Sexual & Reproductive Health & Rights & mHealth in Policy & Practice in South Africa

Information and Communications Technology (ICT) offers enormous opportunity and innovation to improve public health and health systems.This paper explores the intersections between mHealth and sexual and reproductive health and rights in both policy and practice. It is a qualitative study, informed by policy review and key informant interviews. Three case studies provide evidence of what is happening on the ground in relation to ICTs and reproductive health and rights. We argue that in terms of policy, there is little overlap between health rights and communication technology. In the area of practice, however, significant interventions address aspects of reproductive health. At present, the extent to which mHealth addresses the full range of reproductive justice and sexual and reproductive health and rights is limited, particularly in terms of government initiatives. The paper argues that mHealth projects tend to avoid contentious aspects of sexual health, while addressing favourable topics such as pregnancy and motherhood. The ways in which information is framed in mHealth mirrors current gaps within sexual and reproductive health and rights, where a limited and conservative lens predominates, and which may result in narrow programming and implementation of services...

The issues associated with sexual and reproductive rights – sexuality, abortion, gender-based violence, sex-positive messaging and teenage sexual pleasure – are, in addition, politicised, involve religious and moral values and receive polarised opposition. This polarisation is also reflected in government departmental practice. Representatives from the Department of Social Development emphasised their focus on South Africa’s sexual and reproductive rights commitments, in particular, the ready availability of contraception and preventing violence against women and children. In contrast, the Minister of Health prioritises health information systems and maternal health. As noted by one government representative, as a consequence there is “very little interface” between sexual and reproductive rights and ICTs and very little interaction between members of the National Department of Health and the Department of Social Development. Similarly, among researchers and implementers, SRHR experts have limited understanding of the current use of ICTs in health and implementers have only partial perspectives on SRHR. Their sectoral knowledge is accompanied by a complete lack of knowledge about policy, as one implementer of a mobile platform for youth and sexuality commented:

“The scary thing is how possible it is to do this without ever coming up against these policies. Anyone can put a sexual health and advice site up with no restrictions, no regulations.”

As several respondents working in the area of implementation pointed out, even in areas where there is good policy, implementation is challenging,24 and policy is not sufficiently correlated with need. South Africa’s ICT policy focuses on expanding broadband access, and on high-income country standards. It sees cell phones as automatically overcoming gender exclusions, yet some health researchers pointed out that adding more phones may not improve access. Rather, they argued, structural factors (such as poverty, unemployment, literacy, residence, and patriarchal relations) limit women’s use and access to ICTs.1, 37 As one respondent said: “Access [to ICTs] mirrors inequality offline”. Addressing inequality in women’s health is therefore not just about providing more phones. Rather, a transformative approach with dedicated programmes is needed...38, 39

Full article at: http://goo.gl/p050dV

By: Waldman L1, Stevens M2.

• 1Institute of Development Studies correspondence:
• 2WISH Associates and African Gender Institute, University of Cape Town.  

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