Gender, power, and digital health inequities: a narrative review of barriers to digital health access among women in Lesotho

Digital health technologies are increasingly recognised as tools to enhance healthcare accessibility in resource-constrained settings. However, evidence suggests that not every section of society has benefitted equally. Women in developing contexts such as Lesotho, a landlocked country in Southern Africa, are in a more disadvantaged position to become a part of digital health inclusion. This narrative review synthesised peer-reviewed articles, policy documents, and grey literature published between 2010 and 2025. Guided by Gaventa’s Power Cube framework and the Feminist intersectionality theory, the review examines how visible, hidden, and invisible power intersect with gender, poverty, education, geography, and sociocultural norms to shape Basotho women’s access to and engagement with digital health technologies. Findings reveal multifaceted, intersecting barriers that disproportionately exclude specific groups of Basotho women particularly rural dwellers, less educated and embedded in patriarchal marital structures. These include patriarchal norms, limited economic autonomy, time poverty, and technology design exclusion. The review proposes that digital health interventions must adopt intersectional, gender-responsive design principles that address structural barriers rather than assuming technological determinism. This study contributes to the existing literature on the gender digital divide by introducing a novel dimension of power analysis and intersectionality, offering a multidimensional perspective on this phenomenon..