Improving the information environment for sexual and reproductive health and rights

I just saw today this petition by Center for Intimacy Justice to change Meta’s content moderation implementation, where female-related SRH ads are being taken down, while male-related fertility ads are accepted for publication.

This assymetrical, gendered enforcement of content moderation practices is an example of a commercial determinant of health information that shapes the information environments in particular health information area.

I recently wrote about health information in the sexual and reproductive health and rights domain, how infodemic management approaches can be applied, and where are specific challenges. (Applying infodemic management models to misinformation on sexual and reproductive health and rights).

So I returned to this and I expanded the thinking further, specifically looking at what are the tools and research that might be needed to improve the information environment on SRHR. What could a health policymaker and health care provider do to develop better tools and research evidence in this area?

Working across the information environment domains

We need to think about strengthening structures and systems along all five elements of a healthy information environment. You’ll notice that below I don’t talk about chasing misinformation butterflies or debunking. We need to employ different strategies that help us interact with the information environment and how it is designed. Thinking along these five buckets also helps us adapt because especially digital spaces keep advancing and hanging as business models and technology advance.

A reminder, here’s the five buckets:

The below buckets suggest different tools and research directions for each of these domains.

1. recommend that data collection standards for sexual health education should almost always include the collection of the audience’s beliefs in accurate and inaccurate health information, essentially setting a standard that a sexual health education curriculum be responsive to the audience’s information needs.
2. raise awareness about the spread of reproductive health misinformation when countries enact policies to outlaw treatments and preventative measures. This is a proactive step SRH programmes could take here where instead of advocating for a particular policy – just ensuring that we identify common narratives that emerge when these policies change and create a short document that identifies them and provides ways to address them could make a huge difference.
3. advocate for the development of the mis/dis evidence base in this space so we can learn best practices for dissemination and collaborations that we could apply to other fields. We all have a lot to learn from the robust advocacy networks in the SRHR field and as we start to move more and more to mitigation away from monitoring we need to look into best practices more. So we need to determine how SRHR health-related misinformation is different from other types of health misinformation – and potentially develop specific archetypes for common misinformation tropes, like it has been done for COVID-19 and for routine vaccines.

I outline below challenge x action for each of the five buckets.

Policy

Tools:

Ethics of social listening and interventions targeting health information seeking behaviors are critical to develop policies for, especially for stigmatizing topics like SRHR

• Apply the values of currently convened WHO ethics panel on social listening and infodemic management to SRHR

There are organized anti-SRHR groups (like in vaccine space) that propagate mis- and disinformation

• Provide strategies for SRHR-related health workers, organizations, and media on how to address common harmful narratives

Research:

Although there’s been explosion of research around infodemic and misinformation-related harms around COVID-19, vaccines and cancer, there’s far less research on SRHR-related infodemic harms and misinformation, especially in LMICs

• Apply SRHR research agenda domains to questions and concerns of vulnerable populations, and how it relates to the information environment and health misinformation

Commercial determinants of health information

Tools:

There’s profit to be made on SRHR topics, especially in online spaces. Profit motives impact the quality and accuracy of health information that that people receive on their devices.

• Educate programme staff and policymakers on how commercial interests (like the wellness industry) interact in this space and shape the online information environment.
• Develop recommendations on how to responsibly partner with the private sector and social media influencers.

Research:

Understanding information exposure and information seeking of communities of focus, especially online, is difficult to do, due to lack of access to data.

• Develop model protocols for rapid assessments of information exposure and characterization of sentiment in online spaces and communities of focus.
• Evaluate how SHRH topics are marketed and discussed by commercial entities in specific high-priority populations.

Credible, accurate health information

Tools:

The availability of credible, accurate SRHR information, especially by health programmes is not always a given. We are creating an information void when people search for health information but cannot find it from a credible source.

• Update, optimize and expand SRHR digital content with all current partners for a mobile-first world and consider accessibility and usability improvements. (make a checklist!)
• Provide tools to promote active online community engagement on SRHR topics, without putting the institution at the center (meaning, don’t promote the brand of institution, focus on the people needing the information)

Research:

We need to better understand how different types of users look for, process and act on health information, especially for topics linked to people’s identity and values, like SRHR. This is not only an online problem!

• Leverage research approaches from human–centered design, which can be used for social marketing and improving effectiveness and social and behavior change.
• Utilize a broad set of approaches, transferrable to low-resource settings, to develop more effective message frames.

Health information equity

Tools:

SRHR information does not reach all communities equally. Access to information is also mediated by structural, social and economic factors, which need to be taken into account when developing interventions to improve equitable access to health information.

• Develop tools to rapidly assess the information environment related to SRHR and how it might affect specific population segments, eg parents, educators, teens.
• Adapt findings from WHO evidence gap map to develop interventions to promote equitable access to SRHR information

Research:

Many SRHR community engagement and education approaches may touch upon the information environment, but could benefit from a wider and more systematic inclusion into the protocol and reporting.

• Define components of what to assess in the information environment when designing SRHR interventions at individual and community level.
• Develop a policy brief on how to include considerations around information seeking and information environment into health programmes and policy development.

Digital, media, information, science and health literacy

Tools:

Promoting individual literacy across digital, media, information, science and health domains is critical for an individual’s ability to understand and use SRHR-related information effectively.

• Develop capacity building modules for health workers and their clients on how to understand and assess SRHR-related information, detect misinformation, and how to talk to others on SRHR topics.
• Leverage existing networks and promote peer-to-peer approaches (online and offline) to address SRHR misinformation more effectively

Research:

Research in relation to literacies has grown, although they tend to be heavily focused on vaccines and some health promotion topics.

• Promote research into improving literacy-related measures and interventions with health workers and communities of focus on SRHR topics.

One promising area of literacy development has been promoting social inoculation and resilience to misinformation in a gamified format, and applied in different populations.

• Develop and assess game-based approaches to building resilience against SRHR –related misinformation.

I wrote this LinkedIn blog in the summer of 2023, for a seminar to the sexual and reproductive rights department at WHO. Follow me on LinkedIn. if you’d like to read more of my commentaries.