The debate over medication abortion restrictions has gained greater attention in recent months related to COVID-19 and national changes to abortion access. Rapidly changing legal restrictions, the cost of abortion and abortion stigma and shame prompt many people to go online to seek information on abortion. In light of currently heightened reliance on technology during COVID-19 restrictions and long-standing political polarization creating social and practical barriers to abortion access, online abortion information poses substantial opportunities and challenges to public abortion knowledge and access.
Medication abortion has been found to be a safe and effective method of pregnancy termination and is currently approved for use up to 70 days of pregnancy in the United States. But its use remains an area of political conflict in the United States — reflecting the polarizing and politically charged status of abortion in the U.S. overall.
The majority of people use Google for web searches and click-through search results within the first page. To assess what kinds of information was available through a simple search for “abortion pill,” several colleagues and I evaluated the top webpages for searches in 2018 that provided text-based informative content. We recently published the results of this research and here’s what we found: Of the five informational and text-based webpages, only one provided information that was accurate and accessible while three were anti-abortion webpages with disinformation, or false information that is intended to mislead, on the abortion pill.
We also explored the quality of webpages most often presented to Google users searching for the “abortion pill” using a novel, evidence-based tool called the Family Planning Webpage Quality Assessment Tool to evaluate webpage content accuracy and user experience. Only one of the top webpages — Planned Parenthood’s medication abortion information page — provided information that was accurate and accessible. This webpage scored 81% on our tool, reflecting high levels of informational accuracy and user experience. Our assessment indicates that this site provided the most complete factual and balanced information out of the five webpages we assessed, allowing people to make informed decisions about their reproductive health.
The other four webpages we assessed scored between 19% and 33%, which means that they provided limited accurate information, inaccessible to the public for reasons related to textual and visual user experience. Based on past research on search result click-throughs, we know that those five webpages likely represent about 75% of the search traffic on the abortion pill.
Notably, we found that three of the top five webpages were anti-abortion webpages or webpages clearly linked to long-standing national efforts within the United States to deter abortion access through a variety of tactics including disseminating disinformation. Those three anti-abortion webpages presented concerning disinformation about the abortion pill, ranging from claims that the abortion pill leads to future mental health problems to claims of the abortion pill’s “reversibility.”
The presence of anti-abortion webpages within the top webpage results for abortion-related searches on Google has been a concern for researchers and advocates in the past, though little progress has been made to address the presence of misleading content presented to users seeking reliable abortion information and services.
There is more work to be done. The top webpages for recent years and their quality are still undetermined and warrant exploration, particularly considering increased reliance upon the internet as a source of health information and services during COVID-19. Changes in abortion access during COVID-19 further heighten the current importance of online abortion pill searches. Limitation of abortion access by labeling abortion services “non-essential” has forced some clinics already struggling under restrictions to close permanently. National rulings on the provision of medication abortion lifted, then very recently reinstated a ban on telemedicine provision, providing brief but fleeting hope for improved abortion access. While it is too soon to quantify the effects of these changes on abortion access, they highlight the importance of online abortion pill information and point to the pivotal role the internet can play in abortion decisions and services.
The regulation of online content in the United States is a complicated topic evoking concerns about censorship and decision-making power. Online health information is an area where steps have been taken to inform or protect users in content areas challenged by mis- and disinformation, such as COVID-19 misinformation regulation on YouTube and Twitter’s labeling and removal of misleading vaccine-related tweets through Birdwatch. For abortion information — in which lack of education and accessible in-person services are also concerns — the need to address online disinformation is urgent, as it poses a notable threat to informed reproductive choices and population health.
While overt censorship by Google itself may not be feasible or advisable, efforts should be made to facilitate informed consumption and use of online abortion information. This could be done through labeling of online abortion content as trustworthy or otherwise through community sourced-assessments similar to Web of Trust, or the use of a third-party labeling system such as MedCIRCLE. This also means advocating for and enacting widespread provision of digital health literacy education to give users the tools to better use online abortion information, and perhaps health information in general. These vital steps to support reproductive justice and informed choice must be taken, particularly as our reliance on the internet as a resource for health information and services only continues to grow.
Elizabeth Pleasants is a doctoral student at the UC Berkeley School of Public Health.
Sylvia Guendelman is the Advisory Committee Chair of the Wallace Center for Maternal Child and Adolescent Health and professor emerita at the UC Berkeley School of Public Health.
Ndola Prata is the endowed chair of the Bixby Center for Population, Health and Sustainability at UC Berkeley and a professor of maternal and child health
Karen Weidert is a technical and strategic advisor with the Bixby Center for Population, Health and Sustainability.