UK Statistics Authority Data Ethics Services
Daniel Towler, Lily O'Flynn; UK Statistics Authority
To consider the ethics of the use of data for research, the UK Statistics Authority has developed a number of ethical principles. To enable the utilisation of the principles, we developed an ethics self-assessment tool to empower researchers, by allowing them to self-assess their research projects against these ethical principles. To support the use of the self-assessment tool, the UK Statistics Authority provide expert user support, ethics training and online guidance and have also recently established a Centre for Applied Data Ethics to support researchers using novel and emerging methods, such as machine learning and geospatial data, and ensure that ethical issues are considered early in the initial research design stage. The UK Statistics Authority’s ethics framework has been used widely across government, academia and the commercial sector and has helped researchers to thoroughly and efficiently consider the ethics of their data use to ensure they are keeping the right side of the ethical line and are producing research and statistics for the public good. Those projects that are considered most ethically risky are taken to the National Statistician’s Data Ethics Advisory Committee (NSDEC) so that they can benefit from the independent scrutiny of the majority independent committee. We are also leading a UNECE Machine Learning Group Work Stream on the data ethics of machine learning for research and statistical production. This work entails agreement of ethical principles in the machine learning space, as well as the opportunity to present our future guidance on predictive modelling and machine learning.
Census output content design - From question to answer
Samantha Trace; Office for National Statistics
This poster illustrates how information is collected from Census 2021 questionnaire and used to produce outputs relevant to researchers. It also showcases how different combinations of data can be used to answer questions not asked directly on the Census questionnaire. The poster tracks the process through: • Initial consultation with users • Receiving data from the questions • Using variables found in the data • Deciding population bases • Producing exact definitions • Using ‘Derived variables’ to extract the exact information required • Producing tables of useful data Learn about the journey of Census data, from question to output.
Growing up in England - a linked dataset using 2011 and DfE data to address vulnerability gaps and educational attainment
Simon Heckenmueller; Office for National Statistics
Administrative data can provide guidance for evidence-based public policies and services. However, stand-alone datasets can be insufficient to evaluate outcomes affected by multiple, interrelated factors. Aiming to facilitate such analysis in one crucial area, the ‘Growing Up in England’ dataset is currently being built by the Office for National Statistics in partnership with the Department of Education. This dataset comprises de-identified longitudinal information of two million pupils and eight million households and covers the period from 2001/02 to 2014/15 (academic years). The dataset is generated in waves with ‘Wave-1’ and ‘Wave-2’ currently being completed and future waves being scoped out. Wave-1 links record-level data from the English 2011 Census to data from the National Pupil Database and Individualised Learner Records including further education data. Wave-2 extends the scope of Wave-1 by linking additional data, specifically ‘Children in Need’, ‘Children Looked After’, ‘Free School Meals’, and ‘Absences and Exclusions’, from the National Pupil Database and the English School Census. The Growing Up in England dataset will provide researchers with detailed information regarding a child’s educational journey to explore how family characteristics, school type and geography, among others, can affect educational outcomes. The dataset also offers a new level of insight on children who are vulnerable by virtue of their circumstances, for example, children with a disability and children from workless families. The richness and population size of the linked datasets further enables researchers to conduct sub-group analyses. Overall, the dataset will facilitate a detailed evaluation of a key public service.
Using longitudinally linked admin data to measure the integration of refugees in the UK
Gemma Hanson1, Elzemiek Scott-Kortlever1, Zainab Ismail1, Nicky Rogers1, Maria Calem2, Eveie Shaw2; 1Office for National Statistics, 2Home Office
In collaboration with the Home Office, we are developing a longitudinally linked administrative dataset to help us to understand the integration outcomes of refugees in the UK. The Refugee Cohort Study will link key administrative sources from 2015 to 2025, as well as the 2021 Census, to provide at least five years of post-entry information on approximately 100,000 refugees. The aim is to use this evidence to inform future refugee and asylum policies. This fills a current evidence gap as currently it is not possible to identify refugees in most admin datasets. Ahead of creating the linked dataset, we conducted a pilot study testing the viability of linking refugees from the Vulnerable Persons Resettlement Scheme, who are predominantly Syrian, to Home Office border crossing data and National Health Service Patient Register data. In this pilot, we incorporated knowledge about Arabic naming conventions and transliteration into the matching algorithms. We achieved record linkage rates in excess of 96%, addressing concerns about potential bias in the study as a result of linkage failure. During this session we will present the findings from the pilot, as well as the outline design of the Refugee Cohort Study and we will share how we are incorporating both resettlement refugees and asylum route refugees.
Forecasting migration flows between Europe and South America, 1986-2060
Andrea Aparicio-Castro1, Dilek Yildiz2, Michaela Potancokova2, Arkadiusz Wiśniowski1, Francisco Rowe3, Mark Brown1; 1Department of Social Statistics, School of Social Sciences, University of Manchester, 2International Institute for Applied Systems Analysis (IIASA), 3Geographic Data Science Lab, University of Liverpool.
European migration has been mostly intraregional, although this has been changing during the last years. Based on Eurostat data, while migration inflows from EU countries decreased by 7.8% between 2013 and 2018, non-EU immigration increased by a similar proportion in the same period. This change is also noticeable in migrant stocks in Europe reported by the United Nations, for which the trend of migrant stocks suggests that migration towards Europe vary according to the region of origin, which in turn, respond to different determinants of migration. To gain a better understanding of the driving factors of migration towards Europe from a specific region and to quantify how migration may change in the future, forecasting migration flows is crucial. Considering that Latin America and the Caribbean (LAC) migrant stocks in Europe have had the greatest increase in the last decades and South America (SA) countries have had the sharpest growth amongst LAC territories, the main aim of this analysis is to forecast the spatial and temporal patterns of bilateral international migration flows between Europe and SA. This analysis proposes a Bayesian version of an Autoregressive Distributed Lag (ADL) model. This type of model enables quantifying covariate effects on future migration. Data come from the SSP Scenario database built by IIASA. The output is a set of synthetic estimates of bilateral migration flows between Europe and SA until 2060 with measures of uncertainty.
Application of Aged-in-Place Classification (AiPC) - Enhancing Spatial Microsimulation Models
Yuanxuan Yang, Les Dolega, Rich Dunning, Alex Lord, Frances Darlington-Pollock: Department of Geography and Planning, University of Liverpool
Older people make up a growing proportion of the UK’s population, leading to a shift in age structure toward later ages. Responding to this demographic shift requires adaptations in policy intervention and effective planning. These can be facilitated by a fine-grained understanding of the nature and geography of older population. Based on a novel geodemographic classification of older people (age over 50) in England – Aged in Place Classification (AiPC), this study examined the classification’s utility in enhancing spatial microsimulation (SMS) and small area estimation of older people’s household income. AiPC is at a small area (Lower Layer Super Output Areas) level, which helps to capture the diversity of spatial variations of individual-level survey records that are used in SMS. Future works include enhancing the understanding of older people’s housing needs in England and related spatial patterns, and better modelling older people’s social isolation. AiPC has many potentials in various domains such as health and well-being. The classification is therefore a practical tool for advocacy groups, local authority service providers, and Clinical Commissioning Groups to better understand the needs and the barriers of particular services.
How does life expectancy for people with multimorbidity differ by sex and race?
Anastasia Lam1,2, Katherine Keenan1, Mikko Myrskylä2, Hill Kulu1: 1University of St Andrews, 2MPIDR
Multimorbidity, the co-occurrence of two or more conditions, is a growing public health concern, but most research has been cross-sectional and based in high-income countries. It is important to gain a better understanding of multimorbidity in low- and middle-income countries, as population ageing and the prevalence of non-communicable diseases are rapidly increasing. The way in which multimorbidity presents, and the risk factors associated with multimorbidity may also differ between high and low- and middle-income settings. There are also social and structural inequalities within countries that may impact the risk of developing multimorbidity. This study aims to understand inequalities in multimorbid life expectancy in South Africa using five waves of data (2008-2017) from the National Income Dynamics Study. We applied a discrete-time multistate Markov approach to model transitions between the following states of disease accumulation: without disease, with one disease, and with multimorbidity. The transition probabilities are used to compute the life expectancy and the time spent in each state based on different combinations of transitions, individual characteristics, and risk factors. We stratified the models by sex and race. Preliminary results showed differences in both state and life expectancies for males and females and across different racial groups. Females live longer but with more years of multimorbidity and people with more healthy life expectancy spend less time with multimorbidity. Future analyses will stratify by education and explore interactions between race and education. .
Established Small Towns in England - their growth in the nineteenth-century
Joanne Wallace; University of Cambridge
The story of established small towns in the nineteenth century has been lost in the overwhelming narrative of city growth and rural depopulation. Building on the work of Clark, Corfield, Everitt and Dyer on the early-modern small town, this work aims to examine whether in fact these places were lost in that current of internal migration. Did they dwindle along with their rural hinterlands to become indistinguishable from them? Did they continue to play a distinct and significant role in their local urban hierarchy? Did they actively contribute to urbanization? Using a combination of population and functional criteria, the network of small towns that form the subject of enquiry are defined, identified and mapped. Census-based population data for the individual towns is compiled. Changes in population at ‘parish’ level are mapped over the period 1801-1901. Population growth at registration district level is also shown as an indicator of growth in the rural hinterland of the towns. The role of the towns in urbanization, the geography of growth including its relation to hinterland growth, and a possible typology of the towns are considered.
Energy poverty alleviation in the ageing society
Wang Xinyi; The Hong Kong University of Science and Technology (HKUST)
Energy poverty – which occurs when a household experiences inadequate access to modern energy and unaffordability of basic energy services – has negative impacts on public health, education, economic development, social equity and environment. Studies have shown that the elderly are one of the most vulnerable groups that suffer from energy poverty. However, little attention has been paid to the inherent reason why a large number of elderly fall into energy poverty. Considering the fact that the world is facing a profound demographic transition with rapid ageing, it has become an important and urgent issue to explore why the elderly are more likely to struggle to access energy resources. Many characteristics of the elderly have potential influence on their energy status, such as their income, cognitive ability, non-cognitive ability, consumption preferences, social relations, psychological needs, etc. Therefore, our question is: How do older people’s activities and behaviours influence their energy poverty status? This research aims to examine how older people’s activities and behaviours influence their energy poverty status, and to provide policy implications for energy poverty alleviation in an ageing society. I will be obtaining and analysing data with older people in China through participant observation, in-depth interviews and case studies over the next three months. In the presentation, I will present findings regarding the drivers of energy poverty status of older people in China obtained through the field works.
Burden of the joint occurence of cognitive and functional impairment in the US, 1998-2016
Shubhankar Sharma1,2, Jo Mhairi Hale1,2, Mikko Myrskylä1,3, Hill Kulu2; 1Lab of Population Health, Max Planck Institute for Demographic Research, 2School of Geography & Sustainable Development, University of St Andrews, 3Department of Social Research, University of Helsinki
Background: Despite extensive research on cognitive and physical impairments, their co-occurrence is largely ignored. We quantify the burden of their co-occurrence (joint-impairment) using key indicators- lifetime risk and expectancy, for Americans aged 50+.
Data and Methods: We use the Health and Retirement Study (n=37,136; 1998-2016) and multistate models to study joint-impairment for overall population and by race/ethnicity, nativity, education and interactions. Moreover, we analyze how eliminating racial/ethnic differences in educational attainment would mitigate disparities in joint-impairment.
Results: Women aged 50 have greater lifetime risk (58% vs 42%) and expectancy in joint-impairment (3.4 vs 1.9 years) than men. Foreign-born Latinas have 83% lifetime risk compared with Whites’ 52% and 3 times longer jointly-impaired years (8.1 vs 2.7 years). Lower educated men experience 32 percentage points higher lifetime risk and 3 times longer years jointly-impaired than higher educated. Lowest educated minorities carry greatest joint-impairment toll. These large racial disparities in joint impairment reduce considerably once educational differences are eliminated.
Discussion: The study emphasizes the significance of considering cognitive and physical impairment simultaneously when assessing older-age disability. The substantial disparities in the burden indicate that the U.S. has a long way to go to attain health equity. The evidence that educational intervention mitigating those disparities is important for policy perspective.
Key words: Cognitive impairment, physical impairment, lifetime risk, health expectancy, race/ethnicity, nativity, education.
Fertility, economic incentives and individual heterogenity - register data based evidence from France and Germany
Cäcilia Lipowski1, Ralf A. Wilke2, Bertrand Koebel3; 1ZEW Mannheim, 2Copenhagen Business School, 3Université de Strasbourg
This study demonstrates the importance of accounting for correlated unobserved heterogeneity to correctly identify the relevance of career and education for fertility decisions. By exploiting individual-level life-cycle information on fertility, career, and education from large administrative longitudinal data sets, this paper shows that non-linear panel models produce substantially different results than the cross-sectional approaches widely used in previous studies. We suggest a decomposition of the estimated partial covariate effects on the expected number of children that decouples the role of unobserved confounders, such as preferences, from the actual role of the covariate. We hereby show that education and wages of females are substantially related with unobserved factors, rendering cross sectional models invalid. While higher earning females have a lower number of children, the effect is much smaller than the descriptive evidence suggests. This is explained by females with lower preferences for children sorting into certain jobs which yield higher wages. While higher opportunity costs of having children are found to be associated with lower fertility within a country, the magnitude of the adjustment differs strongly across countries. In Germany, fertility decisions are found to depend more on individual circumstances than in France, where better public childcare support enhances the compatibility between family and professional life. By means of a decomposition analysis we find that females in Germany would have a considerably higher number of children if they experienced the same less-negative effects of wages and education on fertility as their counterparts in France.
Relationship between economic development and age-specific fertility rates in the European Union
Tomislav Belić, Hrvoje Štefančić, Roko Mišetić; Catholic University of Croatia
This work examines, using Eurostat data, the fertility-development relationship at the sub-national level and further, the relationship between development and age-specific fertility rates. By conducting simple linear regression, we examine the relationship between economic development, as measured by GDP per capita, and age-specific fertility rates using 5-years cohorts among European countries in 2015. A particular emphasis is placed on 20-39 years cohorts. The relationship is analyzed for each 5-years cohort and each of the 26 European countries individually, covering 1358 NUTS 3 regions. We document a weak negative relationship between GDP per capita and TFR among most countries in 2015. In some countries, the relationship is slightly positive. Although on the one-year data we cannot track long-standing relationship, fertility decomposition into age groups revealed that the fertility-development relationship is formed by two opposite relationships. GDP per capita is in a negative relationship with age-specific fertility rates of the 20-24 and 25-29 age groups. With the age group of 30-34 years a relationship reverses to weak positive, and with the group 35-39 years a positive relationship becomes strong and significant. In younger cohorts and among less developed countries, the impact of GDP per capita on age-specific fertility rates is greater. Since the relationship transition from negative to positive depends on births at later ages, countries with a higher share of births after 30 have a more positive relationship. Following such a finding, the direction of the fertility-development relationship depends on the share of birth of the pre and after 30 subpopulation.
Spatial fertility variation at county-level in China in 2000
Kuoshi Hu, Hill Kulu, and Julia Mikolai; University of St Andrews
To improve our understanding of the fertility transition in China, we analyse spatial variation in fertility. Although some previous studies show that fertility varies across different areas in China, these studies have either relied on data from larger spatial units (i.e. provinces) or used aspatial methods to analyse spatial fertility variation. In this study, we explore fertility variation and its determinants at the county-level in China using Census data from 2000 and spatial lag and error models. We use the compositional and contextual hypotheses to explain spatial fertility variation in the Chinese context. We investigate the role of the local economy, urbanisation, labour structure, marriage, sex ratio, the share of ethnic minorities, and level of education for fertility levels (TFR) in each county. The spatial error model shows that population density, the proportion of ethnic minorities and married population, and the share of the population working in agriculture in a county have a positive relationship with the county-level TFR. At the same time, GDP per capita and females’ average schooling years in a county have a negative relationship with the county-level TFR. The results of this research show that the counties’ contextual environment and the differences of residents’ characteristics influence the fertility variation in China.
Power, policy and transgender identities. A case study of gatekeeping by mental health professionals in the gender transition process in India
Harikeerthan Raghuram, Project Coordinator, Sangath, Bhopal, India
Background: Transgender persons seeking gender transition are often denied or delayed by mental health professionals. Studies of gatekeeping in gender transition are mainly conducted in the Global North and focused on health professionals’ perspectives. This case study from India incorporates a range of perspectives – not only those of health professionals – to contribute new evidence about gender transition. Aim: To examine the role of power in gatekeeping in the gender transition process in India. Methods: A qualitative multi-method study including thematic analyses of key informant interviews (n=9); and policy analysis using policy triangle framework. Data: Transcriptions of key informant interviews (including transpersons of different gender identities, a psychiatrist, an advocate, a journalist and a researcher). Two critical policy documents form the basis of policy analyses (NALSA Judgement (2014), Transgender Act (2019)). Results: Health professionals and transgender persons participate in the construction, performance and reproduction of gender. Gatekeeping is enabled by a persistent gender normativity, although the evidence suggests signs of a change from binormativity to a culturally-intelligible and historically-familiar ‘trinormativity’. Potential application: There is need to examine not just the power of health professionals but the power of socially constructed gender. Transition to ‘trinormativity’ enables gatekeeping and risks creating new forms of gender-related oppression. In light of this, a possible solution is considering gender identity and expression as something not static for each individual, but contingent and emergent. This contingency could form the basis for ‘gender rights of all’ rather than the basis being the rights of a specific transgender community.
Historical trends of global health crisis framing - Rise of hate crimes and marginalization
Muhammad Hassan Bin Afzal; Department of Political Science, Kent State University, Ohio, https://orcid.org/0000-0001-8192-0885
Before the devastating COVID-19 pandemic, Asian Americans and Pacific Islanders (AAPI) witnessed an uptick of bigotry and hate crimes due to politicians', policymakers', and the media's framing and rhetoric capturing the adverse effects of health crises. When the continuation of COVID-19 was blatantly misrepresented as the "Wuhan/China Virus," attacks on the AAPI population increased dramatically. Incidents recorded against the AAPI community vary from verbal and physical assaults, insults, and property damage to violent attacks in classrooms, workplaces, and other public places. This research poster depicts empirical trends in documenting and framing previous health crises and how these subtle and egregious misrepresentations of populations identified with previous health crises sparked civil instability, bigotry, and marginalization of underserved and marginalized vulnerable populations.
Moving out and moving on - The triggering impact of mobility on mental health in the context of union dissolutions
Joan Damiens1, Christine Schnor1, Didier Willaert2; 1UC Louvain, 2Solidaris Health insurance, Belgium
There is already a large contribution of the literature on how union dissolutions increase the risk of depression, but little is known about the underlying process of this relation and the impact of the residential changes on mental health, a fortiori in a context of union dissolution. This research questions how depression risk varies during a period of separation and according to whether the individual moves or not at the moment and/or in the year following the separation. The dataset gathers information about 20 to 69-year-old individuals affiliated to Solidaris, the largest health assurance company in French-speaking Belgium, who lived in opposite-sex partnerships and observable from 2008 to 2018. We defined depression as an antidepressants intake of at least 90 Defined Daily Doses (DDD) over a calendar year. Random-effect logit models are conducted. After controlling for observed and unobserved individuals’ characteristics and compared to 2 years and more before the separation, we found results confirming an increase in the depression risk from the year prior to a separation and a peak in the year of the union dissolution. The depression level then decreases but remains high the year following a separation. Also, we notice a higher risk of depression on the whole separation period for women who move during their separation year. After controlling for selection effect by accounting for the period following the separation only, this result only persists for women who cumulate moves during the year of the separation and during the year after the separation. This research indicates that the relation between depression and separation includes an anticipation effect and short-term consequences. Also, it reminds the material vulnerability of women during and after a separation, by showing that women who go through an unstable residential path during and following their separation face a noticeably high depression risk.
Yoga in school-aged children - impact on children's mental health and well-being during the Covid-19 pandemic
Kirti Khunti1, Nicola Shelton1, Cesar Messias De Oliveira1, Sadie Boniface2, Emma Norris3; 1University College London, 2Institute of Alcohol Studies, 3Brunel University
In recent years mental health and well-being have become a crucial part of public health. It is well known that children that experience stress can lead to both physical and behavioural responses. Evidence shows that children experience stress from as young as 5 years. The rapid spread of COVID-19 and the increasing burden on mental health and well-being require new ways of supporting families that have to maintain the new norms of social distancing. Many families may be under enormous amounts of stress and anxiety caused by losing their loved ones. The current study evaluated Children’s yoga classes offered to South Asian school-aged children in the UK provided by a UK charity (Patanjali Yog Peet Trust). The intervention was designed in a crisis (COVID-19), and the intervention aims to promote the mental health and well-being of school-aged children online. It was hypothesised that online yoga would promote the mental health and well-being of school-aged children in the UK. A total of 176 parents completed the SDQ online, and 14 parents were interviewed. The data collected from the quantitative surveys were compared against the Mental Health of Children and Young People survey by NHS digital. Parents reported several benefits of the yoga classes, including feeling part of a community, and children seemed motivated to practice yoga. Preliminary analysis of questionnaire data and interviews suggest positive changes in their child’s overall mental health and well-being compared to the national data.
Care or self care? The impact of informal care provision on health behaviour
Peter Eibich; Max Planck Institute for Demographic Research
This study examines the impact of informal care provision on carer’s health behaviour in England using data on men and women aged 40-69 from the English Longitudinal Study of Ageing (ELSA) covering the period 2002-2017. I evaluate the validity of several instrumental variables for care provision suggested in the literature. I find little evidence of negative effects of informal care provision on health behaviour. The preferred instrumental variable specifications suggest that informal caregivers are more likely to exercise, and women providing care are less likely to smoke.
Socioeconomic inequalities in early childhood growth and development in South Asia - a rapid systematic review
Damith Chathuranga, Oonagh Markey, William Johnson, Paula Griffiths; School of Sport, Exercise and Health Sciences, Loughborough University.
Research Question: What evidence exists on the relationship of socioeconomic position with early childhood growth and development in South Asia? Methods: PubMed, Cochrane Library, MEDLINE, and Scopus were systematically searched for studies investigating the relationship between household socioeconomic position (SEP) with growth and/or early child development (ECD) among children aged 0-36 months in South Asia. Study quality was assessed and a narrative review for each outcome was constructed. PROSPERO registration: CRD42019131533. Results: Out of 2643 publications that were screened, 52 articles (41 on growth, 8 on ECD, 3 on growth and ECD) met the inclusion criteria and were included in the review. There was strong and consistent evidence from multiple countries (Bangladesh, Bhutan, India, Nepal, Pakistan, Sri Lanka) that higher SEP was related to better growth outcomes, including lower risk of stunting, wasting, and underweight. The 8 papers on ECD included data from India and Nepal considered cognition (5 papers), motor development (3 papers), or language development (6 papers) outcomes. 67% growth and 38% ECD outcomes were positively associated with SEP and the rest were not associated. No associations between SEP and socioemotional development were studied. Potential applications: While the association of SEP with child growth outcomes in a high-risk region (i.e., South Asia) is well established in the literature, evidence for ECD (particularly outside of India) is limited. More detailed studies on the pathways through which SEP may impair ECD, particularly socio-emotional development, in South Asia are needed in order to prevent the risk of poor ECD.
Fewer first births but faster as age at union formation increases in France
Marie-Caroline Compans, Eva Beaujouan; University of Vienna (Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, University of Vienna))
First unions and first births are closely related and have been extensively studied as part of the family formation process or in the wider context of transitions to adulthood. However, even though the influence of age at union formation is often controlled for, it is rarely questioned in itself. We examine to what extent being younger or older at the formation of the first co-residential partnership is linked to the occurrence and the timing of a first birth afterwards. Based on data from the French Study on Individual and Conjugal Trajectories (Épic, Ined-Insee, 2013–2014) and individuals born between 1948 and 1970, we link the age at first union with 1) the occurrence and 2) the timing of childbearing, through respectively logistic regression models and event-history analysis. As age at first-union formation increases, fewer and fewer men and women become parents. These age effects largely reflect different characteristics of unions formed at different stages of the life course (for instance the increasing probability with age of partnering with someone who already has a child), and different individual characteristics of people who begin their partnership history at different ages (e.g., religious practice). However, among those who had a child, a later age at union formation is in itself a factor for accelerating transitions to motherhood and fatherhood once union and individual characteristics are accounted for. While women may feel more biological pressure to conceive, possibly both men and women perceive social pressure to have children before a certain age.
Why women choose at-home abortion via teleconsultation in France:A mixed-method study on drivers of telemedicine abortion
Hazal Atay1, Helene Perivier1, Kristina Gemzell-Danielsson2, Jean Guilleminot3, D. Hassoun4, Judith Hottois4, Rebecca Gomperts4, Emanuelle Levrier1; 1Sciences Po, 2Karolinska Institutet, 3Assistance Publique, Hôpitaux de Paris, 4Women on Web International Foundation
Objectives: In face of the COVID-19 health emergency, France has allowed medical abortions to be performed by teleconsultation until 9 weeks of gestation. In an attempt to understand the demand and main drivers of telemedicine abortion, we analysed the requests that Women on Web (WoW), an online telemedicine abortion service operating worldwide, received from France throughout 2020. Methods: We conducted a parallel convergent mixed-method study among 809 consultations received from France at WoW between 1 January and 31 December 2020. We performed a cross-sectional study of data obtained from the WoW consultation survey and a manifest content analysis of anonymised email correspondence of 140 women consulting with WoW helpdesk from France. Results: We found that women encounter macro-level, individual-level, and provider-level constraints while trying to access abortion in France. The preferences and needs over secrecy (46.2%), privacy (38.3%), and comfort (34.9%) are among the most frequent reasons for women from France to choose telemedicine abortion through WoW. The COVID-19 pandemic seems to be an important driver for resorting to telemedicine (30.6%). The lockdowns seem to have had an impact on the number of consultations received at WoW from France, increasing from 60 in March to 128 in April during the first lockdown and from 54 in October to 80 in November during the second lockdown. Conclusions: The demand for at-home medical abortion via teleconsultation increased in France during the lockdowns. However, drivers of telemedicine abortion are multi-dimensional and go beyond the conditions unique to the pandemic. Given the various constraints women continue to encounter in accessing safe abortion, telemedicine can help meet women’s preferences and needs for secrecy, privacy and comfort, while facilitating improved access to and enabling more person-centred abortion care.