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Aliya Bakheit is the Digital Strategy Analayst at SafeLives. In this blog she discusses why the new partnership with Amazon Alexa and the NHS may be detrimental for those living with domestic abuse.

Last week, we learnt that the UK government has announced a new partnership with Amazon Alexa and the NHS. The output of which will allow people who have access to Amazon’s voice-assisted technology to get expert health advice via the device. The technology will automatically search the official NHS website when UK users ask for health-related advice.

The idea is to support patients, especially the elderly, blind and those with accessibility issues to take more control over their healthcare and to ultimately reduce demand on our already overwhelmed NHS. Security experts have already warned about the lack of privacy surrounding the partnership, but Amazon is making it clear that it doesn't share information with third parties or build profiles on its customers. In a statement to the Times, the firm has said: "All data was encrypted and kept confidential. "Customers are in control of their voice history and can review or delete recordings."

While this initiative is certainly an innovative development in utilizing digital tools to address healthcare needs, here at SafeLives, we believe that further research is required to fully investigate the safety implications for people living with domestic violence in coercive and controlling relationships. And considering that one in five people will experience domestic violence in their lifetime, this is not an insignificant concern. This technology often has default settings that exposes the user’s search history, and this information could potentially be weaponised should a perpetrator obtain these transcripts - which are easily downloadable - putting the survivor at significant and increased risk as well as blocking potential routes for seeking support.

In this specific context also, this initiative could lead to more health-related questions being asked of Alexa (perhaps around pregnancy or birth control) which could be discovered by perpetrators. We know that a third of all domestic abuse begins in pregnancy, so this is a particularly risky time for survivors, and makes them ever more vulnerable to the abuse escalating should the perpetrator uncover the Alexa transcripts.

In order to understand these potential risks, gaps and opportunities presented by technology in the context of domestic violence and abuse, SafeLives, Snook and Chayn undertook a collaborative research project, 'Tech vs Abuse’, commissioned by Comic Relief in January 2017. This research was carried out over six months and gathered insights from over 200 survivors of domestic abuse (over 18 years old) and 350 practitioners who support them. There were concerns about the potential for further coercive control made possible by the ‘internet of things’ within people’s homes, such as the Amazon Alexa device. Overall, there was a sense that the perpetrator was always one step ahead. This resulted in a lasting fear of using technology, both by survivors and practitioners. They viewed technology as potentially dangerous, both during abusive relationships and recovery. Women chose, or were often advised, to remove all technology from their lives. This left them further socially isolated and with less control.

Making health information more accessible by all is generally to be welcomed, we know that GPs, nurses and other health professionals are really well placed to identify and respond to domestic abuse – there is no substitute for a trained, empathetic person who can ask the right questions at the right time. The research highlighted in our Cry for Health report, shows that nearly nine out of ten (86%) referrals to hospital Idvas came from hospital departments and we know that a high percentage of domestic abuse cases are first uncovered during a visit with a health care practitioner, midwife or community nurse practitioner in particular. There are obvious risks associated with obtaining your health advice online; however not being physically seen by someone who is trained to spot for signs of distress and abuse is a considerable one.

As part of the Government’s new Domestic Abuse Bill launched on Tuesday, it has been outlined that ‘from April 2020, NHS England are planning for Independent Domestic Violence Advisors (IDVAs) to be integral to every NHS Trust Domestic Violence and Abuse Action Plan, as part of the NHS Standard Contract.’ This is of course a great step in the right direction, however we believe that anything that prevents potential victims from being seen in person, such as this new partnership with Alexa, could be detrimental to them accessing services and support, ultimately delaying or even obstructing any support that could be provided with potentially unthinkable consequences for the victim and the wider family.

We believe that tech giants have a responsibility and duty to respond to the ever growing need to ensure that the internet is a safe place for all, but particularly for the women and girls who are most likely to be targeted in acts of digital violence that reflect the pattern of abuse experienced offline. The tech industry and the health sector must do more to understand how inextricably linked domestic abuse is with them – and technologies must not be developed without thinking through the unintended implications for those living with abuse, sadly far more than we ever realise.

For more information read the Tech vs Abuse report