As healthcare systems go digital, they promise greater access to health information and services, as well as improved efficiency and empowerment. This is especially important for young women in low- and middle-income countries, who gain the opportunity to access sexual and reproductive health information online more easily than they can in a traditional clinic, and without the same fears of gender inequality, manipulation, or moral judgment. Unfortunately, gender inequality has followed young women into the digital age. National and global health agencies must take targeted action, in collaboration with young women themselves, to develop local solutions that uphold their fundamental human rights to privacy, security, and digital justice.
Collecting the data
Our new research report, Paying the Costs of Connection: Human Rights of Young Adults in the Digital Age in Colombia, Ghana, Kenya and Vietnam, sheds light on the deeply gendered inequalities of digital health. The study, conducted from June 2024 through January 2025 in Colombia, Ghana, Kenya, and Vietnam, utilized a community-engaged approach, with young people directly shaping the research through lived experience. We conducted 33 focus group discussions in six languages in rural, urban, and peri-urban regions with over 300 young adults; these conversations were supplemented by interviews with over 40 United Nations (UN) and government officials, community leaders, and individual experts.
In our collaborative qualitative analysis of the resulting data, which exceeded 4,000 pages of material, we noticed that those raising the biggest concerns about lack of access to smartphones, airtime, and justice for online harms were most often young women. They included women living in rural areas, sex workers, trans women, and women living with HIV. Most young adults we spoke with described using web searches (Google) or social media (Facebook, Instagram, TikTok, Snapchat, WhatsApp, or Zalo) as a primary source of health information. Some also used mobile apps for health, such as those that track menstrual cycles.
The findings are stark: while some young women said they felt empowered by being able to use their smartphones to obtain and share health information with others through social media, many in Ghana, Kenya, and Colombia said basic access to online health information is shaped by the pressures of intimate family surveillance and economic precarity, as well as by the threat of violence.
The challenges of obtaining digital access
In Kenya, some young women told us they face a painful choice: purchase mobile data or buy bread for their children. In conservative northern Ghana, one young woman said owning a new smartphone is seen as suspicious because young women are presumed to have traded sex for their device or for data bundles. In Colombia, rural women said they are unable to schedule medical appointments unless their husbands pay for internet access. As the digital health landscape expands, young men grow more adept at navigating online, while some young women are left behind, with fewer opportunities for education and training in technology, and scarce economic resources to pay for access.
Those young women who do get online face stark risks. Many must share their phones with partners, parents, or friends, exposing their web searches and messages to intimate surveillance. Some described being stalked by former partners, or having intimate photos doctored or shared without consent. While sex workers said they had no choice but to use online escort platforms and social media messaging to eke out a living, photos and phone numbers they posted could be reposted on other sites and shared widely without their control, leading to mental health harms, self-harm, and in some cases, physical violence against sex workers whose identities and locations are leaked. As the global network representing sex workers has pointed out, the increasing digitalization of everyday life creates new privacy and security threats, and data protection for groups subject to marginalization and discrimination becomes critically important. From questions about sexuality to access to safe abortions and HIV testing, every text message and every online search offers a chance to get life-saving information, but also carries the risk of stigma, isolation, or violence.
The role of technology-facilitated abuse
A staggering three-quarters of the young adults we spoke to across Colombia, Ghana, Kenya, and Vietnam reported technology-facilitated abuse against themselves or their friends, from cyberbullying to blackmail. It’s little wonder, then, that some women said they avoid seeking or sharing health information online. This is a missed opportunity both for them and for public health, because young women who do access health information often share it with others, becoming resources for friends or older relatives who lack smartphones.
Young women in our study described being interested in using digital tools and platforms to connect with peers and advocate for their rights. Some organized online chat groups to share information on health and rights with peers. Others created online platforms to document abuse and use the data to advocate for aid from the authorities. Sex workers said they were actively demanding small funds for data bundles and airtime from civil society organizations, so that they could share their location when meeting clients. Through our participatory action research approach, young women in their diversity also participated in documenting abuses, and are using the findings to lead national and global advocacy plans. In Vietnam, our national research team pointed out that the government has made some commitments to addressing gender inequality, and we found that young Vietnamese women in our study did not describe the same barriers to getting smartphones or airtime as in the other three countries.
Access to health information is a human right
The United Nations and international human rights law recognize access to health information as a fundamental right. But the young women we met need more, including better knowledge of their rights, legal reforms, training for police, judges, and lawyers, and support services for survivors of technology-facilitated abuse. As The Lancet and Financial Times Commission on Governing Health Futures has argued, young people also need a voice in digital health governance strategies, policies, and decisions.
The global community must act now, not just against the violence women face online, but against the political and economic decisions that treat such violence as normal, or that leave young women dependent on others for their fundamental right to digital inclusion. The cost of inaction is already being paid. Every time a woman can’t seek health information without fear, every time she is forced to trade her privacy for access, and every time she is forced to choose between food and basic information, the digital divide deepens. Young women deserve—and demand—better.