Gendered Fragmented Digital Literacy: A Chilling Effect on Reproductive Rights of Women in India

This article navigates how the lack of digital literacy in India is limiting women’s reproductive rights. While digital healthcare services like e-Sanjeevani, AYUSH, and telemedicine offer new opportunities, many rural and urban women struggle to use these tools due to limited digital skills and awareness. The situation is further complicated by the integration of Aadhaar with digital healthcare data, raising serious privacy and surveillance concerns. Without addressing these digital gaps, women remain vulnerable. The article highlights the urgent need to build a gender-inclusive digital literacy ecosystem to ensure that all women can safely access and control their reproductive healthcare.

Introduction

Digital literacy is the most pressing problem. Indian women are facing issues, especially in relation to their bodies. UNESCO (2021) defines “Digital literacy is the ability to use digital tools effectively, enabling individuals to communicate, access information, and participate fully in the digital economy and society” (UNESCO, n.d.). Healthcare is a basic human and fundamental right (Behanbox, 2023) which is universally recognised. However, the power is not completely vested with women. No matter whether it is urban or rural women, the plight is "gendered". Only a few sections of specific communities can exercise this power. India is a male-dominant country, both traditionally and historically. However, it is also true that it is changing now. However, the harsh reality is that education and awareness are not equally available. The author is attempting to pinpoint this issue from reproductive autonomy because healthcare is the most private and crucial decision for any woman. With the whopping advancement in digital healthcare in India, there are several apps and platforms available, for example, M-health, E-Sanjeevani, AYUSH, Telemedicine services, etc. However, unfortunately, a lack of digital literacy is creating a gendered gap within the digital healthcare system in India. There are several factors. For instance, not every woman in India owns a mobile phone. Many women are economically dependent on the internet, which can lead to issues with charging or network connectivity. Another issue is that decision-making power is still vested within males or decided by men, including the choice of hospital, whether to opt for surgery or C-section, etc (Healthcare Executive, n.d.). According to “Indian Inequality Report 2022: Digital Divide” (Oxfam India, 2022), only 31% of rural people have access to internet services, which is comparatively lower than the urban population.

The next part is identifying the obstacles which create hindrances for women while exercising their reproductive rights, especially in abortion. Digital literacy has two important aspects, which are discussed here to understand the importance and challenges. Indian women are facing. First, knowledge of using digital health platforms; and second, awareness of the obstacles in digital healthcare due to the absence of a proper legal framework in India. The use of digital platforms is beneficial for Indian women in exercising their reproductive rights with ease. For example: Internet Sathi, PMGDISHA, E-Sanjeevani, e-Hospitals, and Digital Saksharta Abhiyan (DISHA). These initiatives have fueled digital healthcare programs. According to studies, these initiatives are improving women's reproductive healthcare. Indeed, while there are challenges attached to these initiatives, which are addressed in the next section, it is true that these government-launched programs are helping in tracking the records of pregnant women through the Reproductive and Child Health (RCH) Portal (Kumar & Singh, 2021). Under the Janani Suraksha Yojana (JSY) (Joshi & Mishra, 2022) scheme, digital payments have been allowed, which has increased "institutional deliveries" and reduced maternal death rates in rural parts of India. A significant example of the digitalisation of healthcare was seen during the COVID-19 pandemic. COVID impacted abortion services, but to resolve this issue, India introduced "telemedicine" or "teleconsultation" services through phone calls by Registered Medical Practitioners. However, telemedicine comes with shortcomings due to social barriers.

This section deals with the obstacles arising due to digital healthcare in India and related privacy concerns. The Indian government launched the “Ayushman Bharat Digital Mission (ABHA)” in 2022 (APC, n.d.). The purpose is to digitalise medical records and store the data in a central database (including sensitive information such as abortion, HIV status, etc.). Every citizen is provided with an ABHA number, which is linked to their Aadhaar number. The grey area here is Aadhaar itself, which becomes a key obstacle for women in exercising their reproductive rights without surveillance and the fear of data breaches. According to a Behan Box report (Behanbox, 2022), women are often not allowed to have abortions in the absence of an Aadhaar card, which leads to unsafe abortions. The key obstacle here is the lack of digital literacy and awareness among Indian women, particularly regarding when and how to say “NO.” The linkage of Aadhaar and ABHA numbers questions the confidentiality and privacy of women's medical records. Although abortion is allowed in India under certain circumstances, this creates surveillance over women’s bodies. Instead of empowering women, it makes them more vulnerable in the digital space. This issue is not limited to one gender. For example, HIV patients (The Hindu, 2015) are forced to provide Aadhaar details for continuation of their treatment, which is inhumane. Another significant issue faced by many women in India relates to telemedicine, which was a saviour for abortion services during the pandemic. The key issue with telemedicine is that it remains an urban-centric abortion solution (Jain et al., 2022), not adequately accessible for rural women. The services of teleconsultation are not inclusive. There are several key issues associated with this problem: first, accessibility for all women; second, language barriers faced by women due to the predominant usage of English-language information (Zhai, 2021); and third, telehealth is not suitable for persons with disabilities (Yang et al., 2020). These are important issues that need to be addressed on a large scale to establish a balanced digital literacy ecosystem for women in India.

The last part addresses the privacy issues embedded in digital literacy within India's digital healthcare system. The privacy comes into question when "informed consent" is absent in the current framework of the DPDP Act 2023, India. There have been recent incidents reported: The Indian Council for Medical Research (The Hindu, 2023) has been targeted by hackers over 6,000 times since 2022. In September 2023, Jharkhand's Ministry of AYUSH (Behanbox, 2023) was targeted for a cyberattack, and 320,000 patients' data was breached. These incidents raise questions about the privacy concerns associated with digital healthcare records. There are two important aspects of digital literacy. First, Women are more vulnerable to this situation. Women's access to technology is far less than men's in India. Distributing mobile phones is dangerous in the absence of digital literacy. The second aspect involves recognising the positive and negative aspects of digital healthcare in the context of reproductive autonomy. Women's data related to their pregnancy and abortion is sensitive; however, as per the current DPDP Act 2023 (S&R Data+, n.d.), there is no distinction between personal sensitive data anymore.

The issue of data breaches is well-connected to digital literacy. The awareness and knowledge of what digital literacy is about abortion services and reproductive rights of women in digital healthcare prevent the data breach at the initial stage. This raises concerns about why gender matters (APC, 2023) in cybersecurity and digital healthcare. Women and marginalised sectors are highly prone to these accidents. Digital literacy is crucial for women because everything is digitised nowadays. However, gender-fragmented digital literacy is a major concern to overcome issues of privacy, data breaches, cyberattacks, reproductive rights of women under Article 21 of the Constitution, Aadhaar surveillance over women's bodies, and ethical and legal challenges. These are important concerns which need to be addressed for the advancement of sustainable digital literacy, necessitating solutions guided by policy, increased funding in digital education, improved internet infrastructure, and more robust legal protections.

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