Googling for Abortion: Search Engine Mediation of Abortion Accessibility in the United States

Among the myriad barriers to abortion access, crisis pregnancy centers (CPCs) pose an additional difficulty by targeting women with unexpected or "crisis" pregnancies in order to dissuade them from the procedure. Web search engines may prove to be another barrier, being in a powerful position to direct their users to health information, and above all, health services. In this study we ask, to what degree does Google Search provide quality responses to users searching for an abortion provider, specifically in terms of directing them to abortion clinics (ACs) or CPCs. To answer this question, we considered the scenario of a woman searching for abortion services online, and conducted 10 abortion-related queries from 467 locations across the United States once a week for 14 weeks. Overall, among Google's location results that feature businesses alongside a map, 79.4% were ACs, and 6.9% were CPCs. When an AC was returned, it was the closest known AC location 86.9% of the time. However, when a CPC appeared in a result set, it was the closest one to the search location 75.9% of the time. Examining correlates of AC results, we found that fewer AC results were returned for searches from poorer and rural areas, and those with TRAP laws governing AC facility and clinician requirements. We also observed that Google's performance on our queries significantly improved following a major algorithm update. These results have important implications concerning health access quality and equity, both for individual users and public health policy.