Dataset Information

Shining the light on abortion: Drivers of online abortion searches across the United States in 2018.

ABSTRACT: CONTEXT:Legal abortion restrictions, stigma and fear can inhibit people's voices in clinical and social settings posing barriers to decision-making and abortion care. The internet allows individuals to make informed decisions privately. We explored what state-level policy dimensions were associated with volume of Google searches on abortion and on the abortion pill in 2018. METHODS:We used Google Trends to quantify the relative search volume (RSV) for "abortion" and "abortion pill" (or "abortion pills" hereafter referred to as "abortion pill") as a proportion of total search volume for all queries in each US state. We also identified the top search queries most related to "abortion" and "abortion pill" and considered these as indicators of population concern. Key exposures were healthcare cost, access and health outcomes, and number of legal restrictions and protections at the state level. In descriptive analyses, we first grouped the states into tertiles according to their RSV on "abortion" and "abortion pill". To examine the association between each exposure (and other covariates) with the two outcomes, we used unadjusted and adjusted linear regression. RESULTS:The average RSV for "abortion" in the low, moderate and high tertile groups was 48 (SD = 3.25), 55.5 (SD = 2.11) and 64 (SD = 4.72) (p-value <0.01) respectively; for "abortion pill" the average RSVs were 39.6 (SD = 16.68), 61.9 (SD = 5.82) and 81.7 (SD = 6.67) (p-value < 0.01) respectively. Concerns about contraceptive availability and access, and unplanned pregnancies independently predicted the relative search volumes for abortion and abortion pill. According to our baseline models, states with low contraceptive access had far higher abortion searches. Volume of abortion pill searches was additionally positively associated with poor health outcomes, poor access to abortion facilities and non-rurality. CONCLUSION:Search traffic analysis can help discern abortion-policy influences on population concerns and require close monitoring. State-policies can predict search volume for abortion and abortion pill. In 2018, concerns about contraceptives and unplanned pregnancies, predicted abortion searches. Current decreases in public contraceptive funding and the Title X Gag rule designed to block millions of people from getting care at Planned Parenthood, the largest provider of birth control and abortion care, may increase concerns about unintended pregnancies that can lead to increases in online relative volume of abortion searches.

SUBMITTER: Guendelman S

PROVIDER: S-EPMC7241764 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Shining the light on abortion: Drivers of online abortion searches across the United States in 2018.

Guendelman Sylvia S Yon Elena E Pleasants Elizabeth E Hubbard Alan A Prata Ndola N

PloS one 20200521 5

<h4>Context</h4>Legal abortion restrictions, stigma and fear can inhibit people's voices in clinical and social settings posing barriers to decision-making and abortion care. The internet allows individuals to make informed decisions privately. We explored what state-level policy dimensions were associated with volume of Google searches on abortion and on the abortion pill in 2018.<h4>Methods</h4>We used Google Trends to quantify the relative search volume (RSV) for "abortion" and "abortion pill ...[more]

PMID: 32437369

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Project description:Background As access barriers to in-person abortion care increase due to legal restrictions and COVID-19–related disruptions, individuals may be turning to the internet for information and services on out-of-clinic medication abortions. Google searches allow us to explore timely population-level interest in this topic and assess its implications. Objective We examined the extent to which people searched for out-of-clinic medication abortions in the United States in 2020 through 3 initial search terms: home abortion, self abortion, and buy abortion pill online. Methods Using the Google Trends website, we estimated the relative search index (RSI)—a comparative measure of search popularity—for each initial search term and determined trends and its peak value between January 1, 2020, and January 1, 2021. RSI scores also helped to identify the 10 states where these searches were most popular. We developed a master list of top search queries for each of the initial search terms using the Google Trends application programming interface (API). We estimated the relative search volume (RSV)—the search volume of each query relative to other associated terms—for each of the top queries using the Google Health Trends API. We calculated average RSIs and RSVs from multiple samples to account for low-frequency data. Using the Custom Search API, we determined the top webpages presented to people searching for each of the initial search terms, contextualizing the information found when searching them on Google. Results Searches for home abortion had average RSIs that were 3 times higher than self abortion and almost 4 times higher than buy abortion pill online. Interest in home abortion peaked in November 2020, during the third pandemic wave, at a time when providers could dispense medication abortion using telemedicine and by mail. Home abortion was most frequently queried by searching for Planned Parenthood, abortion pill, and abortion clinic, presumably denoting varying degrees of clinical support. Consistently lower search popularity for self abortion and buy abortion pill online reflect less population interest in mostly or completely self-managed out-of-clinic abortions. We observed the highest interest for home abortion and self abortion in states hostile to abortion, suggesting that state restrictions encourage these online searches. Top webpages provided limited evidence-based clinical content on self-management of abortions, and several antiabortion sites presented health-related disinformation. Conclusions During the pandemic in the United States, there has been considerably more interest in home abortions than in minimally or nonclinically supported self-abortions. While our study was mainly descriptive, showing how infrequent abortion-related search data can be analyzed through multiple resampling, future studies should explore correlations between the keywords denoting interest in out-of-clinic abortion and abortion care measures and test models that allow for improved monitoring and surveillance of abortion concerns in our rapidly evolving policy context.

Dataset Information

Shining the light on abortion: Drivers of online abortion searches across the United States in 2018.

Publications

Shining the light on abortion: Drivers of online abortion searches across the United States in 2018.

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