Legal abortion restrictions, stigma and fear can inhibit people’s voices in clinical and social
settings posing barriers to decision-making and abortion care. The internet allows individuals
to make informed decisions privately. We explored what state-level policy dimensions were
associated with volume of Google searches on abortion and on the abortion pill in 2018.
We used Google Trends to quantify the relative search volume (RSV) for “abortion” and
“abortion pill” (or “abortion pills” hereafter referred to as “abortion pill”) as a proportion of
total search volume for all queries in each US state. We also identified the top search queries most related to “abortion” and “abortion pill” and considered these as indicators of population concern. Key exposures were healthcare cost, access and health outcomes, and
number of legal restrictions and protections at the state level. In descriptive analyses, we
first grouped the states into tertiles according to their RSV on “abortion” and “abortion pill”.
To examine the association between each exposure (and other covariates) with the two outcomes, we used unadjusted and adjusted linear regression.
The average RSV for “abortion” in the low, moderate and high tertile groups was 48 (SD =
3.25), 55.5 (SD = 2.11) and 64 (SD = 4.72) (p-value <0.01) respectively; for “abortion pill”
the average RSVs were 39.6 (SD = 16.68), 61.9 (SD = 5.82) and 81.7 (SD = 6.67) (p-value
< 0.01) respectively. Concerns about contraceptive availability and access, and unplanned
pregnancies independently predicted the relative search volumes for abortion and abortion pill. According to our baseline models, states with low contraceptive access had far higher
abortion searches. Volume of abortion pill searches was additionally positively associated
with poor health outcomes, poor access to abortion facilities and non-rurality.
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