Digital Inclusion and Women's Health Indicators Across Indian States: An Ecological Analysis of National Family...

Digital inclusion may influence how women access health information and health services, but state-level evidence linking women's digital inclusion with women's health indicators in India remains limited. This study examined ecological associations between women's internet use, women's own mobile phone use, and selected women's health indicators across Indian states and union territories.

This ecological cross-sectional secondary analysis used an uploaded aggregated National Family Health Survey 2019-2021 (NFHS-5) state-level dataset. The India aggregate was excluded, leaving 36 states and union territories. Primary exposures were women who had ever used the internet and women having a mobile phone that they themselves use. Priority outcomes included menstrual hygiene, anemia, maternal health, contraception, and cancer screening indicators. Descriptive statistics, Pearson and Spearman correlations, simple linear regression, exploratory education-adjusted models, and NFHS-4 to NFHS-5 change analyses were conducted.

Among 36 states and union territories, women's internet use ranged from 20.6% in Bihar to 76.7% in Sikkim, while women's own mobile phone use ranged from 38.5% in Madhya Pradesh to 91.2% in Goa. Menstrual hygiene was moderately and positively correlated with internet use (Pearson r = 0.615, p < 0.001) and mobile phone use (r = 0.583, p < 0.001). Anemia among women aged 15-49 years was negatively correlated with internet use (r = -0.432, p = 0.009) and mobile phone use (r = -0.464, p = 0.004). Maternal health, contraception, and cancer screening indicators showed weaker and less consistent associations. In exploratory models adjusted for women's schooling, the associations with menstrual hygiene and anemia were substantially attenuated and were no longer statistically significant.

Higher women's digital inclusion was ecologically associated with better menstrual hygiene and lower anemia prevalence across Indian states and union territories, but associations were weaker for several service-use outcomes. These findings are ecological and should not be interpreted as individual-level or causal evidence. Digital inclusion should be considered part of a broader social and health system context for women's health equity.