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Access to accurate information about reproductive and maternal health can be critical. But on Meta's platforms, simply talking about prescription medication, abortion care, or one's own medical experiences can be enough to trigger content removals and account restrictions.

That's why EFF recently submitted a public comment to the Meta Oversight Board in its consideration of a case involving an Instagram post about prescription drugs during pregnancy and childbirth. The case touches upon a topic we’ve been documenting for some time; last year we collected stories from individuals who had experienced censorship of reproductive health information on various platforms. Meta in particular stood out: Its moderation systems routinely fail to distinguish between prohibited drug transactions and legitimate discussion of medications, including educational information and people's firsthand experiences with healthcare.

Through our Stop Censoring Abortion project, EFF collected nearly 100 submissions from healthcare providers, clinics, educators, advocates, researchers, and others whose reproductive health content had been removed or suppressed by social media platforms. What we found was alarming: systemic over-enforcement, confusing policies, arbitrary takedowns, sudden account bans, de-ranking, and appeals that too often went nowhere.

Talking About Medication Isn't the Same as Selling It

In almost every case we reviewed, the censored posts and accounts did not actually violate the platforms' stated rules. Meta frequently cited its Restricted Goods and Services policy, which prohibits attempts to buy, sell, trade, donate, gift, or request pharmaceutical drugs. But the content EFF documented overwhelmingly consisted of factual or educational information—not attempts to sell or distribute drugs.

The consequences were significant. For example, the Miscarriage+Abortion Hotline had its Instagram account restricted and posts removed even though it was providing information about legally obtaining medication rather than offering pharmaceuticals for sale. Red River Women's Clinic and the RISE reproductive health research center at Emory University had accounts locked after posting about mifepristone.

Other users reported having their content quietly de-ranked or “shadowbanned,” limiting its reach without giving them meaningful notice or recourse. We believe educational content and people's experiences involving reproductive healthcare and medication should not be suppressed in this way.

And when Meta gets these decisions wrong, the appeals process too often fails to fix them. In several cases EFF documented, accounts were restored only after journalists drew attention to the problem or someone with a personal connection inside Meta intervened. A moderation system shouldn't require knowing the right person to get an erroneous decision reversed.

Meta Can—and Must—Do Better

Our submission calls on Meta to make five changes—the same five changes we asked for last year.

First, Meta should publish clear, understandable policies so users can know what content is permitted and what might result in removal, downranking, or account suspension. Second, those rules must be enforced consistently and fairly. Third, Meta must provide meaningful explanations for enforcement decisions, including what rule was violated and how users can appeal. Fourth, users need a functional appeals system that doesn't depend on insider access.

Finally, Meta should expand human review. Reproductive healthcare is precisely the sort of nuanced and context-dependent subject that automated moderation systems struggle to understand. As our research shows, automated systems can mistake education for drug sales, misinterpret terminology, overlook cultural and political context, and even classify legitimate advocacy as dangerous content. Human moderators should therefore play a greater role when automated systems flag sensitive healthcare information or political expression.

Meta has chosen to allow discussion of reproductive healthcare, including abortion, on its platforms. That commitment means little if its moderation systems nevertheless prevent people from accessing or sharing that information.

At a moment when reproductive rights are under attack around the world, the stakes are particularly high. Restricting access to essential healthcare information can have profound consequences, especially for people who already face barriers to reproductive care.

Users deserve a system in which rules aren't applied arbitrarily, appeals actually work, and vital health information isn't silenced because an automated system failed to understand its context. Meta can—and must—do better.

You can read our comment in full below.

Jennifer Pinsof

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