The EMSA study: Sexual debut, menstruation and pregnancy termination on social media

Freckle-faced Lisa is 17 years old, enjoys playing volleyball, loves her dog Lexi and will graduate from high school next year. She has had a boyfriend for 6 months. Her parents know and like him. Sometimes he is allowed to stay over and sleep in the loft bed with her. They are both very much in love and have even talked about getting engaged. They had their first intercourse after being together for exactly 2 months, on the day of their monthly “anniversary”.

Regarding her romantic and sexual experiences, Lisa corresponds to the average among German adolescents: 17 is the typical age for starting an active love and sex life (Scharmanski & Hessling, 2021d). Regarding the other initial conditions in her life, Lisa is doing better than average: German is her mother tongue, she gets on well at high school, is healthy and sporty, has a relaxed relationship with her parents, good friends and a nice boyfriend. Lisa has also been well educated about contraception by her parents, something not all girls in Germany can claim (Scharmanski & Hessling, 2021c).

So, it comes as a shock to Lisa when her period stops one day, and she fears an unplanned pregnancy. She and her boyfriend had always used condoms. She prefers not telling her parents for the time being. Lisa rummages through her memory, but she definitely had not heard anything in school specifically about the possibility of an pregnancy termination; she would have remembered that. In fact, only a good third of all 14- to 17-year-old girls report having been informed about pregnancy termination in sexuality education lessons (Scharmanski & Hessling, 2021b). Pregnancy termination has never been a topic among Lisa’s friends, either. So, with a pounding heart, she does what she does several times a day anyway: She googles, watches YouTube videos, Instagram posts and TikToks.

What information about missed periods and pregnancy termination does she come across there? And how does she make sense of this online information? Do any of the influencers Lisa follows report anything helpful (see Figure 1)?

At the moment, research cannot answer these questions. The reason is that online information about pregnancy termination, menstruation and sexual debut has never been systematically analysed in the German-speaking countries. Only a few content-analysis studies from English-speaking countries have investigated how exemplary topics from sexual and reproductive health and rights are presented on selected social-media platforms (Döring & Conde, 2021). A number of survey studies in English-speaking countries have also explored how different groups of young people search for and find answers to their questions about reproduction and sexuality online, but these findings are hardly transferable to Germany.

The research project “Erstes Mal, Menstruation und Schwangerschaftsabbruch in Sozialen Medien” (EMSA, Sexual Debut, Menstruation and Pregnancy Termination on Social Media) presented here intends to close those research gaps. The project receives funding from the Federal Centre for Health Education (BZgA) and is based on relevant preliminary work on online sexuality education (Döring, 2017a, 2017b, Döring & Conde, 2021). This preliminary work includes a BZgA-funded study on the presentation of contraceptive methods on social media. This study also analysed the quality of contraceptive information on various platforms (Wikipedia, YouTube, Instagram, TikTok). In addition, it measured audience reactions using the comment columns and oral interviews (Döring et al., 2021, 2023; Döring & Lehmann, 2022). The approach of analysing several social-media platforms comparatively using various methods from social-science research proved very successful for the contraception topic and will therefore be transferred to the three EMSA topics.

As part of the EMSA study, we will analyse high-reach YouTube and TikTok videos, Instagram posts and corresponding top audience comments. (The top comments are the public audience comments that received the most likes.) In addition, we will conduct interviews with young social-media users to explore how social-media posts on the EMSA topics are perceived and assessed regarding their credibility.

The results of the EMSA study should initially close a gap in scientific research. We already know from representative population surveys that one in five girls in Germany obtains essential information about sexuality from social media influencers (Scharmanski & Hessling, 2021a). The EMSA study, will specify, for example, whether and how influencers inform girls about menstruation, pregnancy termination, and sexual debut. The findings will also be helpful for the field of sexual education. Should quality deficiencies be identified in the online information about the EMSA topics, this can be counteracted in two ways:

• Specialist practitioners can support the online health literacy of young people by helping them selectively use and critically evaluate information on sexual and reproductive health from social media.
   
• In addition, the professionals themselves are called upon to provide more evidence-based information via social media, especially on those aspects of the EMSA topics that – according to the study results available at the time – circulate particularly large amounts of incorrect, one-sided or incomplete information.

For this reason, the study pays particular attention to disseminating the findings not only in specialised scientific journals (e.g., Bundesgesundheitsblatt, Zeitschrift für Sexualforschung), but also in practise-oriented sexual and media education magazines (e.g., FORUM Sexualaufklärung und Familienplanung; pro familia magazin; merz – zeitschrift für medienpädagogik).

Last but not least, we want to emphasise that the EMSA project serves to create synergies with other projects in the field of sexual and reproductive healthcare. These include, above all, the study “Erfahrungen und Lebenslagen ungewollt Schwangerer – Angebote der Beratung und Versorgung” (ELSA, Experiences and Living Conditions of Unintended Pregnant Women – Counseling and Care Services), which is funded by the Federal Ministry of Health and is currently still ongoing. ELSA is also concerned with analysing the presentation of pregnancy termination on the websites of counselling centres and doctors, among other things. Since the repeal of §219a StGB in 2022, gynaecologists are now allowed to provide information on pregnancy termination online without this being considered “advertising for abortions”, so Lisa can – at least theoretically – find answers to her questions when searching for online information. Whether and how gynaecologists will address pregnancy termination on their websites (a sub-study in the ELSA project) is currently just as unclear as how influencers, journalists or private individuals address the subject on social media (a sub-study in the EMSA project).