The influence of advertising policy on information available online for abortion self-referral

Prior work shows that ads related to abortion services often feature crisis pregnancy centers instead of abortion providers. We investigated whether a change in Google's advertising policy that required advertisers to disclose whether they provided abortion services increased the proportion of ads facilitating abortion self-referral.

We used a standardized protocol to search online for abortion services before, during, and after the policy change; we performed searches in August 2016 to June 2017, June 2019, and October 2019, respectively, using Google, Bing, and Yahoo search engines. We performed searches for the 25 most populous U.S. cities and the 43 state capitals not already included. We classified up to the first 5 ads as facilitating abortion referral, hindering abortion referral, or providing neutral content. We compared search engine results using a chi-square test.

Among ads returned by Google, those shown after the policy change were significantly more likely to facilitate abortion self-referral (66.7% vs. 44.2%; p = 0.003) and slightly less likely to hinder abortion self-referral (33.3% vs. 40.6%; p = 0.33) compared to before the change. These findings were reversed for ads shown by Bing and Yahoo; ads returned after the change were significantly less likely to facilitate abortion self-referral (24.6% vs. 32.8%; p = 0.01) and significantly more likely to hinder self-referral (28.3% vs. 21.6%; p = 0.03) compared to before the change.

A policy requiring advertisers to disclose whether they provide abortion services was associated with increasing the proportion of ads facilitating self-referral. Similar policies should be considered by all search engines.

While the internet is a convenient source of information that individuals often use to locate abortion providers, the information may not actually lead searchers to services. Search engines should consider restricting abortion-related advertising to organizations that provide abortion services in order to ensure that individuals searching online for abortion services are able to locate services in a direct and timely manner.