Britain has no way of measuring how many women can access contraception or how many pregnancies are unplanned. Two key indicators of reproductive choice that the government’s Women’s Health Strategy wants to track simply do not exist in current data. This project will build REPROLINK, a national linked dataset that combines survey responses from the National Survey of Sexual Attitudes and Lifestyles with census and school records, to measure these gaps for the first time. The researchers will also run deliberation sessions with Black, Asian, migrant, and other under-represented groups—including people with experience of sex work or unstable housing—to understand concerns about linking sensitive health data, and co-produce posters, videos, and infographics that explain how data linkage works. If successful, REPROLINK will give policymakers and commissioners a surveillance system that shows where reproductive choice is most constrained, by deprivation, ethnicity, education, or employment. That would allow services to be directed to the communities that need them most, and provide a method for evaluating whether the Women’s Health Strategy is actually working.
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Background Producing representative evidence on reproductive health that harnesses the power of existing data and maximises reproductive choice are key ambitions of the Women's Heath Strategy. However, two key national indicators of fulfilment of reproductive choice (contraceptive prevalence and unplanned pregnancy rates) cannot currently be measured. Measuring these and understanding their association with wider determinants of health is important to aid policymakers and commissioners to direct services to where they are needed most. A potential solution is a linked national reproductive health dataset that uses routine data to monitor these inequalities. Aim To generate high-quality representative scientific evidence on reproductive choice and inequalities and establish a national linked reproductive health dataset that measures inequalities in reproductive choice. Objectives (1) To investigate how indicators of reproductive choice are associated with wider determinants of health and trends over time. (2) To examine the views of under-represented groups on establishing a linked reproductive health data and co-produce accessible materials that address concerns and promotes understanding of data linkage. (3) To establish REPROLINK, a national reproductive health linked dataset that measures inequalities in fulfilment of reproductive choice. Methods WP1: Linked observational cross-sectional study using the National Survey of Sexual Attitudes and Lifestyles-4 (Natsal-4, 2022-24) linked to data from Census21 and National Pupil Database to describe prevalence of reproductive choice indicators (contraceptive prevalence; London Measure of Unplanned Pregnancy) in England with investigation of wider determinants of health (deprivation, employment, education, and ethnicity). Comparisons to previous iterations of Natsal surveys to evaluate changes/trends over the last decade. WP2: A deliberation process with people from Black, Asian, and migrant groups and people with experiences of sex work and unstable housing to establish their views on de-anonymising and linking public health surveillance datasets containing reproductive health data to be able to assess reproductive health inequalities. Co-production of accessible posters, videos and infographics with these under-represented groups to promote understanding of reproductive health data. WP3: Delphi process in a Reproductive Health Data Partnership to establish reproductive health datasets and indicators that can measure inequalities in fulfilment of reproductive choice, establish REPROLINK (a linked national reproductive health dataset). Development of a toolkit and portal for ethical and practical use of REPROLINK. Timelines for delivery Year 1: WP 1 (Natsal-4 analyses), WP2 (Deliberation process); Year 2: WP2 (Co-production; Data partnership); Year 3: WP 3 (REPROLINK governance); Year 4: WP 3 (establish REPROLINK; toolkit). Anticipated impact REPROLINK will provide a robust data surveillance system for measuring inequalities in fulfilment of reproductive choice, and reproductive health more widely. The co-produced visual tools could be used to explain data linkage included in future Reproductive Health Surveys. This will deliver key Women's Health Strategy ambitions and a method for evaluating its success. Dissemination The Natsal-4 linked data and REPROLINK data will be resources for reproductive health researchers. The findings will be shared with the public, service providers, policy makers and research community as blogs, videos, infographics and peer-reviewed publications in collaboration with the NIHR Reproductive Health Policy Research Unit and the Co-Productive Collective.
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