When people are looking for abortion services, they often turn to Google, searching a phrase like "abortion clinic near me" or "planned parenthood."

Yet the ads they'll see at the top of the Google search results are often not abortion providers at all, but instead misleading ads for anti-abortion "crisis pregnancy centers" — facilities that use various tactics to dissuade or delay pregnant people from getting an abortion.

Any delay or confusion can have serious consequences: Strict bans in much of the country mean people seeking surgical abortions may have to travel hundreds of miles, and ordering abortion pills by mail can be legally thorny.

These ads on Google are no small business, according to a new report from the Center for Countering Digital Hate, a U.S.- and U.K.-based nonprofit focused on research, campaigns and policy to counteract hate and disinformation. The group finds that anti-abortion pregnancy centers in the U.S. spent an estimated $10.2 million on Google Search ads over a two-year period, and those ads were clicked on an estimated 13 million times.

The group's researchers began by identifying 976 websites for anti-abortion pregnancy centers. Using the enterprise analytics tool Semrush, they found that 188 of the centers had actively run Google search ads between March 2021 and February 2023. They assessed those centers' ads, websites and the keywords for which they bought paid advertising.

Among the organization's findings: 38% of the centers that advertised on Google in this period had no homepage disclaimer stating that they don't provide abortions. That appears to violate a Google policy prohibiting ads or destinations concealing or misstating information about the advertiser's business, product or service.

Researchers found that the anti-abortion pregnancy centers targeted more than 15,000 queries related to abortion, including phrases like "telehealth abortion pill texas" and "how much is an abortion in california."

Anti-abortion pregnancy centers run ads that are confusing and vague by design

Crisis pregnancy centers are unregulated and often nonmedical. The American College of Obstetricians and Gynecologists (ACOG) notes that the facilities have no legal obligation to provide pregnant people with accurate information or maintain client confidentiality.

Many of the facilities "use false and misleading information, emotional manipulation, and delays to divert pregnant people from accessing comprehensive and timely care from patient-centered, appropriately trained, and licensed medical professionals," ACOG explains, noting that the centers' tactics can include "misrepresenting nonmedical staff and volunteers as clinicians by having them wear lab coats and perform ultrasounds."

Digital marketing firms that specifically cater to anti-abortion pregnancy centers make the ad-buying strategy clear. One such firm, Choose Life Marketing, has a guide that urges the centers to buy Google keywords using abortion terms. "It's vital to reach women on their phones early in the search process, before the abortion clinic can reach them," it says.

Choose Life Marketing's guide recommends that centers note on their websites that they do not provide or refer abortions, while suggesting ad language that's vague about what the center does provide. "You can also be creative and instead use abortion terms in your ads without using them to describe a service offering: 'Get the facts before scheduling an abortion...' or 'Considering Abortion?' " it says. "Reaching abortion-minded women requires centers to be very strategic in all areas of marketing, but especially in Google advertising."

In a guide focused on reaching women in states with restrictive abortion laws, Choose Life recommends that anti-abortion centers "bid on keywords related to the next city or town where abortion is available." Paid advertising, it says, "can help reach her in the knick [sic] of time. This is especially critical for reaching women before they travel for abortion."

Google policies for abortion search terms don't govern all related searches

Google has specific policies for advertisers running ads on abortion queries. To run ads on such queries in the U.S., U.K. or Ireland, Google dictates "you will first need to be certified as an advertiser that either provides abortions or does not provide abortions. If you are not certified, you won't be able to run ads using queries related to getting an abortion."

If the advertiser provides abortions or is a certified online pharmacy providing abortion pills, the Google ads will include a disclosure that says "Provides abortions." If it is an advertiser that does not actually provide abortions, the disclosure on the ad will say "Does not provide abortions."

But there are gaps in the system. Google's abortion ad disclosure policy applies specifically to terms and queries related to getting an abortion. Ads that target more general information keyword terms, however, are not slapped with Google's disclosure labels.

That means a search for "abortion services near me" will trigger a disclosure on Google ads, while a search for "planned parenthood" does not, since Planned Parenthood provides other services in addition to abortion and it's considered a more general information query.

Even if there is a disclosure, that doesn't mean the ads are clear. A Google search for "abortion pill dallas" generates an ad for something called Grapevine TX Women's Clinic that says "The Abortion Pill - First Trimester Abortion" right below smaller type noting the advertiser "Does not provide abortions."

Google says it removes or blocks ads that violate its policies. "We know that people come to Google looking for information they can trust during deeply personal moments and are committed to ensuring advertisements on this topic are clear and easily understood," the company said in a statement to NPR.

After the Center for Countering Digital Hate released a report last year on similar issues with paid Google advertising — such as Google Maps results that would direct those seeking abortions to anti-abortion clinics — Google says it "took immediate action" on ads violating its policies, including those that misrepresented the services they actually provide. The company says it regularly reviews its policies and updates its list of "in-scope abortion queries" as needed.

To ensure that people seeking abortions don't get taken in by misleading ads, the Center for Countering Digital Hate is calling on legislators to ban misleading advertising on abortion. It's also asking Google to make all ads from anti-abortion pregnancy centers bear the disclaimer "does not provide abortions," to require the centers' websites to display clear disclaimers — and for Google's search results to highlight actual abortion clinics.

Copyright 2023 NPR. To see more, visit https://www.npr.org.

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