Facebook Doesn’t Like Sexual Health or Sexual Pleasure: Big Tech’s Ambiguous Content Moderation Policies and Their Impact on the Sexual and Reproductive Health of the Youth

Abstract

This paper explores the modern challenges hindering access to sexual health resources in the age of Big Tech and their impact on public health. Research data from sexual health organizations, Internet experts, and corporate financial documents shows instances of conflict between Big Tech’s business model and the sexual health organizations’ efforts to provide accurate information about sexually transmitted diseases and unplanned pregnancy prevention to the youth. Results show that as younger generations turn to the internet for sexual health resources, they are met with misinformation and roadblocks, enabled by the dominant corporations in the market. Sexual pleasure, for instance, remains an overlooked dimension of these resources despite the fact that it is important to people. In conclusion, given the rise in popularity of tech platforms, and the youth’s reliance on them as basic information resources, Big Tech must be held accountable for its role and impact on public health, and collaborative closely and actively with sexual health experts to establish appropriate content moderation policies for sexual health content online.

The 13th World Congress of Sexology, held by the World Association for Sexual Health (WAS) in Valencia, Spain in 1997, received global attention beyond the scientific community. The Valencia Declaration of Sexual Rights, spearheaded by doctors María Pérez Conchillo and Juan José Borrás Valls, was the catalyst for the World Health Organization’s recognition of sexual rights as a human right (Kismödi et al., 2017). The Valencia Declaration has since been revised was adopted by the World Association for Sexual Health in 1999 and subsequently went through a substantive revision in 2015 (World Association for Sexual Health, 1999, 2015). These declarations served as the inspiration for numerous other key initiatives within the field. In 2008, the International Planned Parenthood Federation issued its own declaration of sexual rights (IPPF, 2008), and in 2015 the US government announced that it would begin using the term “sexual rights” in its human rights and global development discussions (Cara, 2015).

Despite the monumental international progress achieved in the recognition, promotion, and protection of sexual rights thus far, the digitization of society has generated new challenges that require urgent attention. As younger generations turn to the Internet for sexual health resources, they are met with misinformation and roadblocks, enabled by the dominant corporations in the market. Sexual pleasure, for instance, remains an overlooked dimension of these resources despite the fact that it is important to people. This paper explores the modern challenges hindering access to sexual health resources in the age of Big Tech and their impact on public health. In particular, it examines how sexual health content conflicts with Big Tech’s business model, and the subsequent impact on sexual health organizations’ efforts to provide accurate information about sexually transmitted diseases and unplanned pregnancy prevention to the youth. Finally, given the rise in popularity of tech platforms, and the youth’s reliance on them as basic information resources, the paper argues that Big Tech must be held accountable for its role and impact on public health, concluding with specific recommendations.

Analysis

After the initial utopian years of an open and collaborative Internet, the market became concentrated with just a few immensely large corporations dominating the online space. Big Tech, as these corporations are usually referred to, monitor and control everything we do and what we can access online. Consequently, they create the illusion of having “the world at your fingertips,” when in reality it is their world at your fingertips. Facebook and Google have established themselves as gatekeepers of the world’s online information.

The size and diversity of their user base are unprecedented: 9 out of 10 Internet searches are conducted through Google (Oberlo, 2021), and more than half of the social media users worldwide have a Facebook account (Facebook, 2020; Statista, 2021).

The business model of these two companies is very similar. They offer a free platform where users connect, share and create content. Profits are generated mainly from advertising, offering third parties the opportunity to present their products and services to the most likely buyers in the most relevant context possible. In order to do this, their platforms become walled gardens ruled by opaque, algorithmically-powered content moderation rules. Due to the massive volume of daily user-generated content [Facebook generates four new petabytes of data every day (Wiener & Bronson, 2014)], content moderation is one of the most difficult challenges these companies face. As a result of this nearly impossible task, two opposite effects emerge: blanket censorship and the rapid spread of misinformation.

Sexual health content is often flagged as pornography by Big Tech, and consequently, such material is automatically banned. The Association for Progressive Communications and the Humanist Institute for Cooperation with Developing Countries have conducted and promoted extensive research on the topic of sexual rights and the Internet, captured in the Global Information Society Watch 2015: Sexual rights and the internet report (Association for Progressive Communications & Humanist Institute for Cooperation with Developing Countries, 2020). The research conducted by the Internet regulation expert Jillian York (2015) is particularly relevant to understanding how Big Tech’s business model favors the censorship of sexual health content. In her article, “Privatising censorship online,” York breaks down the different reasons these Internet platforms may censor or restrict access to sexual health content: (1) government-requested takedowns (via legal orders or other means); (2) business/market-related decisions (when dividing countries into markets, the policy choice is based on the country with the most restrictive content regulations); and lastly, 3 the company and its employees’ perception of what is “moral” or “appropriate.” York adds that “the impetus behind such content restrictions can be difficult to ascertain, and may involve a combination of the above.” This censorship has a historical precedent. Sexual desire, passion, and pleasure have long been viewed as dangerous—as a threat to the social, political, and religious order. This legacy of a negative interpretation of pleasure, particularly if it is experienced in a context outside of marriage, procreation, or heterosexuality, is still with us today and continues to hinder sexual health promotion.

Sexual health content takedowns are often the result of inadequate and (sometimes intentionally) vague content moderation policies. In her article, When Social-Media Companies Censor Sex Education, therapist Amber Madison (2015) explains how these policies are “enforced with overly strict interpretations, or are so broad that they’re enforced completely inconsistently.” For instance, Google once banned a sexual health organization from using its Google Checkout service to sell contraceptive education kits online. The company’s representatives had deemed the wooden penis model used for demonstrating how to put on a condom a “sex toy.” The kits were then removed from the platform despite multiple attempts by the organization to prove their educational nature to the company’s employees.

Many health organizations, such as the American Sexual Health Association (n.d.), have criticized the systematic inappropriate labeling of public health content. For example, Facebook labeled a campaign to increase vaginismus awareness—a health condition that may result in painful intercourse for women—as a “sexually explicit product.” Similarly, the Great American Condom Campaign, launched by the organization Advocates for Youth, was denied by the platform for violating guidelines about “adult content.” Sexual health organizations have launched numerous public awareness campaigns to put an end to what they consider censorship, but the issue persists. For them, “the need for accurate, unbiased sexual health information is clear,” as every year almost 20 million new sexually transmitted infections are diagnosed in the US, and nearly half of all pregnancies are unplanned (American Sexual Health Association, n.d). Madison (n.d) led one such campaign urging Facebook, Twitter, Pinterest, YouTube, Yahoo, and Google “to stop censoring sex education content from health organizations trying to provide people with the information they want and need to be healthy.”

Many experts consider America’s high rates of sexually transmitted diseases, unplanned pregnancies, and sexual assaults—some of the highest among industrialized countries—an epidemic. While we live in the Information Age, with the entire world accessible through our Internet-connected devices, the corporations that build and operate the main information exchange platforms online continue to hinder access, block, and censor basic sexual health content. Research has proven the relevance of social media as a resource for sexual health education. Studies show that a focus not just on risk and disease, but on the more positive, pleasurable aspect of sex can decrease sexual risk behaviors. Yet, anything related to sexual pleasure would be even more likely to be censored online based on current policy. As Madison (2015) explains, “social media’s strict policies wouldn’t be such an issue if teens (and adults) didn’t use technology as one of their primary sources of sexual health information. But in fact, 89 percent of teens say they learn about a variety of sexual-health issues online.”

Mitchell, Ybarra, Korchmaros and Kosciw (2014), provide compelling evidence for the need to make such content easier to access online, as well as to provide a variety of resources, “where sexual minority youth can seek out help, anonymously and/or privately, if desired” (p. 156). Online searches for sexual health information among the youth are disproportionately higher among those identifying as part of LGBTQI + groups (78% of gay/lesbian/queer youth compared to 19% of heterosexual youth), which makes them particularly vulnerable to Big Tech’s censorship (Mitchell et al., 2014). Mitchell et al. (2014) indicate that the availability of online sexual health information is most valuable to those who lack access to alternative resources, stating that “the most common reasons youth look for sexual health information [online] is for privacy and curiosity” (p. 147).

Other researchers, such as Nicola Döring, have analyzed how adolescents turn to “Dr. Google” for sexual advice, commonly seeking answers from the search engine. Döring (2017), who focused his research on German youth, found that sexual health education content offered by leading professionals was “nearly invisible” online, while inaccurate, unprofessional and oftentimes “click-baity” content was pushed by Google to the top of the search results. As video content becomes increasingly popular among Generation Z and beyond, the researcher also studied the youth’s increasing reliance on YouTube. He found similar patterns of censorship on the video platform, which is part of the same corporation as Google.

The increasing dependence of the youth on the leading Internet platforms for their sexual wellbeing is mobilizing experts from research into practice. The World Association for Sexual Health (2021a), as a leading authority, set “Turn it on: Sexual health in a digital world” as the theme for the 2021 World Sexual Health Day, celebrated on September 4th. According to the World Sexual Health Day Committee, “there is not a broad panorama of tools that address the promotion of healthy sexual practices both among young people and people of any age group. In addition, it is very easy to access information, but it does not mean that they can always discriminate between what is accurate and reliable from what is not.” WAS’ call for a “reframing and reconceptualization” of sexual health online, is another example of the broader movement for a deeper reflection on how technology should be integrated into our modern societies.

People, especially young people who are learning to negotiate their sexuality, seek a sexual activity that feels close, natural, and uninterrupted—where sexual pleasure is often prioritized over risk reduction and contraception. Research shows that pleasure-inclusive messages attract more attention, are easily remembered, and are less likely to induce counterarguments than non-sexual messages. Thus, a goal for sexual health information would involve the presence of more holistic, pleasure-inclusive approaches and understandings of safer sex and sexuality education. Ideally, online resources could incorporate the notion of physical and psychological pleasure grounded in sexual rights, including self-determination, consent, safety, privacy, confidence and communication negotiation. The recent Declaration on Sexual Pleasure issued by WAS at the 2021 General Assembly of the 26th World Congress of Sexual Health in Cape Town, South Africa (World Association for Sexual Health, 2021b), is an important milestone for the consideration of sexual pleasure as integral to broader health, mental health, sexual health, well-being, and sexual rights.

The most recent available data published by the US Centers for Disease Control and Prevention (CDC) found that STDs in the country reached an all-time high for the 6th consecutive year, with over 2.5 million cases of chlamydia, gonorrhea, and syphilis reported in 2019 (Centers for Disease Control and Prevention, 2019). In this context, Big Tech must be held accountable for its role and impact on public health. The situation requires urgent action, in the form of: (1) demanding Big Tech to stop censoring sexual health content; (2) asking these corporations to collaborate closely and actively with sexual health experts to establish appropriate content moderation policies for sexual health content, establishing transparent and unambiguous content moderation guidelines, and removing vaguely written policies that make it difficult for organizations to abide by them; (3) reviewing and updating algorithm-driven content moderation systems to prevent the censorship of sexual health content; and (4) supporting and amplifying the message of the WAS, sexual health experts, the CDC and others in their mission “to continue harnessing the power of digital technology to engage with populations that are especially vulnerable to sexual risk” (as stated by Kachur in Madison, 2015: online).

Declaration of interest

The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.