The Digital Mission aims to develop and maintain three key registries: Health ID, Health Professional Registry (HPR), Health Facility Registry (HFR) and digital infrastructure for data exchange. The digitalisation of health records is part of the agenda under National Health Mission: the Integrated Child Development Services-Common Application Software (ICDS-CAS) was launched in 2018 as an IT-based nutrition monitoring system to track and follow the needs of pregnant women, mothers of young children and their children who need health and nutrition services. The female frontline health workers – ASHAs (Accredited Social Health Activists) and Anganwadi workers (AWWs)– are tasked with uploading data on mothers, children and pregnant women, including photo evidence of the opening of Anganwadis; attendance of children; details of food, weight, and height and updating daily activities so that officials at the district, state, and even at the national levels can monitor this data for improvement in the quality of delivery of targeted health services.
The onus of providing primary health care, particularly to women and children has now shifted towards digitising women’s records and tracking their ‘progress’ from marriages, to pregnancy to child birth and immunisation online. The data is tracked on an online portal called the Reproductive and Child Health portal set up by the Ministry of Health and Family Welfare in India which tracks and targets women’s bodies by linking their electronic health records with biometric identity set up by Aadhar. The portal enhances the delivery of reproductive, maternal, newborn and child health (RMNCH) schemes and programmes. It is intended to facilitate early identification and tracking of women’s reproductive health. It targets health services appropriate to women’s bodies by characterising their age, marital and social status. This data can be entered on the ground, by ASHAs and AWWs alone. Without uploading this information both the mother and the frontline worker cannot benefit from the financial incentives that encourage hospital deliveries under the Janani Suraksha Yojana (maternal safety scheme). Those belonging to wealthier families tend can afford private healthcare and are not enforced to register their births and deaths with the neighbourhood health clinic too avail financial incentives. In terms of privacy and data protection, as well as access to high-quality healthcare treatments, this results in a class split. The relatively wealthy people are sheltered from such inspection, whereas the poor and marginalised women who depend on public health care are subjected to rigorous surveillance and monitoring. Professor Rajiv Mishra of Jawaharlal Nehru University is critical of the extensive use of digital infrastructures and the biometrics-based appropriation of the body for ensuring accessibility and delivery of welfare entitlements. He argues that the use of biometrics identification, with its genesis in colonial India, has been in a social and political context of mistrust, policing, suspect identities and surveillance, as a result of which the body becomes an object of appropriation, both for record keeping and generating data, information, and knowledge on the body for further development of medicine and healthcare. Evidently in this case the state has relied on personal health records to ascertain the age of the mother at childbirth and retrospectively arrest their husband, in-laws and subject them to imprisonment, in all cases these women belong to Muslim families.
As digital interventions proliferate, there is a need for multi-scalar and embodied examinations of their gendered power dynamics across different social groups. Shoshana Zuboff argues the concept of surveillance capitalism is useful to understand private companies, governments and business corporations commodify and make huge profits from this data, usually without the knowledge of the consumers. It is not surprising that surveillant technologies have gendered outcomes, however, what this practice obscures is that this digitalisation is fragmenting women’s bodies into a series of discrete stages from which information flows. The resultant ‘surveillant assemblage’, a term coined by Kevin D. Haggerty and Richard V. Ericson, is reassembled in different locations as discrete and virtual ‘data doubles’. That is, a female body is now reconstituted as an additional self, whose primary purpose is to serve the objectives of a state and its diktats. If the state clamps down on the datafied bodies of underage girls who are being married off, these data records serve them with personal information such as village-level data, the birthdates and marriage information of the couple, their phone numbers, religion, caste, and Aadhar numbers, Below Poverty Level (BPL) or Above Poverty Level (APL) status, medical records related to previous pregnancies, immunisation records during antenatal check-ups and post-delivery information about mother and infant.
Routine collection of such detailed personal information and the dangers of data misuse is addressed through data protection frameworks. However, when we consider that a female body is reconstituted as their data, and what happens to this information, how it is used, how it will affect them and who has access to this information, for what purposes and how much control do we retain in not only our data, but also our body, has far reaching implications for women physically. These implications fall in the grey lines within policy frameworks that separately govern data and bodies. For instance, in the Indian Parliament the law-making body is going to discuss the Digital Personal Data Protection Bill, 2022 in the monsoon session of the Parliament in 2023. The bill sets out the obligations of data fiduciary – any person who alone or in conjunction with other persons determines the purpose and means of processing of personal data - grounds for processing digital personal data, consent, deemed consent, with very limited scope to prevent leakages, and it is more concerned with prescriptive and compliance aspects. The Bill also gives the power to the government to offer exemption from its provisions, “in the interests of sovereignty and integrity of India” and to maintain public order. Such a policy framework aims to protect personal data and not bodies that generate this data. The data protection concerns of an individual cannot override the national security concerns. As witnessed in Assam, the root of the problem is that women’s data were used post-hoc to specifically target families from a religious minority. Hence it is important to question the narrative presented by the government which frames it as a women’s rights issue to serve a political interest.
In 2020, the Government of India passed the Citizenship Amendment Act, 2019. Women, particularly in Muslim minority groups across the country, actively rejected the provision of citizenship based on religious identity. Particularly in Assam, the state has implemented the National Registry of Citizens threatening indigenous identities of the multi-ethnic and diverse tribal and linguistic groups. The current National Register of Citizenship (NRC), an illegal migrant identification exercise that took place in Assam between 2015–2019, rendered 1.9 million people stateless, with the burden of proving citizenship placed on the individual. These people are reduced to non-citizen and non-human status, conflating issues of identity and citizenship, where women’s bodily data is weaponised to target Muslim families.
To reconcile this difference, van der Ploeg in her edited book ‘Digitizing Identities: Doing Identity in a Networked World’ suggests that when data emerges as an extension of our bodies, the harms of data misuse should be reconceptualised as violations of bodily integrity rather than data protection violations so that more stringent criteria may apply to them. This reframing of data protection and bodily protection and integrity is an important policy consideration to avoid the continual reduction of women’s bodies into commodities to instil fear, to impose punishments and to penalise marginalised families. The larger threat of underlying political intentions in using women’s health data for surveillance cannot be ignored and needs to be stopped before it is beyond our control.