al Dahdah 2017), and the interviews conducted for this research are aligned with the literature reviewed. However, the validity decreases since the interviews could not be chosen freely, nor enable contact with organizations and other stakeholders due to the limits in regulation in traveling due to the ongoing pandemic. Internal validity in this research is found as the
correspondence between the researcher’s observation and theoretical ideas.
(Bryman, 2016:84). Still, it would be stronger if the study would be for a more extended period and learn more about social life in the regions observed.
3.1. Analytical framework
This research’s analytical framework will contain empowerment theory, technoscience feminism, and postcolonial perspective. The theories will, in chapter 4, be presented and work as theory triangulation. A metanalysis of Al Dahdah ´s (2017) contribution to a similar study in 5.3 and 5.1, existing interviews in 5.5, additional interviews 5.6, and secondary sources will work as data triangulation.
The research uses an abductive approach that enables the observations to create a theoretical understanding through the studied people but not lose contact with the voices that contributed to the data analyzed (Bryman 2016:394). The theories chosen will work as tools to analyze the existing literature on mHealth projects, maternal health, and empowerment.
Furthermore, the case study of MOTECH will help analyze the absence of a feminist approach in mHealth. The choice of the case study found upon its promise and the contribution to the field by Al Dahdah (2017), which are the few findings on the subject that analyze maternal health in similar aspects. Al Dahdah’s contribution to the field enabled the project’s meta-analysis to be filled with essential aspects from women to complement the digital
interviews executed for this research. Furthermore, due to Western
feminism’s privilege, it will follow with a postcolonial perspective to get a fairer understanding of the women’s situation depending on their location.
The promise of women’s empowerment with a narrative approach with the Empowerment theory will further investigate if the women feel liberated or if the empowerment is liberal.
3.1.2. Ethical considerations
Since this research is desk research, there is not quite the same extent of ethical considerations applicable to this research. The digital interviewees have been anonymized to promote their integrity, and the interviewees have agreed to participate. Further, this research does not reach out to display any of the actors described in specific ways. There has been no forcing in consent and respect to norms and traditions represented in this research in contact with participants. Maternal health can lead to sensitive questions or discussions during the interviews and considered when preparing for the interviews.
3.1.3. Limitations and delimitations
Limitations included in the research are not being able to be in the field and conducting interviews, to learn and observe the culture and traditions, because of the ongoing pandemic. The limitations created by the pandemic concerning travel regulations create obstacles in finding stakeholders that would have been vital informers of maternal health, such as care workers, organizations, and politicians. Further, this makes the possibility of
generalization of maternal health in the global south limited. There is also a limitation of being from the West and risking complementing the existing Western literature. Furthermore, the research relies mostly on existing literature and second-hand information, and a limited number of primary sources. The primary sources collected through digital interviews have contained limitations in questions like internet connection and privacy concerns (Bryman 2016:492).
Still, the interviews conducted in Kenya illustrates rural living situations of maternal health in the global South. Bryman (2016) argues for the flexibility of using skype or like-worthy applications to get contact. Another great point is that connections and meetings can arrange on short notice (Bryman
2016:492). This research has delimited in collecting interviews in quantity but instead focuses on in depth-interviews. Therefore, the research does not aim to generalize or draw assumptions of the three countries or research the women as a unit. The similarity in some findings throughout the interviews and the analysis of existing interviews showed in the final stage were not and could not be planned. Still, there will be similarities because they are from middle-income countries with a lack of healthcare access. They represent different stories and identify as female, even if they come from various
regions, which is the point. Further, a delimitation made was to use a high valid content of Al Dahdah’s (2017) contribution to the field, which gives a valuable foundation to conduct a meta-analysis. According to Bryman (2016), using existing data is an appropriate approach because it is
challenging to produce a comparable data set of quality because of a lack of time and resources (Bryman 2016:309-310).
4. Theories
The following chapter will present the chosen theories to investigate the empowerment of mHealth initiatives’. First, the empowerment theory will comprehend the empowerment itself. Following by feminist technoscience to understand the connection between gender and technology and finally
postcolonial perspective to investigate the power relations and how the western hegemony appears. These three lenses of observation are intended to create a broader understanding of the topic and step away from the narrow observation of economic and resource focus.
4.1. Empowerment theory
In MOTECH and its empowering promises, it is crucial to understand it through the empowerment theory. The theory understands social issues and the oppression of those with the fewest advantages in society through a social, political, and economic environment. Julian Rappaport (1995) further discusses the empowerment to be fruitful if combined with people’s
storytelling; they significantly impact human behavior. Using a narrative theory, Rappaport means that one needs to collaborate with the citizens and other scholars in other disciplines and force one to have an “indigenous expression of community approaches” (Rappaport 1995:796).
Empowerment theory and the concept of empowerment suggests that it contains multilevel constructs and study people in context (Rappaport 1987:127). Still, Rappaport claims that using others’ theories is like
borrowing others’ glasses to see the world (Rappaport 1987:129). Rappaport argues further with his empowerment theory that we should listen to stories.
Rappaport (1995) suggests that empowerment should be fruitful with four
agendas that recognize how communities, organizations, and individual peoples have stories, and these stories can influence mutually between these stories (Rappaport 1995:796).
John Friedmann (1992) argues that the household is the starting point for the development of empowerment, and a polity and economy in miniature is defined in each home. Friedmann (1992) further explains how liberation is not through a resistance to the central state but rather democratizes the system. There needs to be a rethinking of development to reach
empowerment. According to Friedmann, a household contains three forms of power: social, political, and psychological. Alternative development then becomes a process that seeks the empowerment of households and the individuals living in them as involved in social and political actions (Friedmann 1992:32). Friedmann’s view on development is philosophical;
Humanizing a system that has shut out through everyday resistance and political struggle will realize their loving and creative powers within
(Friedmann 1992:13). Thus, development is defined as empowerment, but at the same time, a critique of neoclassical economic growth models and how they have failed in solving poverty and unemployment needs to be addressed.
The alternative development does not aim to replace the state or the economic models but reconstruct them to include the disempowered
(Friedmann 1992:10). The view does not see the government as a part of the problem but instead on how to change it to favor the least advantaged. As quoted about the role of alternative development:
“seek a change in the existing national strategies through a politics of inclusive democracy, appropriate economic growth, gender equality, and sustainability in intergenerational equality” (Friedmann 1992:34).
Rappaport (1995) argues that narratives create meaning for the people we serve. To empower the stories, they need to be discovered and develop settings that make those activities possible (Rappaport 1995,.796). The trees make the forest, a belief of Rappaport (1995:798), and the community narrative and the dominant cultural narratives (803) are the foundation in beginning a process of empowerment.
4.1.2. Feminist technoscience
A techno feminist perspective sees beyond the discourse of the digital divide to the connections between gender inequality. Namely, through a broader perspective, the political and economic basis shapes and deploys the technical systems (Wajcman 2004:121). Through the lens of feminist technoscience, Wajcman (2010) explains how techno feminism exposes the concrete practices in which design and innovation exclude specific users, such as women. STS provides a new vision of the world we live in and how it is shaped, and for whom. The politics of technology needs to be integrated into questions concerning the renegotiations about gender power relations (Wajcman 2010) while liberal feminist sees the relationship between gender and technology as a concern of equality of access and social and radical feminists analyses the gendered nature of technology itself. Wajcman further tells us how the first technologists were indigenous women by creating tools like the sickle and the pestle. From the technology being needlework,
weaving, and mining transforming to strictly applied science, “male machines” replaced the “female fabrics” (Wajcman 2004:15).
Wajcman (2004) argues that in science and technology, one of the paradoxes is that a central premise means that technoscience is socially shaped and political. There has been a reluctance to consider the implications of its
methodologies. Practitioners of technoscience act as if they do not affect the social context and not involve politics. The reflection on how the white, privileged heterosexual men have framed the field is not given the attention it is needed, according to Wajcman (Wajcman 2004:17-18). The relationship between social analysis and projects of social transformations is the
difference between technoscience and techno feminism. For instance, the emergence of postcolonial and black feminism has challenged Western white women’s privilege and given us perspectives on how other women live and experience technoscience, depending on their location. Techno-science feminism enables connections between grassroots activists and macro- politics of global movements. Because of the diversity of feminism and their vision, they align with the hierarchical divisions between men and women (Wajcman 2004:127). Wajcman gives plenty of examples of how political practices have begun to reshape science and technology networks. For instance, the feminist challenge male dominance in technology being at the expense of women’s health and healing skills. The taking back control and knowledge over women’s bodies of their sexuality and fertility were essential for the women’s liberation (Wajcman 2004:17).
Decades of feminist critiques have mouthed out to the transdisciplinary field of feminist technoscience. These critiques have put forward that gender is entangled in natural, medical, and technical sciences. “Techno-science”
ensures the separation of “basic” and “applied” science, and there is no
“basic” science. Pure research is entangled in political interest and societal interests, making it enabled to be held accountable ethically and politically.
The aforementioned applies to technological practices and makes an unavoidable link between technology and science, which creates the
compound word “technoscience.” (Åsberg & Lykke 2010:299). According to Jutta Weber (2006), technology is often described as “masculine culture” and is grounded in patriarchal structures. Weber further explains that some
feminists claim it to be dropped as “natural,” that men’s aggression and desire to control. While other feminists believe in different masculinity forms about different areas of technology, which means that the control over
technology is not to describe as that there only exists one masculinity or one technology (Weber 2006:398).
Moreover, Wajcman (2004) describes how one of the most discussed technologies within gender studies is ARTs. The discussion also shows the abovementioned binary position towards technologies within feminism, namely technology freeing women from patriarchal control versus
technology as reproducing the sexism and patriarchal power structure. The early women’s movement was progressive and showed the link between sexuality and reproduction. Wajcman uses Shulamith Firestone as an example. In the Dialectic of Sex, she argued that free women from the
“tyranny of reproduction” needed to develop effective birth technologies. In this time, patriarchy was the men’s control of women’s bodies, sexuality, and fertility. The feminist opposition did not share this view, and writers from the FINRRAGE. They argued that motherhood was a women’s identity and the qualities that came with it; it makes them not have men’s characteristics, like destructive and violent (Wajcman 2004:9-20).
Weber (2006) tells us how feminists remind us that the male-dominated technologies “reproduce the stereotype of women as technologically ignorant and incapable,” and the technological revolution in the home” is essential (Weber 2006:398).
4.1.3. Postcolonial perspective
Anne Pollock and Banu Subramaniam (2016) have argued that technoscience in the feminist postcolonial analysis is a way to illustrate the materiality of global inequalities. The authors take colonialism and shortcomings of
movements of liberation into account in their studies. Further, this forces one to examine assumptions regarding what we mean by post-colonialism, colonialism, technoscience, and feminism. Pollock and Subramaniam (2016) argue in their essay on STS’s value to consider feminist and postcolonial together. Knowledge and power are always inseparable, and technoscience has worked towards liberatory feminist goals, but leverage creates surprising and uneven results and consequences (Pollock & Subramaniam, 2016:956- 957). Pollock and Subramaniam (2016) use three cases to show Western technoscience’s dominance and how it is tangled in complex power structures. Science is deeply rooted in Eurocentrism and colonialism;
therefore, feminism and post-colonialism need to matter. Thus, our righteous anger and hope can illuminate through resisting and retooling wide-ranging processes of technoscience (Pollock & Subramaniam 2016:960-961).
Similarly, as there are tensions between Nordic feminism and Sámi feminism, there are differences between postcolonial feminism and indigenous feminist interventions. Indigenous feminism looks at the
collective dimension of self-determination and nation-building; moreover, a postcolonial feminist is not considered. Postcolonial feminists do not have the same need for nation-building, and therefore they do not look at questions about building their communities and including everybody. The nation-state’s violence embedded in Indigenous nations’ oppression and structural violence is ongoing for these people and their land. It is an increase in mineral extraction and resources in these areas. The questions about the land resources and land rights are not a part of an analysis from the
postcolonial feminists (Knobblock & Kuokkanen 2015:279-280). Oyeronke Oyewumi (2002) sees obstacles in applying feminist concepts to express and
analyze African realities and is the central challenge in African gender studies. Western gender categories operate in dichotomous male/female duality, and it is an assumption that males are superior, which is alien to many African cultures. Western claims are the ones that claim African realities, and Oyewumi sees a need for rethinking the categories of woman and gender. Moreover, it addresses African Gender Studies concerns to be two-folded, namely that Africa needs to be studied on its terms, and formulation of social theory must include African knowledge (Oyewumi, 2002:4).
These three perspectives of empowerment and gender give us insights into these women’s multi-dimensional challenges. To investigate mHealth initiatives’ empowerment in the global South, there is a need to look at gender, technology, and postcolonial view because of the dualism in the targeted group’s oppression. The neglect of knowledge from the South and West dominance is crucial in this subject’s analysis. The empowerment theory tells us of oppression and the social issues of the least advantaged in our society. Simultaneously, the technoscience-feminism gives us a broader picture of the connections between gender and technology and how
masculine coded technology creates equality in access to its innovations. The sequent chapter will present the findings.
5.Findings
So far, this research has tried to conclude the research gap found in the search and analysis of previous initiatives that empower women. In
contemplating how the projects play out, this chapter will first present overall findings following a presentation of MOTECH, a mobile health program, in section 5.1. After that, developers’ views in section 5.2 and the project’s analysis from Al Dahdah’s research in section 5.3. Following the targeted group in the following sections, starting with empirical data from a research of MOTECH in section 5.5 and conducting interviews for this research in section 5.6.
WHOs recommendations on digital interventions for health system strengthening suggests that resources needed are fewer than in non-digital interventions. Further, they argue that client communication can be difficult for specific populations. They mention the poor and women and those who have low literacy and digital skills (WHO 2019:58). Even if this is present in WHO guidelines, it is vital to underline the lack of a feminist approach to these interventions. Due to science and technology were conducted under the misbelief of women needing to be universal, it constrains women to strict gender roles. When technoscience feminism has brought the question to the surface and noted how science is not neutral but strongly connected with men’s interest, it can be combined and seen through technological
intervention conducted as universal to women. This knowledge about science and technology being male-dominated can be of use for women’s liberation.
The liberal feminism failed to see these connections because they saw technology as neutral. The influence has created critical technologies as contraceptives and abortion that are gender-specific. The gender-specific technologies lead to another important aspect of maternal health:
reproductive decision-making due to the women bound to these obligations as possessors of a female body.
Shortly mentioned in the literature review were other similar projects. Jesse Coleman et al. (2013,2020) made a qualitative study concerning opinions from MAMA, a free maternal mHealth SMS text messaging service, working in the same way as MOTECH. MAMA was offered to pregnant women in Johannesburg, South Africa, to improve maternal, fetal, and infant health outcomes. The feedback from the participants was positive. As the authors mention, the researchers came from MAMA, and the results should not replace testing in other situations and among different populations (Coleman et al. 2013,2020). Another approach in measuring the effectiveness of mHealth outcomes from James et al. (2016). James et al. tried to find motivators and barriers for women to participate in mHealth. The questions asked in this research measured sociodemographic variables, general health literacy, lifestyle and wellness data, and willingness to participate in mHealth research. Even if only women were included in the project, the lack of a feminist approach was apparent. However, the study concludes with several points on different ideas, not directing the women but arguing for a culturally tailored approach (James et al. 2016:93-197). When reviewing existing literature on the subject, the findings show that these mHealth projects are concerned with power relations from different ends (Al Dahdah et al. 2015, Al Dahdah 2017) (Ullah 2004) (Speciale & Freytsis 2013). As Wirth et al.
(2008) argue, it is not just health gaps between rich and poor, but also between groups. However, this research aim is not to present further of the initiatives that exist—merely highlighting the findings in the current approach of being focused on that the women’s reproduction is not a question of discussion, but how it puts down further responsibility on the women living in a patriarchal system. This takes us to decision making regarding reproduction.
What has been claimed of the World Bank is the essential value of the NGOs’ role in empowering women. Ullah (2004) also advocates for NGOs’
critical role and how this empowers the women in their decisions in
questions surrounding reproduction (Ullah 2004:1). Ullah further discusses other issues in what can come between women on the right to decision making regarding reproductive choices. Ullah’s research shows that 52% of the respondents, before NGO intervention, thought that the decision about reproduction was only the husband’s right to take 27% that it was mutual.
Only 3% believed that it was their own decision. Another aspect of this research was in-laws, and 18% thought they needed to satisfy them and give birth to the number of children in their interest. These numbers in order changed post-NGO interventions to 29% (husband’s choice), 53% (mutual), 7% (own choice), and 14% (in-laws’ choice) (Ullah 2004:7). This indeed shows the potential of NGOs changing the women’s status in decision making. Ullah (2004) concludes that NGOs aim to include more male counterparts in the programs to prevent domestic violence and take family members into account to balance women’s power in decision-making (Ullah 2004:8). The NGO intervention of decision-making created awareness of who is making the decision and equalizing the numbers to a greater extent of power over women’s reproductive choices. Ullah (2004) shows that the intervention changed the family dynamics in reproductive empowerment but showed no improvements in other parts of life. Reproductive rights are about seeing the people as agents instead of objects, this would be the goal and the aim, but much work needs to be ready before or else it becomes as for Ullah’s (2004) research showed that women in rural areas see the women’s mobility as correlated with disobedience. Even if the NGO interventions made progress, they have often failed because of less strategy to the social structures in rural areas. Therefore, NGOs should include more men in the
interventions to not create conflicts that lead to domestic violence (Ullah 2004).
These abovementioned findings are vital to comprehend beforehand the introduction of MOTECH and readings of other similar projects. Nowhere to be found in an analysis of the project’s outcome could the culture in words be described or comprehended. In some documents, the culture could be found as an essential pillar in progress to work. Still, African knowledge is not found anywhere; Western knowledge should be applied, according to the literature review. It sums up that it is no interest in either learning from the targeted group or tailor the initiatives made to reduce maternal morbidity.
5.1. MOTECH
The Grameen Foundations MOTECH is a mobile health program intended to reach out to women in rural areas, to improve health outcomes. The project aimed to reach MDGs 4 and 5, with their low cost and simple technology.
The project has partners in Bill & Melinda Gates Foundation and Ghana’s Health Service and has assistance from WHO’s Department of Reproductive Health and Research and mHealth Alliance. Furthermore, it has two
applications, namely Mobile Midwife and the Nurses Application. The first provides SMS with information, alerts, and care reminders. The second helps nurses document the care of women and newborns in their area, then sent to MOTECH servers that check recommended treatments according to the Ghana Health Service (WHO 2013).
It is then two services provided; Mobile Midwife, directed to pregnant women and their families. The alerts can be reminders for care-seeking and
tips for saving money to pay for transportation and educational information.
The second service is directed to the midwives and enables them to enter data about patients, sending them to the MOTECH servers. If a patient misses an appointment, the system sends out a message to remind the patient.
Data collection also generates monthly reports, saving time instead of doing it by hand (Grameen Foundation 2012:2-3).
The project has been active in Ghana from 2010 to 2014 and was engaged in seven of approximately 200 districts. Kilkari is the Mobile Midwife name in India and was launched in 2013 and based on the Ghanaian experience. In this project, there were 100,000 subscriptions, and in the same way as Mobile Midwife in Ghana were working on the same platform and sending out information to pregnant women. The phone service is fee-based, 1 rupee per message, and sends time-specific voice messages in rural Hindi (Al Dahdah 2017:5-6)
5.1.2. Grameen Foundation’s lessons learned
In Grameen Foundations (2012) own paper on what lessons learned during the project, they mainly bring up perspectives on the technology. They also conclude by noting that MOTECH is viewed as a technology project.
Therefore, most lessons learned are about operational issues, but they claim that they also use cultural components as most of the text. They claim that it is the people responsible for the project’s success or failure (Grameen Foundation 2012:73), which implies that they are not taking responsibility themselves if the projects are not working out.
Midwives owned personal phones used, but only 85% could transmit data via SMS, and the battery in the phone was in bad condition. Other reflections
from Grameen were that older nurses had a hard time sending and retrieving SMS, and therefore basic lessons in data entry training were necessary. They made templates, for instance, to overcome this obstacle. They continue to bring up similar issues (Grameen Foundation 2012:15).
Grameen realized that they need to translate into different Ghanaian
languages and localize the applications’ content due to the different cultures within Ghana, according to them, because of their myths and dietary
practices. (Grameen Foundation 2012:23) They also claimed that they paid particular attention to be respectful to local traditions and culture, and timely, concise, and accurate, but take as an example that they should send a
message relevant to the pregnancy time. Their model was that a woman near birth would appreciate a tip on breastfeeding more than early in the
pregnancy. (Grameen Foundation 2012:24) which is not a good example for cultural respect but more on the timely, concise, and accurate explanation.
Furthermore, they bring up “cultural myths” surrounding pregnancy, birth, and newborn care and how to think about, respectfully, explain that it is not in the mother or baby’s best interest and can be dangerous (Grameen Foundation 2012:27).
To learn about the most frequently asked questions, ten Ghanaian women kept a diary for a month. Grameen Foundation reports some of the questions about pregnancy and general health issues, and the written questions asked were reduced by the day. This, together with interviews of a total of 90 individuals that were randomly selected and selected if they had a personal phone, household phone, or public phone (Grameen Foundation 2012:53 &
91). Those two were the only components near looking at a local perspective found in the Grameen Foundations document. The document brought up myths collected from locals to know essential facts to send out to the women.
(Grameen Foundation, 2012:93-94).
John Koku Awoonor-Williams et al. (2012) sum up in their paper, as a group from both Ghana Health Service, Columbia University (School of Public Health) and University of Southern Maine (Department of Computer
Science), that MOTECH represents an essential contribution to mHealth, but also a work in progress. A focus on social and contextual problems involved needs to attend. Further, research needs to involve the full range of
development steps and evaluation (Awoonor-Williams et al., 2012:15).
5.1.3. Do the women feel empowered?
MOTECH is portrayed to be an empowering tool for women and further a double promise in patient empowerment and women empowerment. This promise to help women to get educated as well as adopt the “right” health behaviors. Al Dahdah (2017) describes how women are presented as ignorant in her research projects in Ghana and India. In an interview with funders, they claimed that these women did not care what to do and what to eat during pregnancy (Al Dahdah, 2017:7-8). The conceptualization of liberal
empowerment as seen as a gift is visible in the approach. The focus on access to external resources, goods, and services are of greater importance than group organizing and building trust as a part of the process. These social and political dimensions make it instrumental and methodologies for
empowerment and ignore the exchange of experience and collective reflection, leading to change (Sardenberg 2008:22-23).
Al Dahdah (2017) argues that MOTECH messages are, to some extent, prescribing actions that can be hard to implement for women. If, for example, a female vegetable vendor in rural Ghana gets a message which tells her to go to healthcare on a market day, her income depends on it.
Another example is breastfeeding advocacy without follow-ups, which can be useless. A woman in the project illustrates how she gets tempted to give the child food instead of when the milk does not come in several days. When women’s needs do not consider and do not offer any dialogue, it is
incompatible with the idea of empowerment; then, the device becomes a form of authority that women are not allowed to question. MOTECH becomes a way of avoiding an encounter with health professionals, so it becomes a way to jump out of the health system. There can be a gap between the messages and the reality of accessing healthcare in not correctly working infrastructures. This concludes that MOTECH messages, given by the geographical and financial difficulties, become symbolic violence for these women (Al Dahdah 2017:139-141). As mentioned, mHealth projects targeting women often have a double promise of empowerment, both for women and patients.
Regarding MOTECH, they rely on the idea of educating women to have better health behavior, which suggests that women do not have sufficient knowledge to make the right decisions, leading to women in Ghana
represented as “ignorant.” Al Dahdah (2017) has researched digital politics and the consequences of technologies deployed in the global South. These messages suggest that women’s health will increase if they follow their devices’ instructions. According to Al Dahdah, it has been a top-down prescription instead of the power of autonomy, and women in Ghana have criticized this. First, one needs to have access to a mobile phone to get messages, and it is harder for women because the husband often owns the hardware. Secondly, these women are not always enrolled in these projects voluntarily. It is essential to keep in mind that the link between receiving these messages and changing behaviors was not evidenced (Al Dahdah 2017:141-147). Al Dahdah et al. (2015) argue that mHealth projects raise issues surrounding equity in partnerships. Developed countries control the
projects and technology implemented in developing countries, and MOTECH has numerous stakeholders. American technical operators and funders are dominant in these technology projects, and the collaboration with developing countries needs further study. Local traditions, economic, and political contexts and how it adapts to financial practices, and foreign ethical dynamics needs highlighting (Al Dahdah et al. 2015:227-228).
5.2. Narrative approach
“An emancipatory politics of technology requires more than hardware and software; it needs wetware - bodies, fluids, human agency.” - Judy
Wajcman 2010:77
The previous section looked at MOTECH from the developers, the
participants, and a sociological perspective (Al Dahdah 2017). People living in areas that lack power in social, economic, and political regions often have stories written about them, for them, and in some cases written negatively (Rappaport 1995). This section will contain women’s views in different rural regions to further discuss if women feel empowered. Starting with Al
Dahdahs (2017), interviews from Ghana and India, following by interviews conducted in Kenya for this research (2020). These initiatives direct towards women and the improvement of their health. Therefore, they need inclusion and paid attention to as Rappaport (1995) argues that the narratives create meaning for the people. There is a need to discover and care for a more comprehensive understanding of the stories they possess to reach empowerment.
Even if the stories highlight this chapter, there are still similarities between women’s countries. All three countries are ranked in the medium human development and ranked in the latest HDI, Kenya 147, Ghana 142, and India
129. Further, the GDI as followed, Kenya 0,932, Ghana 0,912, and India 0,829. This shows that Kenya, even if the lowest in HDI, has the highest rank in gender development, measured in three basic dimensions, health,
education, and command over economic resources. Kenya has the highest maternal mortality rate of the three countries, with 510 deaths per 100,000 live births.
Further, Kenya has the lowest percentage of internet users with 17,8%, in contrast with Ghana’s 39% and India’s 34,5% (Human Development Report 2019). These numbers become interesting to analyze with their erratic showings. One could believe that the poorest also would have the most inadequate access to the internet and most impoverished gender
development, which is not the case here. As these three countries are in the medium of human development but differ in other measures, we will listen to women from different regions.
5.2.1. “Health at her fingertips.”
Al Dahdahs (2017) empirical qualitative study in Ghana and India contained interviews with women involved with MOTECH. They had ten focus groups and met 100 women (Al Dahdah, 2017:6). This section will review the women’s answers and further enable a local perspective on the realities of the implementation of MOTECH.
A participant from India opens that the calls’ promises do not occur to be the reality. The facilities are not available, which results in not being able to get herself and her child check-ups (Al Dahdah 2017:12). This puts down the projects’ trust and tells us about the lack of available healthcare workers.
Furthermore, according to one women’s statement, only one vehicle is
available in the village to get to the hospital. When it is time to deliver, and the car is not available, one cannot walk to the facility. Hence, one must give birth at home. (Al Dahdah 2017:12-13) Likewise, a woman from India is telling the same story, and that the carrier takes charge to transport, and the ambulance never comes to where she lives. It becomes an issue of both access and economic barriers. Another woman testifies that it all boils down to money and wishes that she could seek healthcare but unable due to the economic situation. An Indian woman tells how she had to spend her money on everything, medicines, injections, and food, and pay extra because the nurse demanded it. The women further tell how the nurse demanded extra money because she gave birth to a boy. Another woman from India believes that it is better to deliver at home and sees no benefits with giving birth at a hospital and that it is too expensive (Al Dahdah, 2017:13). This sums up to that the institutional deliveries come with barriers in transportation and costs.
Regarding the technology, women from both Ghana and India testify that they do not like that it only speaks to one and cannot talk back. It leads to creating a feeling that makes them not listened to, and foremost, they should listen to what they say and not the other way around. There was a wish to meet a care worker at the other end to ask their doubts and have a dialogue (Al Dahdah 2017:11). Statements from both India and Ghana about concerns the calls’ costs and uncertainties about the registration. Also, about not getting informed about the benefits of MOTECH. One disappointment from accessing the messages is also the registration. If one cannot afford to go to the hospital to register, one does not get any notifications and the need for access to a mobile phone (Al Dahdah 2017:10).
A Ghanaian woman tells how she was told not to give her child water until the sixth month but does not listen because her mother was giving her water, and she is fine and questions the advice coming from the project. In the same
spirit, another Ghanaian woman tells how they get advised not to purge, but her parents have said that it is good and keeps on cleansing. (Al Dahdah, 2017:11). These stories show how a short voice message is not merely enough to break a family-oriented culture that highly respects and listens to their elderly’s experience and knowledge. Previously mentioned, women stated that they could not express their doubts and current issues and take action in what they believe is the most appropriate when they have one-way communication.
As technoscience feminism explains in-depth, there is a masculine culture with technology. Women from India describe how male family members deactivate the application due to the costs and take the mobile phone from the women and women not allowed to touch the phone and husbands that do not understand the calls’ purpose (Al Dahdah 2017:9). Found in Al Dahdah’s research is that the patriarchal values are highly recognized within the
societies researched. The technology is embedded in a masculine culture, as technoscience feminism argues.
5.2.2. Storytelling from Enkokidongoi
This section will contain interviews conducted to give further insights into maternal health in rural areas. This village has no mHealth initiatives implemented but fits in the aspects of lack of access to healthcare. Further, this section will represent voices of the local and female voices needed from WHO (2019) and promised from the projects but absent in the analysis.
Further, the interviews will have three perspectives on maternal health: from a man’s perspective, two mothers from a woman’s perspective, and a female nurse. This insight in Enkokidongoi village will create a more
comprehensive understanding of how challenging mHealth initiatives
implementation can be. Further, it may help to understand why it is not reaching out and empowering women as promised. Oyewumi argues that Africa’s interpretations need to start in Africa (Oyewumi 2002), and the information given is not taken from literature from the Global North to overcome interpretations and assumptions.
In Enkokidongoi, indigenous people, namely the Maasai, live in their traditional nomadic lifestyle and have age-old customs. Enkokidongoi is a village struggling with access to healthcare and lack of education regarding healthcare, which leads the population to act independently and rely on local help available. Enkokidongoi possesses four female “midwives” for the maternal care of the whole village’s women and does not have formal education or equipment. These ladies are all Maasai and are doing the job manually without sufficient protective gear, which is risky due to the spread of infection and the risk of dying during or after childbirth. In Enkokidongoi, there are approximately 700 citizens, and they share one car in the village.
The nearest hospital is four miles away in Mali Tisa and is relatively new and unexplored in its efficiency, and one bigger hospital twelve miles away.
During pregnancy, the process, when not able to go to the hospital, is different. The midwives are gifted with the duty to help the locals, and they can, for instance, interpret the gender of the child by massaging the stomach.
Before the locals had mobile phones, it was harder to reach help in time;
then, it was usual for the midwife to move in with the family and take care of the woman until the child is delivered. Some women hide their pregnancy, which leads to them not taking the local herbs ordinated from the midwives.
Further, it can result in not getting the injections needed at the hospital, which can be risky for women’s health. Most village women give birth at home and get local herbs named “orpando” to get through the pregnancy, and after they take “enkiloriti.” This is the bark from trees that the midwives use
as medicines during the pregnancy. Since the Maasai have a traditional lifestyle with old customs, some do not help girls who are not circumcised.
The experience of Interview 1 of hiding the pregnancy is cultural, and it is not the custom to get pregnant directly after giving birth, for instance.
Another reason for hiding pregnancy can be if the girls are too young, which has increased now when the schools have shut down because of the ongoing pandemic. Some guidelines mean that women should eat little during
pregnancy, so the baby does not end up so big, leading to an easier delivery.
This makes women have less energy and not be strong enough for child delivering and fainting during birth.
Furthermore, cultural traditions are deeply integrated into the community and are vital for how maternal health is executed. The government has made a law against circumcision (The practice of FGM/C is illegal in Kenya under the Prohibition of Female Genital Mutilation Act of 2011 (Kimani et al., 2020)). Still, the Maasai people are doing it at their homes, in secret from the government. This can be an essential perspective on how multi-dimensional the integration of mHealth must be to be successful. According to Interview 1, maternal morbidity does not correspond with the statistic of deaths.
Interview 1 does not believe that the numbers can be right and are random;
many deaths, at home, may not be adequately documented. In Enkokidongoi, the women want to visit hospitals in contrast to some of the women
interviewed in Ghana and India. In their village, it is the accessibility to hospitals which is the main issue at the time being. So, in their case, it is not about preferring to give birth at home, at least from Interview 1s
perspective.
Further Interview 1 explains a government program in 2017 that educated and talked about maternal health in the village. This was a program for both the women and their husbands about breastfeeding, family planning, and
other maternal health topics. This enables these women to listen and learn from outside the village to complement the locals’ existing knowledge further. The intervention takes up on possible ways of thinking concerning family planning. For instance, how to think about the number of children planned and how to think about their providing. The intervention aimed to balance the family’s size with the family’s income, which would enable them to provide their children with basic needs, such as clothing and food. The men and women had separate meetings and then a combined session
together; this enabled the information to be adjusted to the group’s needs and be relevant to the group listening. According to Interview 1, this program gave a lot to the participants, and the progress was in the right direction, but the program did not last long enough to create a well-rooted change that lasted. Still, as for any modification, it takes a long time and needs both financing and time prioritized. The process of transformation takes time, and the local women need advice and training. According to Interview 1, the community’s three priorities are access, training for the midwives, and education (Interview 1).
Interview 2 is a female nurse with experience from different regions in Kenya and tells her story from a woman’s perspective working with maternal health. Interview 2 argues for how women do not afford to give birth at hospitals and have difficulties reaching the hospitals for economic reasons, lack of resources in vehicles, and cultures used to give birth at home. Thus, it creates an environment where most women give birth at home for economic and cultural reasons. Further Interview 2 tells how most of the patients, of her experience, visit the healthcare facilities if there are any complications in the pregnancy or the childbirth. Thus, Interview 2 explains how one sees lots of difficulties surrounding pregnancy and aftercare. Many girls are too young (14-16 years old) and are not fully developed, and in the coming years, they can have six kids in a short period, and the body does not have time to
recover. Follow-ups after birth are not standard if there are no complications of severe degree. Interview 2 shares her thoughts that illiteracy and poverty are the two biggest challenges for these girls and women (Interview 2).
Interview 3 & 4 are both living in Enkokidongoi, Kenya, and are mothers.
They both have access to phones, which they own themselves. However, they see challenges in overcoming the obstacles they face in their village with a mHealth initiative. They do not have access to hospitals, but they need to rely on the midwives because of no other choices due to the challenges in accessing dispensaries, due to bad roads, and no vehicles’ access. Even if they had Mobile Midwife, they would not come to check-ups at the hospitals.
The trust towards the midwives is deficient in that they cannot provide safe care for pregnant women because of the lack of protective equipment and insufficient knowledge.
They would argue for women empowerment not visible; their opinion would not be listened to by their husbands. They had no joint meetings to empower women to be in groups and discuss women’s issues. In the question of whether they had the power to decide over their own body, they both agreed that the final say was with the husband’s word on how many children the family would have. The family’s decision-making is rare to have the women be equal in deciding the reproductive decisions. The striving to change the woman’s position is at least to agree upon reproduction and that the husband listens. Still, they experience a lack of understanding of women
empowerment with the women in the village. Because of the lack of visits to the hospital, they do not have training and education in women
empowerment from healthcare either. Both Interviews 3 and 4 agreed that the visits would be more extensive if a hospital were nearby. They do not think that any village women would freely choose to give birth at home if there would be a hospital nearby.
Contraceptive comes from the dispensaries, so one must carry another baby if one does not access them. The view on contraceptives was positive, and they would choose it, but the husband’s word in the number of children is the final saying in the matter. However, if the husbands were against it, the village women would use them behind their backs in some cases to protect themselves against another pregnancy. Interview 3 explains that if the women want an injection, they need to walk the whole way to the hospitals to get it. Interview 3 gave birth at hospitals with her two children, and when the baby was delivered, the women went home: check-ups cost money.
During the pregnancy, one should go to check-ups once a month, but due to the challenges of inaccessibility to the dispensary, many women do not attend their check-ups. Risks that could have been found earlier in the pregnancy would be appropriate, and when check-ups are not attended, it becomes risky for both the child and mother (Interview 3 & 4).
The interviews from both Ghana, India, and Kenya are different for the simple reason of coming from different regions and cultures. Nevertheless, in all the interviews analyzed, the patriarchal system is close in accordance with technoscience feminism. Kenya’s interviews represented a village without a mHealth initiative and explained its challenges without a hospital nearby.
Further, the feminist movement and technology that made contraceptives possible do not reach out to every woman in a similar way. There was a wish for the usage of birth control, but the patriarchal values, as well as the
distance to the hospitals, made it challenging. For instance, the similarity in lack of access to vehicles enabling reach the healthcare facilities that was an issue in all the regions observed. The next chapter will further discuss the findings found in this chapter.
6. Analysis & Discussion
The previous chapters gave valuable lessons learned from women’s empowerment and how challenging mHealth initiatives can be. Western technology embodies patriarchal values, which for women in the global South are victims of oppressions that become two-folded and needs attention.
The theories chosen in this research have addressed these oppressions and will be further discussed in this chapter. The three research questions will be analyzed in section 6.2-6.4 and follow by a discussion
As said in the introduction, this research aims to have an initial position to be as objective as possible and use feminist studies and local women’s own words in interviews to comprehend the topic. This has been the case in this research so far by putting MOTECH at the center of observations, but this is not about the case itself, but the neglect of feminist perspectives. To visualize the choice of MOTECH, one could think of the project as an object of
observation for the reason of its action, not the project itself. It is worth clarifying that the project is developed for good causes, and this research aims not to put MOTECH in a bad light, just bringing in perspectives missing in the process. MOTECH could have been replaced by any other mHealth initiative and had no other objective in this research than to portray an example of a Western-led agency with a dominant western approach. As Oyewumi has told us about Western dominance and white feminism, the questions become two folded. This leads western projects to face a range of obstacles to tackle before launching new projects. For technology to be gender-free, feminism needs to be integrated with science. Wajcman has enabled a revised version of the feminist perspective that claims women to be victims of technology. Instead, it emphasizes heterogeneity within
technology and how to neutralize it in science with a feminist approach.
