Does Facebook have an Anti-Choice Agenda? Censorship of Information on Misoprostol Raises Questions

UPDATE: 2:37 pm, Monday, January 2nd, 2012: Facebook has issued a formal apology for removing the image from Dr. Gomperts’ page. The apology can be viewed by Dr. Gomperts’ friends on her facebook page.

According to a press release sent out by the organization Women on Waves, Facebook has deleted an image from the page of Dr. Rebecca Gomperts, a well-known abortion rights activist and the Director of Women on Waves – a charitable organization focused on women’s health and human rights.

The image consisted of text instructions of how to safely induce an abortion using medication.

Women on Waves’ mission is to protect maternal health by preventing unsafe abortions. Women on Waves sails a ship to waters outside of countries where abortion is illegal.

On board the ship the medical staff provides sexual education and healthcare services. Early medical abortion (up to 6 1/2 weeks of pregnancy) can be provided safely, professionally and legally.

Applicability of national penal legislation, and also abortion law, extends only to territorial waters. Outside that 12-mile radius it is Dutch law that applies on board a ship sailing under the Dutch flag, which means that all Women on Waves activities are legal.

Women on Waves efforts draw much needed public attention to the consequences of unwanted pregnancy and unsafe, illegal abortion.

To date the ship has sailed to Ireland, Poland, Portugal and Spain.

Women on Waves also supported the launch of  safe abortion hotlines in South Africa, Asia and the Middle East.

In 2005 it founded Women on Web, a telemedicine abortion service that provides medical abortions to women in countries where there is no access to safe abortion.

According to Women on Waves, by removing the picture Facebook is in gross violation of Article 19 of the Universal Declaration of Human Rights. Facebook has a social responsibility to guarantee human rights.

Dr. Gomperts reposted the screenshot of the Facebook censorship message with the picture. Other Facebook users have also been reporting that images that contain information about using or getting Misoprostol are being removed by Facebook.

Gomperts is asking all Facebook users that support abortion rights to repost the message on their page.

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  • basiorana

    I do not know FB’s actual policies, but I know there are many pro-choice groups on there… I suspect this is one of two things.

    First, WoW is offering medical advice here, and not “talk to your doctor” medical advice but the sort of medical advice one normally could only get from a doctor. FB may have a policy against allowing medical advice to be offered. Are there other pages on FB that offer medical advice that are allowed to stay?

    Second, that graphic includes TWO recommendations to lie to medical professionals about your health; first, to claim that you need misoprostol for your grandmother with arthritis, thus lying to obtain it from the pharmacist (which could be extremely dangerous, as you might have a conflicting condition or medication and the pharmacist could not advise you, and is also illegal); second, to tell your doctor that you miscarried rather than inform them you used misoprostol, which would limit their ability to treat you. Despite the difficulty in obtaining an abortion in this country, these statements could be construed as unethical as a woman who follows this advice could have serious health problems as a consequence of lying to medical staff. Thus, FB could be seen as enforcing basic ethics amongst the medical advice offered on it’s pages.

    I recommend that WoW try reposting the graphic WITHOUT the recommendations to lie to medical professionals and see if FB still deletes it. If they do, and there is medical advice on other FB pages, then FB has an anti-choice policy in place. However, until they attempt that, Occam’s Razor, and the plethora of pro-choice pages on FB, indicates that perhaps WoW should be more careful about the advice they provide.

  • bonnie-russell

    I just mentioned the Facebook and Media connection on an article regarding four killed on New Year’s Day in Coronado, CA.  Media whiffed coverage and FB deletes comments.


  • crowepps

    Where do you think all the anti-abortion laws are taking us, but to a society in which women will be passing along underground tips to each other about how to avoid pregnancy and what private steps are necessary to ‘cleanse their womb’ and how they can hide what they’re up to from ‘anti-woman authorities’ like physicians focused on the fetus as their patient who are gathering evidence to punish women who avoid pregnancy for the crime of disobedience?

    I’m old enough to remember when OB/GYN’s weren’t primarily physicians but instead first line guardians of the ‘rights’ of the ‘head of the family’,  monitors of virginity and chastity and obedience, and one of the standards of women’s conversation was coded information about which physicians ‘really understand a woman’s needs’ and which ones ‘take care of lots of Catholics’.

    With the repeated waves of draconian anti-sex, anti-woman laws rolling down from state houses, women and girls need to know who their allies are, who is going to allow them continued access to the information that will help them secretly avoid reproductive slavery, and who is going to oppose women’s interests, cut off women’s access to information, and then claim to still ‘respect’ women while promoting the idea they should volunteer to sit in the back of the bus.

  • jennifer-starr

    Basiorana, did you read the article?  This information is for women in countries where a safe legal abortion is not available and where you could get into trouble, legally  if they discovered that you had one.  Unfortunately these women can’t just ‘talk to their doctors’. This is what so-called ‘pro-life’ regulations lead us to, and if we’re not careful and we don’t stand up for our rights, it could happen here. 

  • sschoice

    While Facebook has apologized for removing the image from Ms. Gomperts’ page and apologized, saying it was a mistake, it’s not clear from what has been posted so far by Ms Gomperts if Facebook gave any other explanation for why it was removed.  It may have been an error more or less intentionally on the part of a human reviewer, and it’s possible some sort of robot-assisted flagging of unusual or suspicious imagery may have been involved.  A human should still be involved in reviewing the actual blocking of owner access to an account, one would hope.  That’s pure speculation on my part, however.

    WoW recognizes there are contraindications and potentially serious side effects with the use of Misoprostol.  They describe those concerns in detail on an information page on the WoW website, which the image links to:

    Contraindications include ecotopic pregnancy and pregnancies later than 9 weeks, and WoW strongly advises the woman obtain an ultrasound before taking Misoprostol.  I would suppose that if a woman sees this image, they’ll see WoW’s web link, and go there for more information, as the image advises them to do.

    A user named basiorana above criticized some of the image’s content, in particular advising women to “lie” in seeking care.  We don’t want to see women “lie” either to get the care they need and deserve, but in situations where the laws make it essentially the only way to get an elective abortion advising women to do so is NOT irresponsible.  If one wants to be helpful to women in those situations, it is best to advise them to do so, and if they do so to act with the best information that can be made available to them.  WoW does that through their website and their service Women on Web, as mentioned above by Katie Slack in the main article.

    Let’s look further at the consequences of “lying” in this context.  As far as “lying” to the pharmacist goes, this might only work in countries where Misoprostol can be obtained directly from a pharmacist.  In countries and in and cases involving specific medications like this it may be seen as necessary for lay people to make personal judgment calls and not give complete information or even give inaccurate information to get medication the buyer needs which they may think they wouldn’t get otherwise, at least not without hassle or criticism, and it’s assumed here that there would be very restrictive laws that otherwise would prevent a woman from seeking an abortion.  I don’t know of a country that has a program to educate women how to use Misoprostol safely OTC to induce abortion.  When women might not have another option they could be reasonably expected to seek out, if it is possible for them to purchase Misoprostol by deceptive means from a pharmacy, it may be better for them to do that than seeking other illegal options, including obtaining Misoprostol from illegal “street” sources with all of the problems that go with that. I can’t say they shouldn’t try to obtain the drug from a legitimate source, namely a pharmacy, by giving false information which does not increase the risk to the pharmacy — the purchaser isn’t stealing it nor are they trying to get the pharmacist to act as some sort of willing accessory. This is a better option for the woman seeking an abortion when other options available to them may be of much greater risk, if it’s possible to judge “risk” at all in dealing with wholly illicit means.

    And as far as “lying” to a medical provider after-the-fact goes, it’s only for the rare cases where a woman has severe bleeding or side effects occur after taking Misoprostol, and only to get the woman in the door to the provider to get the kind of follow-up care that would be sufficient to help her and maybe needed at that point to save her life or future fertility:

    “In countries where women can be prosecuted for having an abortion, it is not necessary to tell the medical staff that one tried to induce an abortion, one can also say one had a spontaneous miscarriage. The doctor CANNOT see the difference. The treatment is also the same. The treatment is, curettage, also known as vacuum aspiration, a doctor will empty the womb.  Doctors have the obligation to help in all cases.”

    It could though help to add a few more words to the image to make sure that women go to the WoW website for more information on how to get and use Misoprostol.  This might be more likely if WoW added a few more words to the image that Facebook removed to emphasize that more information is given on the WoW website about how to obtain Misoprostol and how best to take it and, if needed, seek follow-up care.  That shouldn’t add many words or take away from the simplicity and importance of the message and the dramatic statement that the image makes.  My concern isn’t that the image text gives information which is dangerous, rather it’s that there may be additional barriers facing women in countries with laws barring them from getting an abortion from getting additional information through internet filters which may block the WoW website entirely.

    As it is, I think the image text is basically accurate and highly likely to be used as intended by it’s target audience.  Women likely to read the image will see it on the internet and hopefully — assuming that they don’t have internet filters blocking or redirecting women from the WoW website — they’ll go to the WoW website for more information.  Even if the woman doesn’t do that, she’s probably better off with the information that WoW put in their image as is, because the kind of illegal abortion that women would seek without this information may likely be less safe than using Misoprostol as WoW directs.

    If one does encounter internet filters — which is something that the internet service provider (ISP) or government would have to put in place — hopefully if one is motivated enough to seek out and use Misoprostol to obtain an abortion one would be motivated to try to overcome the barrier with the use of proxy server addresses, etc.  A few more words added to the image text could help encourage that, emphasizing that women should research — in lay language — the indications, contraindications, and reasons for follow-up care, which they’ll find on the WoW website.  This would help encourage women and lay advocates (concerned friends) to seek out the website, and make the extra effort to do so if they are deterred by internet filtering which some countries are known to engage in, and as governments try to gain greater control of the internet and web services and websites like Facebook (and Google, as we’ll mention below) this is likely to be a greater concern for us in the future.  

    WoW has been dealing with these issues for many years.  If someone wants to look into some background on this, WoW’s website has an excellent open letter sent Google in 2009 regarding being denied advertising for their information via Google AdWords:

    If you can open an Adobe Acrobat document, a nicely formatted copy is available from the University of Toronto’s Health Equity and Law Clinic (HEAL Clinic), which wrote the letter with WoW:

    Here’s more information on the HEAL Clinic:

    Similar valid arguments could be made for WoW’s image in question now.  Incidentally, Google apparently still has that policy in effect, though I don’t know currently how prochoice groups are dealing with it.  If you want to see what their current policies are, here’s an explanation from Google:

    I don’t think the lack of a few additional words like this would have deterred whatever process someone or some system in Facebook removed the image with the existing text.  I think Facebook could have rationalized removing the image simply because it advocates behavior which may be highly illegal in some countries, and that the information is intended to be used by people in those countries, of course.  A similar argument could be made by Google, for example, in barring advertising of abortion services in countries that are on the other side of some arbitrary line, where abortion is said to be prohibited, where restrictions are so severe as to make it essentially illegal.

    I hope WoW continues advocacy using tactics like this, and that advocates following this case support them in doing so.  But let’s also recognize that Facebook did the right thing not only by removing the block from Ms. Gomperts account but also by writing a message that acknowledged they made a mistake, and for apologizing and saying on the record they won’t restrict her account from using this image in her profile in the future.

    One thing I have to say about Facebook, if they aren’t restricting Ms. Gomperts page from being seen and used by women in the following countries:

    “Argentina, Antigua & Barbuda, Aruba, Austria, Bahamas, Belgium, Belize, Bolivia, Brazil, Cayman Islands, Chile, Colombia, Costa Rica, Dominica, Dominican Republic, Ecuador, El Salvador, France, Germany, Grenada, Guadeloupe, Guatemala, Haiti, Honduras, Hong Kong, Indonesia, Jamaica, Korea, Malaysia, Martinique, Mexico, Nicaragua, Panama, Paraguay, Peru, Philippines, Poland, Saint Barthélemy, Singapore, St. Kitts & Nevis, St. Lucia, Suriname, Switzerland, Taiwan, Thailand, Uruguay, Venezuela”

    …then Facebook is giving WoW an opportunity to reach women in those countries with information that Google restricts at least from being provided through their AdWords service.

    I’d be inclined to support policies and providers that censor and restrict little or nothing of their content, and while I think Facebook was wrong to remove the image we ought to commend Facebook for the apology and statement they wrote Ms Gompers in response.

    –southern students for choice, athens


  • basiorana

    I know. It’s not like all doctors here are ideal anyway, in many places you can’t tell your doctor safely. But look at this from FB’s perspective, if my theory is right– they have a page offering medical advice that would break the law and possibly endanger the women using it. Thus, this becomes in their eyes not a question of choice but a question of their responsibility as a site to not promote possibly dangerous information to vulnerable people. At the same time, they can’t allow it for this case but not for others, because then they’ll get every charlatan out there claiming their advice should be allowed even though it might be dangerous or illegal.

    Women on Waves should absolutely have this information on their own websites and even more details about how to circumvent anti-choice law, but I can see how FB could honestly not want that kind of medical information on their site without being anti-choice.

  • basiorana

    My objection was to the idea that FB was anti-choice and their decision to remove the informaiton was an anti-choice move, which I found strange and clearly inaccurate. From what you say, it seems likely that FB removed it for the medical advice, then returned it once it was explained that the advice is for people who cannot access safe abortion anyway and who must lie. I know WoW’s site and page make that more clear that the little graphic shown here, but surely it’s clear that a FB reviewer could glance at it and have some red flags.

    I think FB is generally good about political neutrality and has not been restrictive of pro-choice advocacy. The decision to remove this, considering the nature of the content, seemed to me to have nothing to do with anti-choice concerns and more to do with some standard policy regarding medical or legal advice. That said, kudos to FB for acknowledging that those policies should be judiciously applied in certain scenarios.

  • sschoice

    Unless Facebook releases more information on how the human decision (or robotic non-decision) was made to remove WoW’s image of how to induce abortion with Misoprostol, or WoW or Ms. Gomperts says what she was told (if she tried to get more information), it’s apparently not known how the decision was made.

    Facebook doesn’t have any sort of explicit policy relating to medical misinformation except if it crosses another boundary like fraud.  It’s possible that an anti-choice complaint though could be made over nearly any issue, including inappropriate sexual content. Their definition of what crosses that line though is rather arbitrary, and seems at times to be so restrictive one has to wonder whose laws they are trying to follow, like in the cases several years ago when they were censoring images and blocking accounts involving imagry of breasts and breastfeeding:

    Censoring Breastfeeding on Facebook

    Dec 19, 2008, New York Times

    It’s interesting to think about whose laws they were trying to follow here — it’s common to find on occasion imagery of breasts in TV programming related to breastfeeding, breast cancer, and of course historical dramas and art especially from the Reinassance and before often would include exposed breast images, so to see Facebook take a stand to ban all but “PG” (American movie rating) imagery of breasts doesn’t really make sense — creating restictive policies like this actually (obviously) creates more work for them, and it doesn’t seem to make sense unless perhaps they are trying to set a standard that could pass some test in a country they want to market to which has much more restrictive laws than the US does.

    In simple terms, here is what Facebook will take action against:
    Facebook Community Standards

    “…When millions of people get together to share things that are important to them, sometimes these discussions and posts include controversial topics and content. We believe this online dialog mirrors the exchange of ideas and opinions that happens throughout people’s lives offline, in conversations at home, at work, in cafes, and in classrooms. …”

    …and note that while many concerns are covered, expectations for medical accuracy isn’t clearly described anywhere in their standards: Threats, Promoting Self-Harm. Bullying & Harassment, Hate Speech, Graphic Violence, Sex & Nudity, Theft, Vandalism, or Fraud, Identity & Privacy, Intellectual Property, and Phishing & Spam.  It would be a stretch to say that WoW’s image might have been deleted due to allegations of “fraud” — it did mention lying as a tactic to get Misoprostol — but the image didn’t defraud Facebook’s users.  It’s also not reasonable that the content would violate a standard of sexual conduct, though whoever removed the image might have weighed that as a factor.

    Facebook’s terms of service are stated more formally in this document, “Statement of Rights and Responsibilities” — and note that this document is referenced in the Facebook image at the top of this page — but it doesn’t spell out the rules any better to indicate why Facebook would have considered the image to violate this “Statement”

    Statement of Rights and Responsibilities
    Date of Last Revision: April 26, 2011.

    WoW’s image did give information on how to act illegally — but arguably responsibly — to get an abortion.  The fact that would be illegal in the countries that the image was meant to reach out it is not in itself a violation of Facebook community standards.  Facebook pages involving protest, for example, frequently encourage civil disobediance, which involves breaking laws in the interest of social responsibility.  One of the BEST things one can say about what happened is that Facebook apparently “gets it” that while WoW’s image encourages illegal activity it is at least meant to do so in a socially responsible manner.

    Facebook has millions of posts to review daily, and they can only hope to set goals to monitor what shows up in algorithmic screens and respond to complaints.  It’s not likely that the decision to remove WoW’s image was made entirely arbitrarily by one person, especially for reasons related to medical accuracy or risk.  It’s hard to imagine a civil claim being filed that says Facebook would be responsible for the use or misuse of information for some medical purpose, though it might be possible that some legal restriction in some country on providing information on abortion might make accessing information on how to get it illegally an illegal act in itself.

    What would mostly likely skew their system, whatever it is, would be ill-motivated complaints they received about the image.  It’s possible that complaints pushed some sort of algorithm that flags images and accounts for speedy review and action.  It’s also possible that the complaints could have originated from literally anywhere in the world and — for all we know — were reviewed and action taken by some outsourced “customer service associate”-like firm.   That’s pure speculation, but it seems the more likely reason for Facebook’s action — and it would also explain their very quick reversal and carefully worded response to Ms Gomperts:

    Our policies are enforced by a team of reviewers in several offices across the globe. This team looks at hundreds of thousands of reports every week, and as you might expect, occasionally, we make a mistake and remove a piece of content we shouldn’t have. When this happens, we work quickly to address it by apologizing to the people affected and making any necessary changes to our systems and processes. I can assure you that this matter is being looked at carefully by our review team at this time. There should be no issue should you choose to re-post the photo in question. We’ve also removed this warning from your account, so that it does not affect your profile in the future.”

    It is possible that whoever removed the image did so in part because they thought it was bad medical advice, but it seems more likely that they were swayed by unreasonable concern or complaints motivated because of abortion.  It’s easy to imagine anti-choice activists sending bogus complaints — and especially as WoW addressses the issue internationally, it’s easy to imagine how complaints could have been orchestrated from some anti-choice group — or even one individual anti-choice activist — in any country.

    It is likely that some customer service-type associate simply making a mistake by following the rules and messages they’re reviewing from afar in some computerized system and deleted the image and blocked Gomperts’ account pending further review — that would be a lot more easy and likely than imagining Facebook hiring a team of people who had the kind of medical knowledge to review and understand the issues involved and make a judgement call that the image contained medically inaccurate information — especially since the information wasn’t medically inaccurate.  It maybe could have had a few more words added about risks and contraindications, but given the sad situation that so many women find themselves in and given the information that they’d need to have available — which they can get in medically accurate detail from WoW’s website — there was no real basis to delete the image solely on concerns of medical accuracy, certainly not given Facebook’s known policies.