Abstract
ContextLegal 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.MethodsWe 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.ResultsThe 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.ConclusionSearch 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.
Highlights
Abortion rates in the US at 13.5 per 1,000 women ages 15–44 were at an all-time low in 2017, representing a 22% decrease since 2005
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
We focus on the abortion pill since prior research has shown that the abortion pill is the top abortion procedure searched for on Google in the nation. [17, 23] Since the majority of people search for health information using Google [24] our analysis was restricted to this search engine
Summary
Abortion rates in the US at 13.5 per 1,000 women ages 15–44 were at an all-time low in 2017, representing a 22% decrease since 2005. [8] Anti-choice groups link other incremental restrictive policies to the decline [9], even though rates began falling before implementation of a massive number of restrictive laws during 2011–12 and in places with few abortion restrictions. [11] In these states for instance, restrictive policies require mandatory counseling and waiting periods for women seeking an abortion, limiting access to abortion for minors without parental involvement, imposing cumbersome regulations on abortion facilities, and requiring that only a licensed physician perform abortions. [11,12,13] In opposition, pro-choice groups have recently increased efforts to expand access to abortion and contraception and to protect women’s reproductive rights by enacting laws guaranteeing the legality of abortion if Roe v. Wade were to be overturned, requiring insurance coverage of abortion services, [12] and by repealing legislation that creates barriers to accessing abortion. [13] Access has been expanded with the use of telemedicine to administer medication abortion, and by FDA approval for use of medication abortion until later in pregnancy, allowance of administration by non-physicians, and lowered costs. [14]
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