Abstract
Following the US Supreme Court decision in June 2022 that overturned Roe v Wade and scrapped the federal right to an abortion, the reliance instead on states’ laws means 50 sets of regulations regarding abortions across the country. Equally importantly, it also means 50 variants of access to information. This patchwork is profoundly confusing and easily manipulated to the disadvantage of someone seeking an abortion.
A recent Kaiser Family Foundation study shows that many adults in the USA – including women aged between 18 and 49 – are at a loss as to whether medical abortions and emergency contraceptives (the “morning-after pill”) are legal in their states.
“In addition, one in eight adults (13%), including one in 10 women, living in states where abortion is currently banned incorrectly believe medication abortion is legal in their state,” the report stated.
The majority of abortions in the USA today are medical abortions, but getting hold of the pills used for the procedure — mifepristone and misoprostol — isn’t always easy (and the main pill might be outlawed in a number of states). This goes for states with legalised abortions as well as those where abortions are illegal but where people can, in theory, order the pills through the post.
That’s where the internet comes in, and where information suppression and misinformation abound. Sites such as the Digital Defense Fund, which offers security and technology resources within the abortion rights movement, and the Electronic Frontier Foundation, which defends digital privacy, try to keep the internet honest about abortion information and how both abortion seekers and medical providers can protect themselves and receive the needed medication. Reddit has also become a go-to for information. But it’s a complicated, expansive online universe.
The group Mayday Health, led by Jennifer Lincoln, uses creative communications strategies to publicly share information about abortion pills in areas where abortion is either illegal or restricted. Employing billboards, radio and television adverts and the internet, they reach critical audiences as they figure out how to circumvent suppression attempts.
Mayday Health’s public advocacy has faced “truly horrifying attempts to suppress this issue”, according to Sam Koppelman, a communications specialist and co-founder of the group. Yet each time Mayday has received a subpoena to take down public billboards, it’s responded by adding more.
“We got a subpoena from Mississippi to suppress our billboards. The subpoena was illegally served,” Koppelman told Index. “Our lawyers wrote back and said we wouldn’t comply.”
In addition to the three billboards already up, they added 20.
“These states think they can chill speech by intimidation even though they know they have no case in the courts,” he said. “So they probably think that by sending us a subpoena, they can intimidate us into silence.” So far, that hasn’t worked.
At the University of Idaho, Mayday drove a billboard truck with abortion information across the campus, receiving local news coverage when the university tried to ban it. The organisation repeated this on several other conservative college campuses.
Spotify rejected its ad, so Mayday retaliated. “We put up a playlist of all the [alleged] rapists and sexual predators that Spotify still has on the platform. We posted this on social media. Spotify immediately changed its policy and said they would run our ad,” Koppelman said.
“Then, after tons of meetings with their lawyers, they backed off from airing the ads again. So we put the ads on [rival site] Pandora and we reached something like 750,000 people in the targeted states.
“We know that every bit of information we communicate as an educational non-profit is First Amendment protected, we are not going to let any attempts to chill our speech stop us from promoting that message.”
People anxious to obtain abortions can be left feeling vulnerable, creating opportunities for anti-abortion activists to prey on them. This is one reason the reproductive rights advocate Renee Bracey Sherman started We Testify.
“I shared my story because I didn’t hear stories like mine,” she told Index of the site. She wanted to erase the stigma and self-censoring which has led to such fear that some people are turning to self-managed care, trying to force a miscarriage. The sacred bond between doctor and patient is being lost, she warned.
Bracey Sherman has also had run-ins with internet platforms. She claims that Twitter attaches warning notices to her feed when she posts about abortion pills. None of her appeals to Twitter has been answered.
Jenna Sherman, programme manager at Meedan’s misinformation-busting Digital Health Lab, researches the intersection of technology and reproductive health equity. She and others point to fear of litigation by internet companies as one reason that organisations mark and monitor abortion medical information in a manner that is punitive towards abortion seekers. And, of course, these companies are money makers who earn more from the highest-paying customers.
Pro-choice and pro-life activists go head-to-head before the decision to overturn Roe v Wade in Washington, June 2022
CREDIT: Rod Lamkey/CNP/ABACAPRESS.COM
Anti-abortion activists are funded by deep-pocketed donors and Sherman said that, as a researcher, she can “follow the money”.
“Known perpetrators [of spreading false information] have the largest influence: crisis pregnancy centres, Students for Life of America, Live Action. These organisations are spearheading misinformation claims online and posting the most,” she said.
She had been on the website Live Action just before we spoke, and said: “It is chock full of misinformation and they go uncensored. When it comes to abortion, it is really the pro-abortion folks who are getting censored online, not the antis. Politics and money are at play here in really nefarious and concerning ways.”
Meanwhile, it’s no surprise that the states with the most abortion restrictions are those where more people turn to the internet for information. They are also populations with lower digital and health literacy, making the prevalence of disinformation even more dangerous.
“It is an issue of health justice and basic digital rights and healthcare protections,” Sherman stressed. “The internet was a safe place for people on the margins of society to access content in its origins. Now, the internet is a replica of the offline world regarding who gets seen, who is most likely to be harmed.”
Accurate information has been protected by internet companies in the past. For example, during Covid companies protected against misinformation.
In January, the FDA – the agency that oversees prescription drugs across the USA – made abortion pills available in chain pharmacies. But this protocol isn’t available to those in the most restrictive abortion law states. That’s one reason why abortion providers are switching to use a new protocol with just the single pill – misoprostol – which can often be obtained easily without a prescription. This drug, when used in lesser doses, is used to treat ulcers. But it has proven to be effective on its own to terminate pregnancies. It’s all part of the race as science tries to outrun censorship in the ongoing heated US abortion war.
When Roe v Wade was overturned last summer, people across the USA were justifiably worried about what it would mean not just for reproductive rights but for privacy more generally. In Virginia, for example, this February a bill to prevent the ability of law enforcers to obtain private menstrual records of women has been struck down. Republican Governor Glenn Youngkin thwarted attempts to pass the bill in the Democrat-led state senate. The bill would have stopped police being able to issue search warrants for menstrual data stored in tracking apps on mobile phones or other electronic devices. Despite half the chamber’s Republicans supporting the bill, Youngkin killed it through a procedural move in a subcommittee of the Republican-controlled House.
Youngkin’s actions follow a failed attempt in January to ban abortion after 15 weeks with exceptions, down from 26 weeks and 6 days, by Republicans in the Virginian senate.
One state across, in Florida the High School Athletic Association is currently floating the idea of female high school athletes recording their menstrual cycle histories and submitting them to their schools. According to the committee collecting such information is simply good practice for monitoring girls’ physical health because period abnormalities can be, they say, a sign of “low energy availability, pregnancy, or other gynecologic or medical conditions”. That wording alone is deeply suspicious.
It’s no wonder in this climate that women across the USA have been deleting period apps en masse. Even before the overturning of Roe v Wade, women had concerns about these apps. It wasn’t until 2021 that Flo, one of the most popular, agreed to obtain user permissions before sharing personal health information, after reaching a settlement with the Federal Trade Commission. From 2016 to 2019, the company passed on certain health details of its users to technology firms.