Pregnancy apps become a battleground of vaccine misinformation

Pregnancy apps become a battleground of vaccine misinformation

December 26, 2021

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For generations of parents, Heidi Murkoff’s 1984 pregnancy guide What to Expect When You’re Expecting has been a trusty companion, offering calm, scientifically informed advice for a nerve-wracking nine months.

These days, of course, there’s an app for that: What to Expect’s “Pregnancy & Baby Tracker,” which offers personalised articles, videos, graphics of your baby’s development, and other features based on your due date.

Pregnancy discussion forums have been rife with misinformation about vaccines.Credit:iStockphoto

But parents who’ve used What To Expect’s app say they also offered something they weren’t expecting: a “community” section rife with scare stories, conspiracy theories, and outright falsehoods about the safety of vaccines, posted by other users and surfaced by the app’s search functions and email notifications.

Mashaya Engel, 26, who gave birth to a daughter in August, said she encountered multiple posts expressing scepticism about the safety of getting vaccinated against the coronavirus during pregnancy. “I searched in the group discussions for vaccines, and it popped up – some moms having discussions about not vaccinating your children, or getting delayed vaccines,” Engel said. Other users noted a similar phenomenon: “Most antivax and microchip conspiracy comments I’ve ever seen,” one tweeted in May.

While social media giants like Facebook and YouTube have faced heavy pressure to crack down on misinformation during the pandemic, smaller apps have also struggled to police their platforms and rein in falsehoods. Apps aimed at first-time parents, who often face an overwhelming volume of new decisions, have proven particularly vulnerable to users looking to promote all manner of vaccine hesitancy.

On Glow, for example, which helps users track their ovulation patterns, a search for “vaccine” turns up numerous posts in which parents discourage each other from vaccinating their kids. There’s also a review of a children’s book called Vaccine-Free Me: A Trip to the Doctor with a link to purchase the book on Amazon. (“Charlie is excited to go to his yearly doctor appointment … Can he explain to the doctor why he will NOT be getting vaccinated?”)

Popular advice book, What to Expect When You’re Expecting, has spawned a 2012 Hollywood movie, as well as apps and websites. Credit:Melissa Moseley

And on the parent-connecting app Peanut, named one of the Best Apps of 2021 by Apple, lists of books and resources about the purported dangers of vaccines have circulated in the discussion forums.

Sites including What to Expect and Peanut have for years had policies against misinformation about vaccines. But for a long time, they didn’t strictly police it – until falsehoods and fear-mongering about the COVID vaccines brought into stark relief the impact of allowing it to percolate. Widespread misinformation linking the COVID vaccine to infertility and pregnancy complications has been blamed for low vaccination rates among pregnant individuals. Only 35 per cent of pregnant people between 18 and 49 had been fully vaccinated as of December 4, nearly four months after the CDC released new data supporting a recommendation for pregnant people to be vaccinated.

This year, What to Expect’s “Pregnancy & Baby Tracker,” which has 2 million users a month, made significant new investments in content moderation and began banning conspiracy theorists on the first offence, the company said last month. The difference was readily apparent: By late November, a review of its forums turned up far fewer posts casting doubt on vaccines’ safety and more signs of posts and threads that had been taken down. (Much of the same content can be accessed from What To Expect’s app and its website.)

“It changed,” said Engel, a graduate student in Reliance, South Dakota, and social services assistant at a behavioral health clinic on a reservation. She also noticed more articles encouraging users to get vaccinated. “It was like [the app was] kind of, like, more ‘for it’ – for pregnant mums getting vaccinated.”

Many families seek practical information on specialist sites following a pregnancy.

Hannah Hastings, head of brand and communications for Peanut, said in a statement that it had removed the aforementioned anti-vax posts and banned their authors in line with its 2019 “Community Guidelines.” Glow did not respond to a request for comment.

The experience of What to Expect shows that, when smaller apps do explicitly prioritise content moderation, the results can be striking.

What To Expect has “gradually redefined how we moderate posts about vaccines,” Christine Mattheis, the site’s vice president and editorial director, wrote in an email, as “vaccine misinformation has increased in our community during the COVID-19 pandemic”.

In the past couple weeks, the Omicron variant has increased the urgency of questions on the What To Expect discussion boards about getting vaccinations for both pregnant individuals and kids ages 5 to 11. Multiple users have recently posted asking for advice on whether to get a booster shot during pregnancy as an extra layer of precaution against omicron.

Any platform that allows users to interact or create content eventually will face questions about how to deal with offensive speech, said Evelyn Douek, a lecturer at Harvard Law School who researches online content moderation. Smaller sites tend to lack the resources to moderate users’ discussions as effectively as the large platforms, she added, and can become hubs of misinformation.

On What to Expect, the community aspect is built into its identity – “word of mum” is how Murkoff, the author of the bestseller book, describes the way that users interact and support each other. “We have to give their worries a platform, without giving a platform to the misinformation that’s fuelling their worries,” she said.

Part of a franchise built around the book series, What to Expect’s “Pregnancy & Baby Tracker” projects scientific credibility and promises “thousands of medically accurate articles, plus stories from real parents and parents-to-be.” It’s part of a digital media group called Everyday Health Group, which also includes the parenting site BabyCentre, clinical news outlet MedPage Today and wellness brand DailyOm, among others. The group was acquired in 2016 by the New York-based digital media conglomerate Ziff Davis.

Like other pregnancy and parenting apps, What to Expect features community pages where expectant individuals can connect with others who share their interests, concerns, or due-date month. These were among the pages that users say became hotbeds of vaccine scare stories, conspiracy theories, and misinformation.

The app’s “Top stories” tab listed numerous, apparently professionally written articles, rooted in evidence, according to a search on the app for “vaccines” in October. There were official recommendations that the coronavirus vaccines were safe and effective for pregnant women and other pregnant individuals, with the benefits outweighing the risks. For example, one article was titled, “No evidence that COVID-19 vaccines increase miscarriage risk during pregnancy.”

One swipe to the left, however – to the “Discussions” tab, or the chat forum – and things quickly got murky. A discussion page titled “Any moms not sure about vaccines” touted “Doctor Paul Thomas’s delayed vaccine schedule plan” for routine childhood vaccinations. The plan recommends “no vaccines” during pregnancy, skipping babies’ vaccinations for Hepatitis B, Rotavirus, and IPV, among others, and makes the MMR vaccine optional. A respondent pointed out that Thomas had his medical license suspended for misleading patients about vaccinations; another replied, “That just makes me want to follow his vaccine schedule.” Thomas didn’t respond to a request for comment.

The majority of respondents were either supportive or sympathetic to skipping vaccines. Parents offered tips on how to find paediatricians who won’t “push back,” and what states allow vaccination exemptions for religion or personal belief.

A commenter identifying herself as a registered nurse wrote, “my baby is unvaccinated completely! She hasn’t even had a needle touch her yet at almost two years old. Healthy as a horse.” Numerous respondents cheered her on and said it was good to hear such reassurances from a nurse. One said she’d performed “too many autopsies on babies and small children… and noticed ‘well child visit’ in their history info within the last 14 days”.

Conspiracies around the efficacy of vaccines long flourished on sites such as What to Expect. Many experts considered it a form of debate – that it was healthy to tolerate different viewpoints.

What made the debates feel high-stakes on the What to Expect app was that people were coming there undecided, asking questions and looking to the community to make up their minds, said Renee DiResta, research manager at the Stanford Internet Observatory and an expert on digital communities. She used the What to Expect app when she had her first child years ago.

“Nobody believed they were going to change the mind of the diehards on either side of things,” DiResta said. “But there were a lot of people who hadn’t given a lot of thought to vaccinations prior to getting pregnant, because this is a major phase shift in their life. There’s a major opportunity to reach people, because they’re trying to make the best decision for their baby.”

Most pregnant women can’t realistically expect to be able to reach their doctors for reassurance every time they have a hyper-specific question or whenever something feels a little weird. But they can look to other moms, and often do, in places like What To Expect.

For Claire, a 32-year-old from New York City who works in film and is expecting her first child, that impulse to connect with other pregnant individuals proved powerful. (She spoke on the condition of only using her first name for fear of online harassment.)

Thrilled and nervous after a positive pregnancy test, Claire downloaded the app the same day. She followed prompts to join a forum for those with January due dates and began receiving daily automated email digests of the discussion threads.

She soon found, to her dismay, that the forum’s top posts over the summer often included conspiracy theories about vaccines, including the COVID-19 vaccines. Though Claire had resolved to get vaccinated before downloading What to Expect, she was afraid to click. She knew she was in a vulnerable state. She didn’t trust herself not to get spooked.

The presence of anti-vaccine rhetoric wasn’t entirely surprising to Claire, though it irked her that the app seemed to be “actively serving it to you without you looking for it” via the email digests. “What really pissed me off and alarmed me was people trading advice on how to get around vaccine mandates” at their workplaces and children’s schools, she said. For example, in one thread that was served to her inbox, “Somebody who was pregnant but had other children was asking other mums for advice on how to forge vaccine documents for their kid’s school.”

The CDC’s release of an official stance on vaccination during pregnancy was an inflection point for What To Expect. “We drew the hardest line when the CDC began explicitly recommending that pregnant people get vaccinated, and released a lot of data showing that not getting vaccinated is far more dangerous than the shot itself,” Mattheis wrote.

What to Expect already had a policy against posts that contained blatant anti-vaccine disinformation. But it hadn’t been as focused on enforcing it. And, as Mattheis noted, “the total volume of this violation type has risen so dramatically this year.”

What To Expect has adopted a number of strategies to combat the proliferation of misinformation on the discussion pages, Mattheis said. First, What to Expect expanded its moderation staff’s hours so that its nine moderators now work in shifts to ensure 24/7 coverage.

Mattheis also noted that the app developers built a keyword detector that would flag posts about vaccines for moderator review and invested in a third-party “abuse-detection service” to identify and flag potential misinformation. The company also adjusted its user interface to make reporting misinformation and guideline violations easier, adding “misinformation/conspiracy” to the list of violations that members can report.

The company regularly adds to its collection of “evidence-based, medically reviewed articles” about vaccines (including the coronavirus vaccine and routine childhood vaccinations), and adds video content featuring Murkoff talking to experts such as Anthony Fauci and CDC director Rochelle Walensky.

By late November, not one of the top 15 discussion threads under the “vaccines” search included conspiracy theories or evident COVID-19 misinformation. One thread titled, “Theory: COVID Vaccine caused my miscarriage,” raised questions about whether the vaccine could cause miscarriage. The majority of replies assured the original poster that it was most likely a coincidence. Several users noted that they had friends or relatives who had conceived successfully after vaccination, while others pointed out that miscarriages are common among the unvaccinated as well.

Still, of course, these measures are limited in their power to quash misinformation. Some posts slip through the filters. Not every post that should be flagged gets flagged; human moderators and AI detection systems both fail sometimes, or don’t recognise and delete misinformation as quickly as would be ideal. Plus, Mattheis added, anti-vaccine activists often understand and successfully evade What to Expect’s screening tools.

What to Expect’s struggles with vaccine conspiracies make for “a fascinating case study,” said Harvard’s Douek. “It’s a lot to expect from What to Expect to develop really sensitive and nuanced content moderation technology to distinguish lies from opinion from disinformation.” Those kinds of issues can stymie even tech giants with vast resources, such as Facebook and Google’s YouTube.

On the other hand, Douek added, niche apps may represent a more tractable moderation problem if people accept that they’re not meant to be a public square for political speech.

“You have some sympathy for the people that run these platforms wanting to just provide a forum for people to discuss these issues,” said Douek. “And then suddenly they’re thrust into this unenviable role of deciding the boundaries of public conversation.”

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