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Quality of Information Available Online for Abortion Self-Referral

Dodge, Laura E., ScD, MPH; Phillips, Sharon J., MD, SM; Neo, Dayna T., MPH; Nippita, Siripanth, MD, MS; Paul, Maureen E., MD, MPH; Hacker, Michele R., ScD, MSPH

doi: 10.1097/AOG.0000000000002950
Contents: Abortion: Original Research

OBJECTIVE: To assess the quality of information available online for abortion self-referral and to determine whether quality varies by region or distance to an abortion provider.

METHODS: This was a cross-sectional study. We used a standard protocol to perform internet searches from August 2016 to June 2017 for abortion services in the 25 most populous U.S. cities and the 43 state capitals that were not one of the 25 most populous cities. We classified the first 10 webpage results and the first five map results and advertisements as facilitating abortion referral (local independent abortion provider, local Planned Parenthood facility, national abortion provider or organization, prochoice website, or abortion directory), not facilitating abortion referral (nonproviding physician office, nonmedical website, abortion provider greater than 50 miles from the location, news article, general directory, other), or hindering abortion referral (crisis pregnancy center or antichoice website). We used U.S. Census Bureau subregions to examine geographic differences. We made comparisons using a χ2 test.

RESULTS: Overall, from 612 searches from 68 cities, 52.9% of webpage results, 67.3% of map results, and 34.4% of advertisements facilitated abortion referral, whereas 12.9%, 21.7%, and 29.9%, respectively, hindered abortion referral. The content of the searches differed significantly based on U.S. Census Bureau subregion (all P≤.001) and distance to an abortion provider (all P≤.02).

CONCLUSION: Two thirds of map results facilitated abortion self-referral, whereas only half of webpage results did so. Advertisements were the least likely to facilitate and the most likely to hinder self-referral. Quality was lowest in areas that were farthest from abortion providers.

Although the internet may be a viable source of abortion self-referral, it seems least useful for those in greatest need of help finding an abortion provider.

Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, the Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, the Department of Epidemiology, Harvard T.H. Chan School of Public Health, and the Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts.

Corresponding author: Michele R. Hacker, ScD, MSPH, Beth Israel Deaconess Medical Center, 330 Brookline Avenue KS 3, Boston, MA 02215; email:

Supported by the Harvard Catalyst, the Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102), and financial contributions from Harvard University and its affiliated academic health care centers.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the 2017 North American Forum on Family Planning, October 13–15, 2017, Atlanta, Georgia.

Each author has indicated that he or she has met the journal's requirements for authorship.

Peer review history is available at

Received June 25, 2018

Received in revised form August 16, 2018

Accepted August 23, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.