JMIR Publications

ABSTRACT

Background:

As access barriers to in-person abortion care increase due to rapidly evolving legal restrictions and efforts to mitigate COVID-19, individuals may be turning to the internet for information and services on out-of-clinic medication abortions. Google searches provide an opportunity to explore timely population-level interest in this topic and assess its implications.

Objective:

We sought to examine the extent to which people searched for out-of-clinic medication abortions in the US in 2020 through three initial search terms: ‘home abortion’, ‘self-abortion’ and ‘buy abortion pill online’.

Methods:

Using the Explore function of the Google Trends website, we estimated the relative search index (RSI) – a comparative measure of search popularity—for each of the initial search terms and determined its peak value during 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 API. We then 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. Using the Custom Search API, we took a snapshot of the top webpages to contextualize the information most often presented to people searching for each of the three initial search terms.

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 wave of the pandemic, at a time when providers were allowed to dispense medication abortion using telemedicine and by mail. The top queries for ‘home abortion’ with the highest RSVs indicate that searchers were most often seeking information on medication abortion performed at home with provider 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 anti-abortion sites presented health-related disinformation.

Conclusions:

During the pandemic in the US, there has been considerably more population-level interest in clinically supported home abortions than in minimally or non-clinically supported abortions. Clinically supported home abortions may overcome multiple legal, economic and cultural barriers since they may be more private, convenient, affordable, and less stigmatizing than in-clinic abortions. Our findings highlight the need to maintain access to telemedicine abortion services, particularly when in-person access is restricted.