Han Leo, Boniface Emily R, Han Lisa Yin, Albright Jonathan, Doty Nora, Darney Blair G
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, United States.
Department of English, Arizona State University, Tempe, AZ, United States.
J Med Internet Res. 2020 Oct 26;22(10):e20619. doi: 10.2196/20619.
People use the internet as a primary source for learning about medical procedures and their associated safety profiles and risks. Although abortion is one of the most common procedures worldwide among women in their reproductive years, it is controversial and highly politicized. Substantial scientific evidence demonstrates that abortion is safe and does not increase a woman's future risk for depressive disorders or infertility. The extent to which information found on the internet reflects these medical facts in a trustworthy and unbiased manner is not known.
The purpose of this study was to collate and describe the trustworthiness and political slant or bias of web-based information about abortion safety and risks of depression and infertility following abortion.
We performed a cross-sectional study of internet websites using 3 search topics: (1) is abortion safe?, (2) does abortion cause depression?, and (3) does abortion cause infertility? We used the Google Adwords tool to identify the search terms most associated with those topics and Google's search engine to generate databases of websites related to each topic. We then classified and rated each website in terms of content slant (pro-choice, neutral, anti-choice), clarity of slant (obvious, in-between, or difficult/can't tell), trustworthiness (rating scale of 1-5, 5=most trustworthy), type (forum, feature, scholarly article, resource page, news article, blog, or video), and top-level domain (.com, .net, .org, .edu, .gov, or international domain). We compared website characteristics by search topic (safety, depression, or infertility) using bivariate tests. We summarized trustworthiness using the median and IQR, and we used box-and-whisker plots to visually compare trustworthiness by slant and domain type.
Our search methods yielded a total of 111, 120, and 85 unique sites for safety, depression, and infertility, respectively. Of all the sites (n=316), 57.3% (181/316) were neutral, 35.4% (112/316) were anti-choice, and 7.3% (23/316) were pro-choice. The median trustworthiness score was 2.7 (IQR 1.7-3.7), which did not differ significantly across topics (P=.409). Anti-choice sites were less trustworthy (median score 1.3, IQR 1.0-1.7) than neutral (median score 3.3, IQR 2.7-4.0) and pro-choice (median score 3.7, IQR 3.3-4.3) sites. Anti-choice sites were also more likely to have slant clarity that was "difficult to tell" (41/112, 36.6%) compared with neutral (25/181, 13.8%) or pro-choice (4/23, 17.4%; P<.001) sites. A negative search term used for the topic of safety (eg, "risks") produced sites with lower trustworthiness scores than search terms with the word "safety" (median score 1.7 versus 3.7, respectively; P<.001).
People seeking information about the safety and potential risks of abortion are likely to encounter a substantial amount of untrustworthy and slanted/biased abortion information. Anti-choice sites are prevalent, often difficult to identify as anti-choice, and less trustworthy than neutral or pro-choice sites. Web searches may lead the public to believe abortion is riskier than it is.
人们将互联网作为了解医疗程序及其相关安全性和风险的主要信息来源。尽管堕胎是全球育龄女性中最常见的手术之一，但它颇具争议且高度政治化。大量科学证据表明，堕胎是安全的，不会增加女性未来患抑郁症或不孕症的风险。互联网上所提供的信息在多大程度上以可靠且无偏见的方式反映这些医学事实尚不清楚。
本研究旨在整理并描述关于堕胎安全性以及堕胎后抑郁症和不孕症风险的网络信息的可信度、政治倾向或偏见。
我们使用三个搜索主题对互联网网站进行了横断面研究：（1）堕胎安全吗？（2）堕胎会导致抑郁症吗？（3）堕胎会导致不孕症吗？我们使用谷歌关键词工具来确定与这些主题最相关的搜索词，并使用谷歌搜索引擎生成与每个主题相关的网站数据库。然后，我们根据内容倾向（支持选择、中立、反对选择）、倾向的清晰度（明显、介于两者之间、难以判断/无法判断）、可信度（1 - 5分制，5分表示最可信）、类型（论坛、专题报道、学术文章、资源页面毛新闻报道、博客或视频）以及顶级域名（.com、.net、.org、.edu、.gov或国际域名）对每个网站进行分类和评级。我们使用双变量检验按搜索主题（安全性、抑郁症或不孕症）比较网站特征。我们使用中位数和四分位距来总结可信度，并使用箱线图直观地比较不同倾向和域名类型的可信度。
我们的搜索方法分别针对安全性、抑郁症和不孕症主题得到了111个、120个和85个独特的网站。在所有网站（n = 316）中，57.3%（181/316）为中立，35.4%（112/316）为反对选择，7.3%（23/316）为支持选择。可信度得分中位数为2.7（四分位距1.7 - 3.7），各主题之间无显著差异（P = 0.409）。反对选择的网站不如中立（得分中位数3.3，四分位距2.7 - 4.0）和支持选择（得分中位数3.7，四分位距3.3 - 4.3）的网站可信（得分中位数1.3，四分位距1.0 - 1.7）。与中立（25/181，13.8%）或支持选择（4/23，17.4%；P < 0.001）的网站相比，反对选择的网站更有可能具有“难以判断”的倾向清晰度（41/112，36.6%）。用于安全性主题的负面搜索词（如“风险”）所产生的网站可信度得分低于带有“安全”一词的搜索词（得分中位数分别为1.7和3.7；P < 0.001）。
寻求堕胎安全性及潜在风险信息的人们可能会遇到大量不可信且有倾向/偏见的堕胎信息。反对选择的网站很普遍，往往难以识别其反对选择倾向，且不如中立或支持选择的网站可信。网络搜索可能会使公众认为堕胎比实际风险更大。
