Exploring Google Searches for Out-of-Clinic Medication Abortion in the United States During 2020: Infodemiology Approach Using Multiple Samples
Authors: Guendelman Sylvia , Pleasants Elizabeth , Cheshire Coye , Kong Ashley 
Published: May 2022

Background
As access barriers to in-person abortion care increase due to legal restrictions and COVID-19–related disruptions, individuals may be turning to the internet for information and services on out-of-clinic medication abortions. Google searches allow us to explore timely population-level interest in this topic and assess its implications.

Objective
We examined the extent to which people searched for out-of-clinic medication abortions in the United States in 2020 through 3 initial search terms: home abortion, self abortion, and buy abortion pill online.

Methods
Using the Google Trends website, we estimated the relative search index (RSI)—a comparative measure of search popularity—for each initial search term and determined trends and its peak value between January 1, 2020, and January 1, 2021. RSI scores also helped to identify the 10 states where these searches were most popular. We developed a master list of top search queries for each of the initial search terms using the Google Trends application programming interface (API). We estimated the relative search volume (RSV)—the search volume of each query relative to other associated terms—for each of the top queries using the Google Health Trends API. We calculated average RSIs and RSVs from multiple samples to account for low-frequency data. Using the Custom Search API, we determined the top webpages presented to people searching for each of the initial search terms, contextualizing the information found when searching them on Google.

Results
Searches for home abortion had average RSIs that were 3 times higher than self abortion and almost 4 times higher than buy abortion pill online. Interest in home abortion peaked in November 2020, during the third pandemic wave, at a time when providers could dispense medication abortion using telemedicine and by mail. Home abortion was most frequently queried by searching for Planned Parenthood, abortion pill, and abortion clinic, presumably denoting varying degrees of clinical support. Consistently lower search popularity for self abortion and buy abortion pill online reflect less population interest in mostly or completely self-managed out-of-clinic abortions. We observed the highest interest for home abortion and self abortion in states hostile to abortion, suggesting that state restrictions encourage these online searches. Top webpages provided limited evidence-based clinical content on self-management of abortions, and several antiabortion sites presented health-related disinformation.

Conclusions
During the pandemic in the United States, there has been considerably more interest in home abortions than in minimally or nonclinically supported self-abortions. While our study was mainly descriptive, showing how infrequent abortion-related search data can be analyzed through multiple resampling, future studies should explore correlations between the keywords denoting interest in out-of-clinic abortion and abortion care measures and test models that allow for improved monitoring and surveillance of abortion concerns in our rapidly evolving policy context.