title: Influence of mHealth interventions on gender relations in developing countries: a systematic literature review.
abstract: BACKGROUND
  Research has shown that mHealth initiatives, or health programs enhanced by mobile phone technologies, can foster women's empowerment. Yet, there is growing concern that mobile-based programs geared towards women may exacerbate gender inequalities.
  
  
  METHODS
  A systematic literature review was conducted to examine the empirical evidence of changes in men and women's interactions as a result of mHealth interventions. To be eligible, studies had to have been published in English from 2002 to 2012, conducted in a developing country, included an evaluation of a mobile health intervention, and presented findings on resultant dynamics between women and men. The search strategy comprised four electronic bibliographic databases in addition to a manual review of the reference lists of relevant articles and a review of organizational websites and journals with recent mHealth publications. The methodological rigor of selected studies was appraised by two independent reviewers who also abstracted data on the study's characteristics. Iterative thematic analyses were used to synthesize findings relating to gender-transformative and non-transformative experiences.
  
  
  RESULTS
  Out of the 173 articles retrieved for review, seven articles met the inclusion criteria and were retained in the final analysis. Most mHealth interventions were SMS-based and conducted in sub-Saharan Africa on topics relating to HIV/AIDS, sexual and reproductive health, health-based microenterprise, and non-communicable diseases. Several methodological limitations were identified among eligible quantitative and qualitative studies. The current literature suggests that mobile phone programs can influence gender relations in meaningfully positive ways by providing new modes for couple's health communication and cooperation and by enabling greater male participation in health areas typically targeted towards women. MHealth initiatives also increased women's decision-making, social status, and access to health resources. However, programmatic experiences by design may inadvertently reinforce the digital divide, and perpetuate existing gender-based power imbalances. Domestic disputes and lack of spousal approval additionally hampered women's participation.
  
  
  CONCLUSIONS
  Efforts to scale-up health interventions enhanced by mobile technologies should consider the implementation and evaluation imperative of ensuring that mHealth programs transform rather than reinforce gender inequalities. The evidence base on the effect of mHealth interventions on gender relations is weak, and rigorous research is urgently needed.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. ljenning@jhsph.edu.
authors.forename: Larissa
authors.initials: L
authors.lastname: Jennings
authors.forename: Laina
authors.initials: L
authors.lastname: Gagliardi
mesh_terms: D040421:Cell Phone; D003153:Community Health Services / Q000379:methods; D003906:Developing Countries; D036262:Empirical Research; D005260:Female; D063005:Health Information Systems; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D012747:Sexual Partners / Q000523:psychology*; D017216:Telemedicine / Q000379:methods