Shining the light on abortion: Drivers of online abortion searches across the United States in 2018.

CONTEXT: Legal abortion restrictions, stigma and fear can inhibit peoples 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. METHODS: 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. RESULTS: 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