Soon after the end of Roe v. Wade, President Biden issued an executive order attempting to ensure access to reproductive health care services nationally. One outcome of the executive order was the creation of a website, ReproductiveRights.gov, to offer Americans seeking reproductive health care stable, consistent, and accurate information and guidance.
The site launched shortly after the formation of the Reproductive Rights Task Force late summer 2022. But so far, it falls far short of the needs, expectations, and opportunity of an online digital toolset for reproductive health seekers and providers. Here’s how to fix it.
Currently, ReproductiveRights.gov provides a static overview of federal laws that may provide protections for all U.S. citizens regardless of state of residence but does not cover any local or state laws or bans that may contradict federal protections. For example, the site lists “Your right to emergency care” as per the Emergency Medical Treatment and Labor Act. But arbitrary restrictions in states with abortion restrictions make it difficult to interpret what the law means by “life threatening,” resulting in poor protections for patients and clinicians. The recent Texas case involving Kate Cox, a mother who had to leave the state after the Texas Supreme Court failed to grant her an abortion for a fetus with a terminal condition, is the consequence of such intentionally vague laws. Other content includes “your right to medication,” “your right to birth control,” etc. but all sections are short, dry, and nonspecific to specific reproductive health care-seeking situations.
Further, the site lacks safety-driven moderation. It links to pages that link to pages that are clearly insecure. In. fact, the website recognizes the hazards of its own lack of active moderation with disclaimers stating, “Note that the inclusion of external hyperlinks does not constitute endorsement or recommendation by the U.S. Government or HHS of the linked web resources or the information, products, or services contained therein.” Then why are you linking to it?
Most importantly, the site often does little more than direct the information seeker back to their local state laws as per the “Your Right to Access Abortion,” section which simply states, “Following the Supreme Court’s decision to overturn Roe v. Wade, access to abortion will depend on the state you live in even more than before.”
And while it’s called ReproductiveRights.gov, the site is notably devoid of any valuable information on sex education, menopause, gender-affirming care options, and a host of other critical issues.
In essence, the government is phoning it in. We can do better.
The platform should be a gateway to specific, accurate, and safe reproductive health care information and access to services. Instead of dry text, it should be gamified and include multimedia to promote learning, interaction, and community. Instead of legalese, the portal should approach people at the level that they are accustomed to being addressed. Right now, it shares unhelpful facts, such as how to file a HIPAA complaint, which would take months, require the sharing of a significant amount of personal information, and be unlikely to provide any protections in an acute setting. Instead, the digital platform should provide timely and specific guidance and suggestions for specific scenarios while protecting medical privacy.
Creating this kind of dynamic, interactive site will require more attention to protecting privacy, particularly because anyone seeking abortion care may be at risk in the future of state-level prosecution for simply seeking information. This is not hyperbole. Legislative censorship and content banning, or content blocking, are tactics that can prohibit online content in certain areas, and the National Right to Life Committee has proposed model legislation that would criminalize, “knowingly or intentionally hosting or maintaining an internet website, providing access to an internet website, or providing an internet service, purposefully directed to a pregnant woman who is a resident of this state, that provides information on how to obtain an illegal abortion, knowing that the information will be used, or is reasonably likely to be used” for illegal abortions.
So privacy and security must be built into every step. This can be accomplished by the immediate funneling of first-time users to content that educates and enables safe site usage via a brief gamified curriculum that walks users through the steps to access and install a virtual private network and/or secure browsing tools sets like TOR. Privacy and security could be further enhanced via organized curricula that help users protect their identity, search history, and all two-way communications.
Once users have secured their information, they should be presented with four channels: information, education, seeking care, and advocacy. (See the figure below for our idealized site architecture.) The content must be curated, moderated, and fully up to date. For example, a first step in the information channel should include a splash page that prominently displays a simple ZIP-code search box that will provide the user with a summary of all reproductive health bans or prohibitions within their state and local jurisdictions as well as clear information on where to find legal services. This is essential as bans are becoming local to counties and municipalities. Further, this dynamic information is valuable for health care providers, who should be considered another important constituency of the site.
Across all channels, content utilization and efficacy will depend upon ensuring that users feel safe, period. This can be aided by multiple levels of engagement and by ensuring that users can get maximal content via providing the least amount of personal data.
The other channels must be similarly up to date, comprehensive but inclusive of all capabilities that are local to the health care seeker. For example, all channels should present information organized via geolocation enabling a clear picture of local and distant options for finding health care providers, advocacy groups, or mental health support.
Much of the content should take advantage of gamification, which has been shown to improve student retention and performance. Each channel should include up-to-date information and educational content enhanced via mini courses, games, quizzes, and challenges. Some people are likely to quickly browse the site, get the information they require, and move on, while others may choose to dig in deeply. Both types of users must be accommodated. Other subject areas of the site should include the latest news and current events, information and training on online privacy and security, and comprehensive education on contraception, human reproductive biology, abortion, adoption, sex, menopause, how to spot medical and policy misinformation, and gender-affirming medical care.
The utilization and efficacy of the site and content must be actively measured without web trackers. Otherwise, such information could be used by prosecutors in states with heavy restrictions. While some officials in abortion ban states claim they do not intend to punish abortion seekers, it is very clear that these states do intend to focus upon and prosecute providers who deliver essential health care. This not only limits the availability of reproductive health care further, it’s doing so in states that already have the poorest maternal health and childcare statistics. Lastly, dedicated expert oversight is essential to ensure the technology is robust and secure, ensure the content is accurate and up to date, and to provide confidence to users.
All of these suggestions seem obvious — so why does the current incarnation of ReproductiveRights.gov fall so short of the need and potential? One might assume it is intentional. More likely, the battles between the current administration and abortion ban states makes up the very fabric of our political disfunction. We assume that the Biden administration saw the current site as a way to do something without inspiring political and legal challenges. But for the site to be useful, it likely must inspire political and legal challenges. The Biden administration has been willing to take that chance before: It provided additional HIPAA protections on sensitive reproductive health information, an effort that has been attacked by 19 state attorneys general as well as health technology companies and health systems. The latter group claimed the policy presents risks to health care data interoperability but offered no alternative solutions to protect reproductive health seekers or providers.
Unfortunately, that HIPAA approach is an outlier. And it’s also very true that a future administration that isn’t committed to reproductive rights could take the website down on Day 1 — or, perhaps worse, fill it with misinformation.
For these reasons, it is highly unlikely that we will ever see a truly functional version of ReproductiveRights.gov. That leaves it to the private sector to fill the void, and it will take a tech-savvy team to pull it off.
But if we are to build a platform that truly serves the public, we think it needs to go further than just providing information on access and care. Mobilizing the majority of Americans who want to protect and expand reproductive rights is essential for moving us forward. Failure to do so will only result in more challenges to our rights and further damage to our health care system. Do you want Clarence Thomas weighing in on the health care decisions of your child?
Therefore, the platform, under private control, should provide a scorecard for all state and federal officials’ views on the full range of reproductive health issues. It should provide model legislation and ballot initiatives that can be used to push back against the incessant efforts to limit access to accurate information and services. And it should aim to use such information to turn users into activists for protecting Americans’ rights to understand their reproductive health and get the services they need.
Michael Stebbins, Ph.D., is a health and science consultant and served in the Obama White House. Eric Perakslis, Ph.D., is a medical and privacy researcher and has served in the FDA.