Intersectional Invisibility & ICT: HCI, Digital Civics and Marginalised Women’s Health

This final blog post will synthesise several of the key themes and ideas that have emerged throughout this module by situating them within my own research interests. As such, it will explore the role of technology in both perpetuating and tackling the exclusion of marginalised women from civic issues, with a particular focus on health.

His and Her HCI

In a health system traditionally dominated by men, historical and taken-for-granted assumptions of innate biological differences between the sexes created the ‘Gender Paradox’ – women outliving men, but experiencing higher rates of morbidity [35]. Such social constructions of gender have subtly yet powerfully shaped healthcare provision and access throughout history, leaving women persistently facing constrained choices and health inequities [12]. Whilst much technology has acknowledged these inequities, historically deterministic perspectives within the (overwhelmingly male-led) computer sciences have considered ICT a “neutral tool” that simply requires the mastering of basic skills [25]. Such perspectives have understood women to be ‘deficient’ in skill and as such placed the onus upon women to “…conform to the IT cultural norms and values that perpetuate the advantages and privileges that have been traditionally enjoyed by white males” [25] (p.113).

Taboo surrounding women’s bodies has led to a deficit of HCI work in women’s health. Almeida et al. [2] use the example of the vaginal speculum, a medical device that has remained largely unchanged since it’s conception in the 19th century, to demonstrate how technology has failed to adapt alongside improved knowledge around women’s bodies and experiences.  That being said, a growing body of Feminist HCI research has begun to deconstruct this taboo, acknowledging sexuality as a central tenet of women’s wellbeing [6][15][7][4]; bringing with it the development of high quality, digitally-enabled, designer sex toys [4].

However, it is important to recognise how such design still reflects and perpetuates marginalisation in and of itself. Which women are benefitting? Are highly-priced, designer products of this sort only empowering for those who are able to afford it? And if so, are we as a field inadvertently making female sexual empowerment a luxury?

Race but not Racism in HCI

In line with broader Third Wave Feminist and Postcolonial perspectives on gender and sexuality, this calls into question the privileging of white western female experiences within debates and research aimed at overcoming gender inequity [23]. Many of the key issues of inequitable health access, availability, acceptability and quality faced by women intersect with the same concerns for marginalised or ethnic minority populations [34]. My own research has explored intersectional marginalisation through the specific lens of FGM, highlighting how dominant western narratives, and ideals can stigmatise communities with vastly different cultural norms. Therefore, whilst there is clearly a need to consider and counter gender discrimination within HCI, designs aimed at improving health outcomes and experiences of women through technology cannot and should not overlook the intersectionality of gender with other issues of race, religion, sexuality and class [22] .

Although a significant body of HCI work has looked at race, far less has looked at racism [21]. Hankerson [21] argues that this oversight stems, not from a conscious effort to design based upon racial bias, but instead from a tendency to design around it.

Ubicomp: Pervasive or Postcolonial?

As our own in-class debates around this topic passionately demonstrated, the jury is still very much out on whether Weiser’s vision of ubiquitous computing [38] has yet been fully realised. Nevertheless, it’s hard to deny the vast technological strides that have been taken towards widespread, affordable and accessible use of technology in our everyday lives [29]. The somewhat idealistic and utopian promises of Ubicomp to improve the everyday lives of people through technology, however, have come under criticism in recent years for overlooking global imbalances in power, wealth and political influence [39]; unsurprisingly, as technology becomes ever-more pervasive, so too do the inherent biases embedded within its design.

In a naïve yet well-intentioned bid to design value neutral, “race-blind”, pervasive technology, there involves an inherent smoothing-over of the cultural ‘cracks’ (or differences) in experience and needs across diverse cultural landscapes. However, as Hankerson et al. [21] put it, “…one cannot simply close ones eyes and avoid the effects of pre-existing bias” (p.473).

Here, I turn to two recent viral social media posts to demonstrate how such omission of race in the design process can serve to not only ignore, but perpetuate racism within HCI.

To many, myself included, the automatic tap represents the ultimate example of Ubicomp at its most “successful”. As a white person, I had never given a second thought to this seemingly simple concept; not because I have poor personal hygiene (a debate for a separate blog perhaps), but because its design has never given me cause to. However, as the video above shows, the design of such devices inherently favours the lighter-skinned user. What’s more, it is apparently an easy fix; this well-documented design flaw can be easily adjusted for within installation, yet seldom is [21]. This not only represents the presence of racial bias in the design phase, but the lack of responsive efforts to rectify the issue in the nearly 30 years since initial conception, further demonstrate the pervasive privileging of the white user within Ubicomp.

A second example comes from Google’s facial recognition software, whereby photos of black users were being tagged as apes and gorillas. Whilst Google blamed the specific algorithms in place in the software, Hankerson et al. [21] suggest that this is yet another example of white-skin bias in technological design – reflecting the under-representation of ethnic minorities in Silicon Valley and the resulting lack of racial diversity in algorithm testing.

It is important to acknowledge here that substantial efforts have been made within the HCI community to tackle global disparities and social injustices. HCI4D and the rapidly increasing adoption of mobile technology across the African continent testify to the potential of Ubicomp for widespread impact in non-western settings and has allowed for considerable technological innovation and intervention within the global health domain and beyond [1]. Despite this, these efforts, however well-intentioned, are not and should not be immune from critique.

Postcolonial perspectives on Ubicomp offer a much-needed critical reflection upon our practices and impact as a research community and in-turn provide opportunities for continual improvement as a field. In my previous blog post “Pervasive or Postcolonial? The Need to Decolonise Ubicomp”, I summarised the commentary of Dourish and Mainwaring [14], who challenge the colonial underbelly of Ubicomp. Such perspectives critique a constructed “logic of lack”[14] that places ‘developing’ nations below ‘developed’ nations in an imagined global hierarchy, and suggest that a lack of technological skill, knowledge and innovation is to blame for their apparent “lagging behind”[24] (mirroring similar deterministic perspectives on women as “deficient” in technological skill). Furthermore, rather than acknowledging the role of colonialism and western oppression in stifling technological advancement to begin with, Ubicomp instead adopts  a ‘civilising’ narrative reminiscent of Imperialistic justifications of the White Man’s Burden [16], suggesting a unidirectional transfer of knowledge and design from the developed ‘core’ to the developing ‘peripheries’[14]; ‘we’ can help ‘them’ because ‘we’ know what’s best!

To illustrate these concerns, we can turn to one of the most ambitious HCI4D interventions in recent years: the One Laptop Per Child (OLPC) programme. The initiative’s mission statement is as follows: “To create educational opportunities for the world’s poorest children by providing each child with a rugged, low-cost, low-power, connected laptop with content and software designed for collaborative, joyful, self-empowered learning”. Undeniably, this is a campaign with great intentions, yet the programme was not received as anticipated [30]. So why was such a positive concept not a roaring success the world-over?

To unpick this question, we must ask: Whose intervention was it? Whilst the intended beneficiaries were the “world’s poorest children”, the OLPC programme was conceived in one MIT Media Lab in Cambridge, Massachusetts. Here we see this inherent imbalance of power in full force, with one small “core” team of educated western researchers taking on the role (or “burden”) of empowering children in the global “peripheries”. But as Warschauer [37] explains, the success of an initiative of this scale requires an in-depth understanding of the role of technology within culturally complex contexts. Whereas middle-high income children would no doubt benefit from individual laptops, in many of the less economically developed countries being targeted by OLPC, providing laptops is a futile endeavour if not hand-in-hand with fundamental reforms to the infrastructural foundations of the education system itself (e.g. building schools, training teachers and developing and strengthening curriculum, assessment and evaluation)[37]. To assume a laptop can solve the World’s educational problems is to neglect the importance of situating technological research and deployment in local culture. Design based on such assumptions may at best create technologies that are usable, but that do not translate well out of context, ultimately reducing the chance of finding sustainable and meaningful solutions [36].

All of this said, who’s to say technology provides all the answers anyway? Who’s asking the questions in the first place? And are answers always necessary?

The Problem with Problem-Solving

My very first blog post on this module was a crash course in the contested ground that is HCI. Reviewing the paper “HCI Research as Problem-Solving” by Ulasvirta and Hornbæk [33] highlighted the messiness of defining such a diverse and multi-disciplinary field. Whilst many find strength in the mess, critics seek to iron out the kinks; in the case of Ulasvirta and Hornbæk, this involves reframing HCI as a problem-solving discipline. In doing so, they believe a clear conceptual framework can be developed that will enable evaluations of relative “success”. Overlapping with Ubicomp, the problem-solving paradigm sees technology as the answer to the world’s problems.

“In the future, people will spend less time trying to get technology to work…because it will just be seamless. It will just be there…If we get this right, I believe we can fix all the world’s problems” Google’s Executive chairman, Eric Schmidt

However, strong reactions to the paper reject the fundamental concept of problem-solving within HCI, warning of the dangers of applying reductionist, solutionist paradigms to complex global issues [31][9]. As Blythe et al. [9] argue, solutionism seeks answers before questions have fully been asked and in doing so, glosses over the intricacies and cultural complexities that shape experiences, understandings and behaviours. How can we possibly expect to solve a problem, if we don’t fully understand it?

There are clear parallels to be drawn between anti-solutionist critiques and the postcolonial critiques of Ubicomp. Embedded within both critiques are the underlying and biased presumptions of those behind the technology. Who defines what constitutes a problem to begin with, and who is deciding the most appropriate way to “solve” it?

Nowhere is asking these questions more relevant than in reflections upon HCI’s impact upon the health of marginalised women. At the confluence of two fields of research that remain overwhelmingly white male-led (medicine and computer science), how can solutions to intersectional problems possibly be designed without first listening to the voices of those who are disproportionately and detrimentally affected?

Referring back to my own work as an example, a lack of cultural consciousness amongst western health services and the wider public surrounding the complexities of FGM and its role within the community has hindered, rather than facilitated, efforts to promote abandonment. Lack of cultural awareness has instead inadvertently perpetuated stigma, subsequently making it harder for services to access and protect those at risk. Ultimately, FGM interventions that ignore the cultural experiences of practising communities and push change based solely on western perspectives are undeniably destined to fail.

Digital Civics: A New Type of HCI?

Now, in case you’re feeling a little bruised and battered from my overwhelmingly critical commentary thus far, fear not, for it’s time to shine a little positivity on the whole affair! Whilst the field of HCI as a whole undoubtedly has its problems (have I made that clear yet?), there is an emerging body of inspiring research that is actively and effectively reshaping the way we ‘do’ HCI.

Although, of course, not the first nor only researchers to be doing so, Open Lab and in particular the Digital Civics agenda, provides one such example of technological research and development that seeks to challenge the inherent issues of representation, bias, agency and power that are often taken-for-granted in wider HCI work. Digital civics as a discipline focuses on reconfiguring citizenry through opening up dialogue “…across differences in experience, values, and knowledge” [32](p.62).

This focus on raising and sharing citizen voice and facilitating citizen engagement in decision-making that directly affects them provides a multitude of opportunities for overcoming the barriers and social exclusion faced by women and marginalised groups.

Progress through Participation

So much of Digital Civics centres on participation and increasingly HCI research is acknowledging the need to design for people’s experiences[27]. In order to engage with citizens and improve understandings and design outcomes, the use of Participatory Design (PD) is commonplace due to its core values of empowerment, mutual learning and democratisation of design [11].

When designing specifically in the context of marginalised women’s health, the opportunities for PD techniques to counter inequities are vast. Numerous past projects point to the benefits of stakeholder engagement in design processes for the empowerment of marginalised communities and cross-cultural understanding. Clarke et al. [13] have utilised PD to enable digital storytelling for women from a local ethnic minority women’s organisation. Not only did the design outcomes promote the raising of participant voice, but the process itself promoted sustained engagement, mutual learning and the development of life skills. Furthermore, where issues of accessibility and a fear of judgement by “outsiders” may stifle initial and ongoing engagement between marginalised communities and the research community in traditional research settings, living labs offer potential to bridge this barrier. The Malmö Living Labs present one such example of how immigrant women engaged in collaborative community-based research and in-turn became active co-creators of design solutions that addressed their own needs [8].

Despite offering potential for overcoming some of the issues of agency and representation within HCI, PD is not immune to its own issues of bias. Past critiques of PD’s ‘cultural blindspot’ suggested a need to consider the applicability of traditional PD methods to non-western settings, paving the way for further cultural adaptation of co-design methods [20]. For Example, cultural probes provide opportunities for participants to express their holistic identity throughout the design process [18][17]. Finally, as was discussed in more depth within a previous blog post, there remains a need to critically reflect upon the evaluation of PD processes. As Bossen et al. [11] explain, many of the core values of PD are contradicted in current evaluations, with researchers speaking on behalf of participants in reflective commentaries.

Although PD continues to develop, the opportunities it provides for tackling marginalised women’s health are promising and novel. Despite this, it is important to remember that empowerment cannot come from giving voice alone: What use is shouting if no-one is listening? And what’s more, what use is listening if no-one acts?

The Art of Activism

In considering these questions, I look to my penultimate blog post “Designing for Defiance: Antagonistic Activist ICTs”. Activist technologies and antagonistic design move beyond traditional forms of participation and envisage and enable alternate forms of democracy [3]. In doing so, they can empower neighbourhoods and connect citizens to policy-makers. Although relatively small, pockets of HCI research have taken activist approaches to issues of marginalisation and health. ICT for Inclusion moves beyond traditional individualistic behaviour-change technologies and instead seeks to mobilise communities to take charge through the design and provision of activist tools [19][10][26].

Asad & Le Dantec’s paper “Illegitimate Civic Participation: Supporting Community Activists on the Ground”[3] explores how the fluid, intersectional and unpredictable nature of activism does not lend itself to outcome-oriented design and suggests value in ambiguity and spontaneity. Mirroring the celebration of process within anti-solutionist critiques of HCI, ambiguous design and activist art provides an interesting and provocative space within which to challenge marginalisation and stigma. The menstruation machine provides a well-known example of provocative, ambiguous design that has sparked conversation around women’s bodies, gender and sexuality within HCI (and beyond) [5]. Art has even been instrumental in provoking conversations around FGM in the West; for example, Makode Aj Linde’s FGM cake sparked global debate and media attention. Interactive technologies and participatory live-art installations also provide potential spaces for exploring bodily experience and ritual across cultures [28].

Conclusion

This post has explored how social constructions of gender and race have both influenced and been influenced by the unequal production of technological knowledge and design that privileges white, western male perspectives. Citizens who sit at the intersection of multiple “minority” identities face constrained health choices and limited agency in decision-making in traditional top-down approaches to civic organisation. All too often the needs of marginalised populations are either dictated by those whom do not share the same experiences of discrimination or are overlooked altogether in the quest for ubiquitous solutions.

Through exploring the emergence of Digital Civics and the new methods at its core, it is clear however, that positive steps are being taken to promote new and improved forms of civic engagement and empowerment through technology. Increasing acknowledgment of both the value and necessity of experience and culture in design processes is moving us beyond reductionist, solutionist and patriarchal modes of research towards methods that celebrate, rather than ignore, difference. Moving forward I hope to embed many of the values and methods at the core of both participatory processes and activist design into my own future research.

To end, whilst celebrating the progress being made, it remains critical that we continue to be reflective and responsive to our own biases and the direct role that we, as individuals and as a research community as a whole, play in shaping knowledge and perceptions of those who are (for now at least) under and mis-represented within our current democratic system.

Word Count: 2,987

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