Condensation:
We document abortion method decision-making through analyzing posts on Reddit, a popular social media platform.
Objective
Most abortions take place in the first trimester, when both medication and surgical abortions are options. Several investigations document people’s modality decisions, with patient preference often driving decision-making in the absence of medical contraindications.1–3 Online anonymity may make the internet appealing for seeking abortion information. Most research on method decision-making relies on surveys or interviews of abortion clinic patients; while valuable, this data may exclude deliberations before clinic visits, including for those who never get through clinic doors.1–3 We aimed to better document abortion method decision-making through analyzing posts on Reddit, a website used by nearly a quarter of U.S. young adults containing user-aggregated content dispersed over two million user-created and monitored message boards.4
Study Design
In February 2020, we used Python to web-scrape the 250 most recent posts that mentioned abortion, removing all identifying information and usernames and assigning each post a unique number. We focused on posts related to modality choice prior to obtaining abortions; we established codes, then themes, using a combined deductive/inductive analytic approach. We excluded posts clearly posted from outside the U.S. Three qualitatively trained evaluators coded the posts in NVivo 12, reaching saturation after analyzing 148 posts. The University of Wisconsin-Madison Health Sciences IRB approved this study.
Results
We identified four themes related to abortion method decision-making: emotional experiences, pregnancy profiles, process-specific concerns, and structural barriers (Figure 1). Posters who discussed emotional experiences considered the perceived affective impact of abortion modality. Some favored medication abortion because they felt the clinical setting necessary for surgical abortion would be psychologically challenging, whereas others preferred the in-clinic emotional experience of surgical abortions. Some users incorporated their pregnancy profiles, including gestational age or underlying medical conditions, into modality decisions. Posters earlier in gestation leaned toward medication abortion, while others with underlying medical conditions wondered if medication abortion was the right option for them. Process-specific concerns pertained to method duration, effectiveness, and associated pain. Pain-related posts documented anticipated pain during surgical procedures only. Finally, structural barriers encompassed external circumstances, primarily transportation and cost. Many posters referenced needing medication over surgical abortion, which requires procedural sedation, because they could not secure a ride home or to the clinic at all. The two most common themes were emotional experiences and process-specific concerns.
Figure 1:
Themes derived from Reddit user posts regarding abortion method-choice, with examples of posts relating to each theme
Conclusion
Social media research regarding abortion likely captures individuals who either never obtain or self-manage abortions. In this exploratory study, similar to in-clinic research with abortion patients, Reddit users deciding abortion modality considered method impact on psychological or physical pain, as well as access to external resources such as finances and transportation.1–3 Because of individual variation in preference, access to all medically appropriate abortion methods is essential. Evidence-based information about abortion should be widely available online.
Study strengths include the novel use of social media to obtain information from populations perhaps unreached by traditional research methods. A weakness is that because we did not scrape usernames, separate posts may have come from the same individual or from outside the United States. Future research on abortion could benefit from engagement with online data.
Acknowledgements:
The authors express gratitude for the anonymous family foundation who supported both this project and CORE’s infrastructure. They also thank Joanna Venator of the University of Wisconsin-Madison for her assistance with Python, Liza Fuentes of the Guttmacher Institute for her consultation regarding Reddit, and Amy Williamson of CORE for her indispensable administrative leadership.
Funding support:
This research was supported by a grant from a large, anonymous family foundation. That same foundation provides center funding for UW CORE (The Collaborative for Reproductive Equity), which supplied administrative and research management support for the project.
Footnotes
Conflicts of interest:
The authors report no conflicts of interest.
References
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