{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:53:24Z","timestamp":1791176004369,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Crisis Pregnancy Centers (CPCs) have expanded their digital presence using social media to promote services, advance ideological messages, and disseminate potentially medically inaccurate claims. Despite extensive use of platforms such as Instagram for outreach, little empirical work has examined the content and engagement patterns of CPC\u2010related posts. We systematically analyzed Instagram posts to identify key themes, assess engagement patterns, and determine factors influencing the reach and impact of CPC\u2010related content.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a mixed\u2010methods content analysis of publicly available Instagram posts published between June 24, 2022 and October 15, 2025. A total of 716 posts met inclusion criteria. Posts were coded using an iteratively developed codebook that yielded four overarching themes and 13 subthemes. Hashtags were classified into service, wellness, advocacy\/identity, and location categories. Engagement outcomes (likes and comments) were log\u2010transformed to address skew. Multivariable ordinary least squares (OLS) regression models estimated associations between content characteristics and engagement, controlling for account features, post timing, and hashtag use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Service Promotion &amp; Outreach was the most common theme (49%), followed by Emotional Appeals (23%), Ideological Messaging (18%), and Misinformation &amp; Misrepresentation (10%). Posts containing misinformation or misrepresentation received significantly higher engagement, with a 46% increase in predicted likes compared with Service Promotion &amp; Outreach posts (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a00.38,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.05). Log followers was strongly associated with engagement (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a00.68,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). Reels received substantially more likes than still\u2010image grid posts. Certain posting months and wellness\u2010 or location\u2010based hashtags were associated with lower engagement. Subtheme analyses revealed that content portraying abortion as immoral or harmful and posts exposing or correcting CPC misinformation generated the highest predicted engagement. Results for comments followed similar directions but were generally smaller in magnitude and not statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>On Instagram, CPC posts containing misinformation and misrepresentation received disproportionately higher engagement compared to service\u2010oriented content. These findings highlight the visibility advantage of misleading content in reproductive health contexts. They also underscore the need for proactive public health communication strategies that counter misinformation in the reproductive health ecosystem.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmf2.70473","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:46:20Z","timestamp":1791175580000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Crisis pregnancy center messaging in the post\u2010Dobbs era"],"prefix":"10.1002","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1266-9436","authenticated-orcid":false,"given":"Jim P.","family":"Stimpson","sequence":"first","affiliation":[{"name":"Department of Health Economics, Systems, and Policy University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3951-5866","authenticated-orcid":false,"given":"Aditi","family":"Srivastava","sequence":"additional","affiliation":[{"name":"University of California Berkeley  Berkeley California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ketan","family":"Tamirisa","sequence":"additional","affiliation":[{"name":"Institute for Public Health Washington University in St. Louis  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7546-7678","authenticated-orcid":false,"given":"Emily C.","family":"Baudot","sequence":"additional","affiliation":[{"name":"Department of Health Economics, Systems, and Policy University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2204-3936","authenticated-orcid":false,"given":"Kimberley","family":"Sladek","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4060-2685","authenticated-orcid":false,"given":"Emily H.","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"An Analysis of Federal Funding for Crisis Pregnancy Centers, 2017\u20132023","author":"Rabinovitz J. R. D.","year":"2024"},{"key":"e_1_2_10_3_1","volume-title":"Health Care Funding: Information on Crisis Pregnancy Centers, Fiscal Years Through 2024","author":"Office USGA","year":"2018"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.2025.308055"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2014.07.003"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/journalofethics.2018.20.3.pfor1\u20101803"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0324228"},{"key":"e_1_2_10_8_1","volume-title":"Nowhere to Go: Maternity Care Deserts Across the US","author":"Stoneburner A. L. R.","year":"2024"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.2196\/60001"},{"key":"e_1_2_10_10_1","unstructured":"Swartzendruber A.andD.Lambert.2021. \u201cCrisis Pregnancy Center Map.\u201d Accessed August 13 2026http:\/\/www.crisispregnancycentermap.com."},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.2196\/16726"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.2147\/ijwh.S288861"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.20424"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2012.06.001"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.2196\/23656"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.1933"},{"key":"e_1_2_10_17_1","unstructured":"Fuller S. A.2023. \u201cTeens Need Access to High\u2010Quality Comprehensive Digital Information About Reproductive Health Options.\u201dAdolescent Health & Well\u2010being: Children's Hospital of Philadelphia Policy Lab. Posted July 6 2023. Accessed Sept 27 2026.https:\/\/policylab.chop.edu\/blog\/teens\u2010need\u2010access\u2010high\u2010quality\u2010comprehensive\u2010digital\u2010information\u2010about\u2010reproductive\u2010health."},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.5888\/pcd20.220194"},{"key":"e_1_2_10_19_1","volume-title":"Social Media Services for Pregnancy Centers","author":"Choose Life Marketing","year":"2022"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.2196\/43349"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.2196\/67515"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1200\/OP.21.00871"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.2196\/54407"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.3758\/s13428\u2010019\u201001202\u20108"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/001316446002000104"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.37016\/mr\u20102020\u2010033"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.aap9559"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010024\u201009118\u20106"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41586\u2010021\u201003344\u20102"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpag.2019.10.008"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010024\u201054030\u2010y"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010018\u20104703\u20104"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40537\u2010023\u201000796\u20103"}],"container-title":["Pregnancy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmf2.70473","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pmf2.70473","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmf2.70473","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:46:34Z","timestamp":1791175594000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/pmf2.70473"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,4]]},"references-count":32,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1002\/pmf2.70473"],"URL":"https:\/\/doi.org\/10.1002\/pmf2.70473","archive":["Portico"],"relation":{},"ISSN":["2997-9684","2997-9684"],"issn-type":[{"value":"2997-9684","type":"print"},{"value":"2997-9684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,4]]},"assertion":[{"value":"2026-03-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70473"}}