JMIR Publications

ABSTRACT

Background:

Black women in the United States (US) disproportionately suffer adverse pregnancy and birth outcomes compared to White women. Social determinants of health such as economic adversity and implicit bias during clinical encounters may lead to physiological responses that place Black women at higher risk for maternal mortality or other adverse birth outcomes. The novel coronavirus disease of 2019 (COVID-19) further exacerbates this risk, as Blacks are more likely to die from the disease, and COVID-19 safety protocols increase social isolation in clinical settings - limiting opportunities to advocate for unbiased care. Twitter, one of the most popular social networking sites, has 192 million daily active users, and about 500 million tweets are shared everyday [1]. It has been used to study a variety of issues of public interest, including health care, among others [2]. Twitter is considered a social media platform that may accurately capture public discourse during the COVID-19 pandemic, and is being used in several infodemiology studies by public health experts.

Objective:

This study aims to assess the feasibility of Twitter for identifying public discourse related to social determinants of health and advocacy that influence maternal health among Black women across the US, and to examine trends in sentiment between 2019 and 2020 in the context of the COVID-19 pandemic.

Methods:

Tweets were collected from March 1, 2020 to July 13, 2020 from 21 organizations and influencers, and from four hashtags that focused on Black maternal health. Additionally, we collected tweets from the same organizations and hashtags from the year prior, from March 1, 2019 to July 13, 2019. The Python programming library, Twint, was used for our data collection and analyses. We gathered the text of approximately 17,000 tweets, as well as all publicly available metadata. Topic modeling and k-means clustering were used to analyze the tweets.

Results:

We saw a variety of trends when we compared the 2020 dataset to the 2019 dataset from the same period. In our topic models, tweets on reproductive justice, maternal mortality crisis, and patient care increased by over 65% in 2020 versus 2019. Topics on community, advocacy, and health equity increased by over 30%. In contrast, tweet topics that decreased in 2020 from 2019 were as follows: tweets on Medicaid and medical coverage decreased by over 40%; discussions about creating space for Black women decreased by just under 30%.

Conclusions:

Our results indicate the COVID-19 pandemic may have spurred an increased focus on advocating for improved reproductive health and maternal health outcomes among Black women in the US. Further analyses are needed to capture a longer time frame that encompasses more of the pandemic, as well as more diverse “voices” to confirm the robustness of our findings.