The Abortion Web Ecosystem: Cross-Sectional Analysis of Trustworthiness and Bias

Abstract

Background People use the internet as a primary source for learning about medical procedures and their associated safety profiles and risks. Although abortion is one of the most common procedures worldwide among women in their reproductive years, it is controversial and highly politicized. Substantial scientific evidence demonstrates that abortion is safe and does not increase a woman’s future risk for depressive disorders or infertility. The extent to which information found on the internet reflects these medical facts in a trustworthy and unbiased manner is not known. Objective The purpose of this study was to collate and describe the trustworthiness and political slant or bias of web-based information about abortion safety and risks of depression and infertility following abortion. Methods We performed a cross-sectional study of internet websites using 3 search topics: (1) is abortion safe?, (2) does abortion cause depression?, and (3) does abortion cause infertility? We used the Google Adwords tool to identify the search terms most associated with those topics and Google’s search engine to generate databases of websites related to each topic. We then classified and rated each website in terms of content slant (pro-choice, neutral, anti-choice), clarity of slant (obvious, in-between, or difficult/can’t tell), trustworthiness (rating scale of 1-5, 5=most trustworthy), type (forum, feature, scholarly article, resource page, news article, blog, or video), and top-level domain (.com, .net, .org, .edu, .gov, or international domain). We compared website characteristics by search topic (safety, depression, or infertility) using bivariate tests. We summarized trustworthiness using the median and IQR, and we used box-and-whisker plots to visually compare trustworthiness by slant and domain type. Results Our search methods yielded a total of 111, 120, and 85 unique sites for safety, depression, and infertility, respectively. Of all the sites (n=316), 57.3% (181/316) were neutral, 35.4% (112/316) were anti-choice, and 7.3% (23/316) were pro-choice. The median trustworthiness score was 2.7 (IQR 1.7-3.7), which did not differ significantly across topics (P=.409). Anti-choice sites were less trustworthy (median score 1.3, IQR 1.0-1.7) than neutral (median score 3.3, IQR 2.7-4.0) and pro-choice (median score 3.7, IQR 3.3-4.3) sites. Anti-choice sites were also more likely to have slant clarity that was “difficult to tell” (41/112, 36.6%) compared with neutral (25/181, 13.8%) or pro-choice (4/23, 17.4%; P<.001) sites. A negative search term used for the topic of safety (eg, “risks”) produced sites with lower trustworthiness scores than search terms with the word “safety” (median score 1.7 versus 3.7, respectively; P<.001). Conclusions People seeking information about the safety and potential risks of abortion are likely to encounter a substantial amount of untrustworthy and slanted/biased abortion information. Anti-choice sites are prevalent, often difficult to identify as anti-choice, and less trustworthy than neutral or pro-choice sites. Web searches may lead the public to believe abortion is riskier than it is.

Understanding the Abortion Experiences of Young People to Inform Quality Care in Argentina, Bangladesh, Ethiopia, and Nigeria

“…For example, YouTube or social media platforms may be a youth-friendly medium through which to deliver evidence-based information on what to expect and how to access services, and to dispel abortion myths and misinformation since these platforms are already a trusted source of healthcare and abortion content. However, the quality of content on YouTube and other social media platforms is difficult to standardize, and clients may need guidance identifying evidence-based sources given the substantial amount of untrustworthy and biased abortion information also available (Han et al, 2020); therefore, caution should be applied when promoting patient education materials through these channels (Gabarron et al, 2013). More research is needed to investigate how young people determine which sources are trustworthy.…”

Gynecology Meets Big Data in the Disruptive Innovation Medical Era: State-of-Art and Future Prospects

“…Han et al [ 56 ] carried out a cross-sectional study of internet websites related to abortion, in order to investigate its relationship with psychological wellbeing and safety, depression, and mental health, as well as infertility. For this purpose, they exploited the Google AdWords tool to retrieve the keywords most associated with the topics under study and Google Trends to monitor and track Google’s search engine to build a list of databases of websites commonly consulted.…”

Factors Associated With Perceived Trust of False Abortion Websites: Cross-sectional Online Survey

“…We selected our websites from a database of abortion websites used in a previous study [10]. For each website in that database, three investigators determined the slant (prochoice, neutral, or antichoice) and slant clarity (easy, moderate, or difficult to determine website slant) based on their impression of the website.…”

“…Although the abortion rate in the United States (abortions per 1000 females aged 15 to 49 years) has declined over the last decade, internet searches for abortion-related information have steadily increased [8,9]. As the demand for online abortion information rises, many top search results contain incorrect and misleading information [10]. Many misleading websites are created by crisis pregnancy centers (CPCs) and other antichoice organizations, which seek to dissuade patients from accessing abortion and other reproductive health care services [11].…”