PMID- 32687527 OWN - NLM STAT- MEDLINE DCOM- 20200921 LR - 20240330 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 15 IP - 7 DP - 2020 TI - Does having a mobile phone matter? Linking phone access among women to health in India: An exploratory analysis of the National Family Health Survey. PG - e0236078 LID - 10.1371/journal.pone.0236078 [doi] LID - e0236078 AB - BACKGROUND: The disruptive potential of mobile phones in catalyzing development is increasingly being recognized. However, numerous gaps remain in access to phones and their influence on health care utilization. In this cross-sectional study from India, we assess the gaps in women's access to phones, their influencing factors, and their influence on health care utilization. METHODS: Data drawn from the 2015 National Family Health Survey (NFHS) in India included a national sample of 45,231 women with data on phone access. Survey design weighted estimates of household phone ownership and women's access among different population sub-groups are presented. Multilevel logistic models explored the association of phone access with a wide range of maternal and child health indicators. Blinder-Oaxaca (BO) decomposition is used to decompose the gaps between women with and without phone access in health care utilization into components explained by background characteristics influencing phone access (endowments) and unexplained components (coefficients), potentially attributable to phone access itself. FINDINGS: Phone ownership at the household level was 92.8% (95% CI: 92.6-93.0%), with rural ownership at 91.1% (90.8-91.4%) and urban at 97.1% (96.7-97.3%). Women's access to phones was 47.8% (46.7-48.8%); 41.6% in rural areas (40.5-42.6%) and 62.7% (60.4-64.8%) in urban. Phone access in urban areas was positively associated with skilled birth attendance, postnatal care and use of modern contraceptives and negatively associated with early antenatal care. Phone access was not associated with improvements in utilization indicators in rural settings. Phone access (coefficient components) explained large gaps in the use of modern contraceptives, moderate gaps in postnatal care and early antenatal care, and smaller differences in the use of skilled birth attendance and immunization. For full antenatal car, phone access was associated with reducing gaps in utilization. INTERPRETATION: Women of reproductive age have significantly lower phone access use than the households they belong to and marginalized women have the least phone access. Existing phone access for rural women did not improve their health care utilization but was associated with greater utilization for urban women. Without addressing these biases, digital health programs may be at risk of worsening existing health inequities. FAU - Mohan, Diwakar AU - Mohan D AUID- ORCID: 0000-0002-7532-366X AD - Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America. FAU - Bashingwa, Jean Juste Harrisson AU - Bashingwa JJH AD - Computational Biology Division, University of Cape Town, Cape Town, South Africa. FAU - Tiffin, Nicki AU - Tiffin N AD - Wellcome Centre for Infectious Disease Research in Africa, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. AD - Health Intelligence Initiative, Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. AD - Division of Epidemiology and Biostatistics, Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. FAU - Dhar, Diva AU - Dhar D AD - Bill and Melinda Gates Foundation, New Delhi, Delhi, India. FAU - Mulder, Nicola AU - Mulder N AD - Computational Biology Division, University of Cape Town, Cape Town, South Africa. FAU - George, Asha AU - George A AD - School of Public Health, University of the Western Cape, Cape Town, South Africa. FAU - LeFevre, Amnesty E AU - LeFevre AE AD - Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America. AD - Health Intelligence Initiative, Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. AD - Division of Epidemiology and Biostatistics, Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. LA - eng GR - WT_/Wellcome Trust/United Kingdom GR - R01 HD080465/HD/NICHD NIH HHS/United States GR - U24 HG006941/HG/NHGRI NIH HHS/United States GR - 203135/Z/16/Z/WT_/Wellcome Trust/United Kingdom PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20200720 PL - United States TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Adult MH - Cell Phone/*statistics & numerical data MH - Female MH - *Health Status MH - *Health Surveys MH - Housing/statistics & numerical data MH - Humans MH - India MH - Maternal Health Services/statistics & numerical data MH - Multivariate Analysis MH - Ownership/statistics & numerical data PMC - PMC7371204 COIS- Diva Dhar is an employee of the Bill and Melinda Gates Foundation and managed the Kilkari Impact Evaluation grant. All remaining authors declare no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials. EDAT- 2020/07/21 06:00 MHDA- 2020/09/22 06:00 PMCR- 2020/07/20 CRDT- 2020/07/21 06:00 PHST- 2019/06/20 00:00 [received] PHST- 2020/06/30 00:00 [accepted] PHST- 2020/07/21 06:00 [entrez] PHST- 2020/07/21 06:00 [pubmed] PHST- 2020/09/22 06:00 [medline] PHST- 2020/07/20 00:00 [pmc-release] AID - PONE-D-19-17547 [pii] AID - 10.1371/journal.pone.0236078 [doi] PST - epublish SO - PLoS One. 2020 Jul 20;15(7):e0236078. doi: 10.1371/journal.pone.0236078. eCollection 2020.