Next Article in Journal
Attitudes of Mental Health Professionals towards Telepsychology during the Pandemic: A Pilot Study
Next Article in Special Issue
How Do Midwives View Their Professional Autonomy, Now and in Future?
Previous Article in Journal
The Experiences of Midwives Who Attend Births by Women with Life-Limiting Fetal Conditions (LLFC): A Phenomenological Research Study
Previous Article in Special Issue
Key Maternity Care Stakeholders’ Views on Midwives’ Professional Autonomy
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Healthcare
Volume 11
Issue 11
10.3390/healthcare11111541
healthcare-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Google Trends Analysis Reflecting Internet Users’ Interest in Selected Terms of Sexual and Reproductive Health in Ukraine

by
Joanna Błajda
1,*,
Anna Kucab
1,
Aldona Miazga
1,
Maciej Masłowski
1,
Marta Kopańska
2,
Anna Nowak
3 and
Edyta Barnaś
1
1
Institute of Health Sciences, Medical College, University of Rzeszow, 35-959 Rzeszow, Poland
2
Institute of Medical Sciences, Medical College, University of Rzeszow, 35-959 Rzeszow, Poland
3
Center for Foreign Language Studies, University of Rzeszow, Aleja Rejtana 16c, 35-959 Rzeszow, Poland
*
Author to whom correspondence should be addressed.
Healthcare 2023, 11(11), 1541; https://doi.org/10.3390/healthcare11111541
Submission received: 20 February 2023 / Revised: 31 March 2023 / Accepted: 14 April 2023 / Published: 25 May 2023
(This article belongs to the Special Issue New Waves of Sexual and Reproductive Health)
Browse Figures
Versions Notes

Abstract

:
Introduction: The war in Ukraine has had adverse impacts on all areas of life, including health-related issues. Limited access to medical care increases the need to look for alternative sources of medical information. Aim: To analyze trends of Internet users’ interest in sexual and reproductive health in Ukraine based on Google Trends. Materials and Methods: The retrospective study was based on the analysis of terms related to sexual and reproductive health searched by Ukrainian Internet users. The tool used was Google Trends. The period from 1 January 2021 to 1 January 2023 was analyzed. The time variability in search growths and peaks was assessed from the perspective of two time intervals (before the war and during the war) using the chi-square test. Results: Significant changes have been demonstrated in the interests of Internet users from Ukraine regarding selected issues of sexual and reproductive health during the ongoing war. Compared to the pre-war period, a marked increase was observed in active searches for terms such as “condoms” (p = 0.0081), “rape” (p = 0.0008), “syphilis” (p = 0.0136), “ovulation” (p = 0.0002) and “pregnancy test” (p = 0.0008). Conclusions: The conducted analysis clearly indicates an increased need for information regarding sexual and reproductive health among Ukrainian citizens during the ongoing armed conflict. The analysis of trends among Internet users interests can be a valuable source of knowledge for decision makers, including human rights organizations, regarding the scope and coordination of activities aimed at protecting the sexual and reproductive health of the inhabitants of Ukraine.

1. Introduction

Reproductive health is a component of sexual health. According to the WHO, it is a set of biological, emotional, intellectual and social aspects of sexual life, necessary for the positive development of human personality, communication and love. The definition given clearly classifies that sexuality should be based on respect, safety and freedom from discrimination [1]. Armed conflicts prevent the full realization of all the assumptions that are assigned to the defined terms. The war in Ukraine has resulted in a crisis in access to safe childbirth and neonatal care, contraceptives to prevent unwanted pregnancy, safe abortion, comprehensive sex education for youth, prevention and treatment of HIV and other sexually transmitted diseases, and protection of people of different sexual orientations and gender identity [2]. The global organization Sexual and Reproductive Health and Research emphasizes that attention should be paid to the impacts of conflicts and forced migration on the sexual and reproductive health of Ukrainian citizens [3].
Sexuality as well as contraception are no longer taboo topics; the key role in this matter is played by open access to information via the Internet, which is a popular source of knowledge about health. In the opinion of users, the Internet gives a great sense of freedom in searching for information [4]. Nearly three-quarters of Internet users look for health information on the Internet [5]. The role of the Internet during armed conflict can be of particular importance as it is frequently the only available source of information. For numerous Internet users, it is the first-choice source of information before seeking advice from a medical specialist [6]. A Research & Branding Group survey from February 2021 demonstrated that the Internet was, for the first time, the main source of information (51% preferred the Internet and 41% television) for Ukrainians [7].
According to the international ranking conducted in February 2022, the most popular Internet search engine in the world is Google (Google—73.95%, Bing—15.81%, Baidu—3.88%) [8]. An interesting Google service is the free tool Google Trends (GT), a service that provides daily insight into what the world is searching for on Google, showing the relative amount of search traffic for any query in any language depending on the time and region of queries directed to Google Search. The analysis of web search trends can be useful for advertisers, economists, scientists and all other people interested in knowing what Internet users are interested in [9,10,11].
The subsequent parts of the paper include the purpose of the work, the methodology of the research conducted and a list of the keywords analyzed. The results of the analysis of 22 keywords, including the peaks of interest in them both before and after 24 February 2022, were analyzed. The relevance of the results is compared with the literature in the discussion section, making arguments for the conclusions section.

Aim

The aim of the study was to analyze trends of Internet users’ interest in sexual and reproductive health in Ukraine based on the Google Trends tool.

2. Material and Method

In this retrospective study, a selection of sexual and reproductive health keywords searched on the Internet were analyzed. The tool used was Google Trends, with the help of which we obtained data on the number, origin, dependence on time and main regions of queries directed to the Google search engine. The ranking of the obtained entries was sorted by language (all entries were entered in Ukrainian); the entries were also sorted by country (the territorial scope was selected—Ukraine).
The analyzed keywords were selected in a multi-stage process. Initially, keywords were chosen by brainstorming possible words that we thought were common in the fields. In addition, we checked what other GT researchers had analyzed on related topics to find out about any important topics or keywords that we might have missed. While performing the analysis in GT, we also paid attention to similar topics displayed in GT, which were a hint of what other terms were being searched by other users searching for terms similar to ours. Keywords for which the number of searches did not reach the minimum value threshold in the analyzed time were excluded. Table 1 is presented below.
The study was conducted between 2 and 5 January 2023. The period from 1 January 2021 to 1 January 2023 was analyzed. According to the Google Trends algorithm, search interest was quantified on a normalized scale of 0–100 GT, with the highest indicator assigned to 100. The study included, in detail, the growths and peaks of searches on a scale of 0–100 GT. Keywords for which the number of searches did not reach the minimum value threshold in the analyzed time were excluded. The time variability in the search was assessed from the perspective of two time intervals, i.e., before 24 February 2022, prior to the outbreak of the war, and after 24 February 2022, during the war. We used the goodness-of-fit chi-square test and checked whether the observed proportions differed from the expected values, assuming an even distribution of results (50% each before and after the war). This is otherwise known as the chi-2 concordance test. It was assessed whether the numbers in terms of interest in given terms were significantly different in these time intervals. The chi-square test was used assuming a significance level of p < 0.05.

3. Results

The conducted analysis showed that in the case of 15 out of 22 identified keywords, the peak of interest occurred during the war (after 24 February 2022)—Table 2.
The greatest interest in the keyword “contraception” was recorded on 25–31 August 2021 and 16–22 October 2022 (100 on the GT scale)—Figure 1. The greatest interest in the term “emergency contraception” was recorded on 24–30 July 2022 (GT 100). The peak of interest in the term “morning-after pill” was recorded between 28 February and 6 March 2021. The research showed no significant difference in interest in the terms “contraception” (p = 1.0000), “emergency contraception” (p = 0.1349) and “morning-after pill” (p = 0.6658) during the war compared to the time before the conflict—Table 2.
The most frequently searched term in the field of contraception was “condoms”. The greatest interest in the term “condoms” was recorded between 30 October and 5 November 2022 (100 on the GT scale)—Figure 1. The analysis showed a significant increase in interest in the term “condoms” during the war compared to the time before the conflict (p = 0.0081)—Table 2.
The greatest interest in the term “contraceptive pills” was recorded between 20 November and 26 November 2022 (GT scale 100). The results did not show contrast in the interest in this term in the analyzed time periods (p = 0.4670)—Table 2.
The greatest interest in the term “intrauterine device” in the analyzed time period was recorded on 2–8 January 2022 (100 on the GT scale)—Figure 1. The analysis showed a significant decrease in interest in the term “intrauterine device” during the war compared to the time before the conflict (p < 0.0001). The lowest interest in the analyzed time period was recorded from 5 March 2022 to 30 July 2022 and from 17 September 2022 to 19 November 2022 (0 on the GT scale)—Table 2.
The greatest interest in the term “abortion” was recorded on 10–16 January 2021 (GT scale 100). No differences were demonstrated in the comparison of the interest in this term in the analyzed time periods (p = 0.3046)—Table 2.
The greatest interest in the keyword “sexual violence” was recorded during the war on 24–30 July 2022 (100 on the GT scale). There was no significant difference in the interest in this term in the analyzed time periods (p = 0.3815)—Table 2.
The analysis showed a significant increase in interest in the term “rape” during the war compared to the time before the conflict (p = 0.0008)—Table 2. The greatest interest in the keyword “rape” was recorded on 10–16 April 2022 (100 on a scale GT)—Figure 2.
The analysis showed a significant increase in interest in the keyword “HIV” during the war compared to the time preceding the conflict (p = 0.0083)—Table 2. The greatest interest in the term “HIV” was recorded on 22–28 May 2022 (100 on the GT scale)—Figure 2.
The research showed a significant increase in interest in the keyword “syphilis” during the war compared to the time preceding the conflict (p = 0.0136)—Table 2. The greatest interest in the term “syphilis” was recorded on 13–19 November 2022 (100 on the GT scale)—Figure 2.
There was no significant difference in interest in the term “gonorrhea” in the analyzed time intervals (p = 0.2382)—Table 2. The greatest interest in this term was recorded on 24–30 January 2021 (100 on the GT scale).
The greatest interest in the term “surrogate” was recorded on 9–15 January 2022 (GT scale 100). The results did not show contrast in the interest in this term in the analyzed time periods (p = 0.0704)—Table 2.
The greatest interest in the term “surrogacy” was recorded at the beginning of the war on 20–26 March 2022 (100 on the GT scale), but no significant difference in interest in the term “surrogacy” during the war compared to the time preceding the conflict was found (p = 0.2382)—Table 2.
The analysis showed a significant increase in interest in the term “ovulation” during the war compared to the time preceding the conflict (p = 0.0002)—Table 2. The greatest interest was recorded on 6–12 November 2022 (100 on the GT scale), and the smallest on 28–6 February 2021 (0 on the GT scale)—Figure 3.
No differences were demonstrated in the comparison of the interest in the term “birth” in the analyzed time periods (p = 0.0704)—Table 2. The greatest interest in this term was recorded on 7–13 August 2022 (100 on the GT scale).
There was no significant difference in the interest in the term “symptoms of pregnancy” in the analyzed time periods (p = 1.0000)—Table 2. The greatest interest in this term was noted before the war on 3–9 October 2021 (100 on the GT scale), and after the outbreak of war on 3–9 July 2022 and 20–26 November 2022 (99 GT).
The results did not show contrast in the interest in the term “pregnancy” in the analyzed time periods (p = 0.1809)—Table 2. The greatest interest in the term “pregnancy” was recorded on 3–9 July 2022 (100 on the GT scale).
The research showed a significant increase in interest in the term “pregnancy test” during the war compared to the time preceding the conflict (p = 0.0008)—Table 2. The greatest interest in the term “pregnancy test” was recorded on 24–30 July 2022 (GT scale 100). The smallest interest was recorded on 6–12 March 2022 (17 on the GT scale)—Figure 3.
No differences were demonstrated in the comparison of the interest in the term “gynecologist” in the analyzed time periods (p = 0.3046)—Table 2. The greatest interest in the term “gynecologist” was recorded on 30 October–5 November 2022 (100 on the GT scale).
The results did not show contrast in the interest in the term “menstruation” in the analyzed time periods (p = 1.0000)—Table 2. The greatest interest in the term “menstruation” was noted on 12–18 June 2022 (GT scale 100).
The results did not show contrast in the analyzed time periods (p = 0.1833)—Table 2. The greatest interest in the keyword “tampon” was recorded on 25–31 July 2022 (GT scale).

4. Discussion

The impacts of war and related forced migration significantly affect sexual and reproductive health. During armed conflicts, the need for contraception is also an important issue, as is the availability of basic and menstrual hygiene products [2]. Access to intimate hygiene products can become particularly difficult as products become difficult to access, increasing the risks of compromised sanitary health, stigma, discomfort and safety [3,12]. In this project, no significant difference was found in the interest of Internet users from Ukraine in terms of “menstruation” and “tampon” in the analyzed time periods.
Contraception is a basic element of birth control, and the choice of contraceptive method depends on many factors; the ideal contraceptive method should be effective, safe, reversible, cheap, widely available and easy to use. Various methods of contraception are available, including hormonal contraception such as birth control pills, implants under the skin, patches, intrauterine devices, injections, and vaginal rings (contraceptive rings); barrier methods such as female and male condoms, cervical caps, vaginal sponges with spermicide, and diaphragms; and surgical sterilization or natural methods with sexual abstinence during the fertile period [13]. Insufficient knowledge about the methods of conception control can lead to unwanted pregnancy. Ukraine was one of the 189 countries that signed the UN Millennium Declaration (A/RES/55/2) committing to achieve the Millennium Development Goals by 2015 [14]. In the 2030 Agenda for Sustainable Development, goal 3.7 states: “By 2030, ensure universal access to sexual and reproductive health services, including family planning, information and education, and integrate reproductive health into national strategies and programs”. This indicator is useful for assessing the overall level of coverage of family planning programs and services. Access to and use of effective pregnancy prevention measures help women and their partners exercise their right to freely and responsibly decide the number and spacing of their children, and to have the information, education and resources to do so. This indicator is calculated using nationally representative household survey data and compiled into a global dataset on global contraceptive use. Global and regional estimates are derived from estimates and projections of family planning indicators. Sustainable Development Goal (SDG) indicator 3.7.1 refers to the percentage of women of reproductive age (aged 15–49) who have their family planning needs met by modern methods. [15,16]. Despite the increase in the prevalence of contraception worldwide (from 54.8% in 1990 to 63.3% in 2010), there was no sharp change in the contraceptive prevalence rate in Ukraine (from 66.6% in 1990 to 67.0% in 2010) [17]. Among the long-acting reversible methods of contraception, only intrauterine contraceptives are available in Ukraine. From August 2017, implants have been unavailable in Ukraine. The cost of a copper IUD is around EUR 15–20 and a levonorgestrel-releasing IUD is around EUR 700. Injectable contraceptives containing medroxyprogesterone acetate cost EUR 15–20 per injection, while oral contraceptive pills for three months’ use are around EUR 10–15. The economic crisis in Ukraine in 2014–2015 contributed to a sharp increase in the cost of imported drugs, which also affected hormonal contraceptives. The advertising of modern long-acting reversible methods of contraception on Ukrainian social media is not allowed; however, there are many other forums and websites where women share their experiences with using hormonal contraception [18]. It is important that progress towards meeting the demand for contraception takes into account the changing context in which it is used [19]. The conducted analysis showed no significant difference in the interest of Ukrainian Internet users in the terms “contraception” and “emergency contraception” in the analyzed time periods.
Intrauterine contraception and subdermal implants are the most effective methods of contraception, especially for women who choose long-acting methods [18].
The study by Podolski et al. showed that Ukrainian women prefer natural methods of contraception, condoms and oral contraception [18]. The use of barrier contraception in the form of condoms among married women aged 15–49 in Ukraine has increased in recent years [20]. This is confirmed by the results of research conducted in a group of 500 women from Ukraine who had an abortion or childbirth (250 women after abortion and 250 women after childbirth). These studies have shown that there is little knowledge about contraception such as intrauterine devices and implants. Barrier methods and oral contraceptives were the most commonly used methods, while only a few women used IUDs [18]. High rates of IUD use were found in a study conducted in the western region of Ukraine in 2003 [21], while reports from other regions in the same period indicate barrier methods as being the preferred method of family planning [22,23,24]. The probable reason for this difference may be the fact that the western region closely borders two European countries, allowing women access to information on modern methods of contraception [25,26]. In Ukraine, since the beginning of the war, many women have been actively involved in the defense sphere, especially in the eastern regions of the country. This requires addressing gender-related medical issues such as birth control, menstrual regulation, hygiene issues and pregnancy. Women in the active military service are characterized by a high percentage of unwanted pregnancies and low use of contraceptive methods, which may be related to the lack of awareness and limited access to contraception. Hormonal contraception may be beneficial for this group of women [27]. The analysis showed a significant increase in interest in the term “condoms” during the war compared to the pre-conflict period, as well as a significant decrease in interest in the term “intrauterine device” during the war. However, there was no significant difference in interest in the terms “contraceptive pills” and “morning-after pills” in the analyzed time periods.
At the outbreak of the war (24 February 2022), there were 9.4 million women of reproductive age in Ukraine, of whom 265,000 were pregnant [12,28,29]. The population of Ukraine has been gradually decreasing since 2000; in 2020, it had 41,902.4 citizens. According to official statistics, the total fertility rate in Ukraine in 2018 was 1.301 per woman aged 15–49, a decrease from 1.776 in 1991, when the country gained independence [20,28]. Counselling on family planning methods in Ukraine is usually provided by obstetricians and gynecologists in family planning clinics, outpatient clinics or hospitals (maternity homes) [18]. The analysis carried out in our study showed a significant increase in interest in the terms “pregnancy test” and “ovulation” during the war compared to the time before the war. However, there was no significant difference in the interest in the terms “pregnancy”, “symptoms of pregnancy”, “birth” and “gynecologist” in the analyzed time periods.
The incidence of STIs over 5 years in Ukraine (2014–2019) has changed as follows: syphilis has decreased by a factor of almost 1.5 (from 8.65 to 6.01 per 100,000), but has remained significantly high at reproductive age (13.25 vs. 9.56 per 100,000), and men are more susceptible; a significant reduction in the incidence of gonorrhea by a factor of 1.8 (from 14.85 to 7.97 per 100,000) has been observed, but among men and women of reproductive age, it has increased by factors of 2.5 and 3, respectively (37.26 and 24.12 per 100,000), and men are more susceptible [30]. Contraception is also a method of preventing sexually transmitted infections. This study showed, from the results of internet users, a significant increase in interest in the term “syphilis” during the war, but no significant difference in interest in the term “gonorrhea”.
At the beginning of the war, approximately 260,000 adults and children had HIV [12]. Aggression against Ukraine has had a major impact on the health and safety of people living with and infected with HIV. Those who remain in the country face the deprivation of required health services, and the availability of required services is also an issue for those seeking refuge in other countries. As noted by the International AIDS Society in its recent statement, Ukraine has the second largest HIV epidemic in Eastern Europe and Central Asia, with an estimated 250,000 people living with HIV, and one of the largest HIV responses in the region. More than 150,000 people in Ukraine are on antiretroviral therapy. Many thousands of others are at particular risk of HIV infection due to difficulties in accessing HIV prevention methods [12,29]. The conducted analysis showed a significant increase in Internet users’ interest in the term “HIV” during the war compared to the time before the armed conflict. Due to the influx of refugees in Eastern European countries, it is crucial to strengthen HIV prevention and monitoring activities in these regions [31].
Several million people, mainly women and children, have decided to flee the war, seeking a safe asylum in neighboring countries, or have moved from eastern to western parts of the country [32,33,34]. According to data from 3 January 2023, there were 7,915,287 registered refugees from Ukraine throughout Europe [35]. The extent of the displacement is not yet clear; the numbers may escalate further. Most of the displaced persons and refugees are women and children. These people are particularly exposed to the risk of sexual violence, sexually transmitted infections, including HIV, and unwanted pregnancies [2,12]. Another problem during war is sexual violence, which affects people both in war-affected areas and people fleeing [32,33,36]. The analysis in our study showed a significant increase in interest in the term “rape” during the war compared to the period before it. However, there was no significant difference in the interest in the term “sexual violence” in the analyzed time periods. Increasing the availability of contraceptive methods as well as appropriate education are necessary to reduce the rate of unplanned pregnancies and abortions among Ukrainian women [18]. Abortion is legally available in Ukraine during the first twelve weeks of pregnancy; from 12 to 28 weeks for a variety of reasons, including medical, social and personal; and for any reason following approval from the medical board [3]. Abortion is free, but if additional treatment is needed or complications occur, such as infection or prolonged bleeding, women must pay for it themselves. Medical abortion using mifepristone and misoprostol is also available in Ukraine, but it is expensive and all drugs are paid for by the woman [18]. In 1995, the abortion rate in Ukraine was among the highest in Europe. According to official abortion statistics, abortion rates dropped from 41.3% in 1995–2000 to 9.3% in 2009–2010 [18,20]. According to the Ministry of Healthcare of Ukraine (MHC), the number of abortions in 2019 reached 74,606, including 727 abortions in minor individuals [37]. However, in the face of war, access to abortion is significantly limited, and the conditions in which it is carried out may raise many concerns [12]. Our study did not show any significant difference in the interest of Internet users in the term “abortion” in the analyzed time periods. Sexual and reproductive health and rights needs are a serious concern in Ukraine. Access to medical facilities in the field of obstetrics is also a problem; many women are forced to give birth in difficult conditions without proper care, for example, in basements and bomb shelters. Women during pregnancy and in the perinatal period are exposed to direct hazards to themselves and their offspring [2,3,36]. Another important problem is the safety and future of newborns born via surrogacy. The war in Ukraine put pregnant women, future parents and newborns in a very difficult situation. Ukraine is considered an international center of surrogacy; it is one of a few countries in the world that legally allows foreigners to enter into surrogacy contracts [3,12]. Our study did not show a significant difference in the interest of Ukrainian Internet users in the keywords “surrogate motherhood” and “surrogate mother” in the analyzed time periods. Before the war, the Internet in Ukraine was well developed and access to it was constantly growing [38,39]. In 2011, 33.9% of Ukrainian citizens (15.3 million users) had access to the Internet, while in 2012, 36.8% of Ukrainians had access [40]. In January 2021, approximately 30 million Ukrainians (85% of the country’s population aged over 15) were Internet users [41]. In September 2020, Ukraine was ranked 59th among the countries in the world in terms of broadband speed. The median speed of the Internet network in Ukraine in November 2022 for the mobile network was as follows: download 11.23 Mbit/s, upload 7.50 Mbit/s. For the broadband network, the median speed was as follows: download 60.00 Mbit/s, upload 62.67 Mbit/s. [42]. Google Trends is an objective data source increasingly used in healthcare research [43]. These trends have been particularly useful in assessing the general awareness of public health issues [44,45]. The study of Sousa-Pinto et al., the purpose of which was to assess whether GT data related to COVID-19 were all related to media coverage or epidemic trends, indicated that GT data related to COVID-19 are more closely related to media coverage than to epidemic trends. Similar results were obtained in the study of Datt et al., which showed a significant increase in the interest in contraception among Internet users in the GT in the aftermath of Roe v. Wade being overturned in 2022 [46,47]. Equally interesting results were obtained in the Guldi study, which showed that the teenage birth rate decreased with greater access to information through broadband access, the results being in line with other studies on the influence of media on teenage fertility [48]. Sexual and reproductive health issues are concerns not only for those facing the war situation in Ukraine, but also for millions of people who have become migrants and refugees in neighboring countries in a matter of days [12]. It is important to respect, protect and implement the sexual and reproductive health, needs and rights of all those affected by the war in Ukraine [3]. Therefore, it is imperative that further efforts are made to ensure the availability of sexual and reproductive health services.
Google Trends is a free and easily accessible way to access big search data to gain meaningful insights into population health behavior [49]. The main advantage of GT is that the data are available in real time and that users can obtain data that would be difficult or impossible to obtain. Due to the confidentiality of online searches, it is possible to analyze and predict sensitive diseases and topics such as AIDS [50].
Despite the large number of studies on GT over the past decade in healthcare research, there are no guidelines or agreed standards for the appropriate use of this tool, and the literature on the subject lacks a specific methodological framework [42,51].
There are also some limitations on how GT data can be used. The sample size is not clear and cannot be shown to be representative. Internet searches do not provide reliable results in places where there are obstacles to Internet access or freedom of expression [52]. It is also important to bear in mind that media reports and unexpected events can affect the reliability of results. Additional demographic characteristics, such as age and gender, are not included in the study, as the sample size is unknown [53].
While GT and other search engine databases will never replace traditional methods of obtaining information, if properly validated, GT data can become an important and complementary source of additional data for researchers and decision makers investigating unique topics and challenges at local, national and global levels [49].

Limitations

An important limitation of the survey is the inability to extract results that would take into account the fact of migration of Ukrainian residents after the outbreak of war, i.e., after 24 February 2022. It is worth noting that the reported numbers of people who left Ukraine and stayed in Poland are subject to evaluation, some of whom decided to return to their homeland. Moreover, the scale of impediments to Internet access in the areas directly affected by the war is unknown and there is no reliable information related to this. The present study is aimed at assessing how the trend of keyword search on Google Trends has changed after the outbreak of the war; unfortunately, as of today, there are no tools to determine the cause(s) of this trend. Nevertheless, showing the trend itself may inspire further research exploring issues in the area of reproductive and sexual health.
The strength of the study is that no work in the medical literature to date has dealt with assessing the trend of Internet users’ interest in selected reproductive and sexual health issues in terms of the ongoing war in Ukraine. The topic is novel and provides a basis for further exploration and in-depth research based on other methods and tools.

5. Conclusions

For the majority of the analyzed keywords (15 out of 22), the peak of interest among Ukrainian Internet users occurred after 24 February 2022. A significant increase in interest in the keywords “ovulation”, “pregnancy test”, “condoms”, “intrauterine device”, “rape”, “HIV” and “syphilis” was shown during the war compared to the time before the conflict.
The conducted analysis clearly indicates an increased need for information in the field of sexual and reproductive health of Ukrainian citizens during the ongoing armed conflict there.
The current analysis of trends in the interests of Internet users can be a valuable source of knowledge for decision makers, including human rights organizations, regarding the scope and coordination of activities aimed at protecting the sexual and reproductive health of the inhabitants of Ukraine.

Author Contributions

Conceptualization, J.B. and E.B.; methodology, J.B. and M.M.; formal analysis, J.B. and A.K.; data curation, A.M. and M.M.; writing—original draft preparation, J.B., M.K., A.N. and E.B.; writing—review and editing, A.N. and E.B.; visualization, A.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable. Opinion of the Institutional Review Board of the University of Rzeszow no. 2023/03/21 on 1 March 2023.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. World Health Organisation. Reproductive Health. Available online: https://www.who.int/westernpacific/health-topics/reproductive-health (accessed on 11 March 2023).
  2. Ukraine Crisis: Sexual and Reproductive Health and Rights are Non-Negotiable and Lifesaving. Available online: https://www.countdown2030europe.org/storage/app/media/uploaded-files/Ukraine%20crisis%20are%20non-negotiable%20and%20lifesaving.pdf (accessed on 6 January 2023).
  3. Kismödi, E.; Pitchforth, E. Sexual and reproductive health, rights and justice in the war against Ukraine 2022. SRHM 2022, 30, 1. [Google Scholar] [CrossRef] [PubMed]
  4. Marcinkow, A.; Parkhomchik, P.; Schmode, A.; Yuksel, N. The Quality of Information on Combined Oral Contraceptives Available on the Internet. J. Obstet. Gynaecol. Can. 2019, 41, 1599–1607. [Google Scholar] [CrossRef] [PubMed]
  5. Pew Research Center. Health Fact Sheet. 2013. Available online: https://www.pewinternet.org/2013/01/15/health-online-2013/ (accessed on 3 January 2023).
  6. Hesse, B.W.; Moser, R.P.; Rutten, L.J. Surveys of physicians and electronic health information. N. Engl. J. Med. 2010, 362, 859–860. [Google Scholar] [CrossRef] [PubMed]
  7. Available online: https://www.unian.info/society/media-space-internet-bypasses-tv-as-main-news-source-for-ukrainians-11330729.html (accessed on 4 January 2023).
  8. Ranking of Search Engines on an International Scale on Desktop Devices. Available online: netmarketshare.com (accessed on 19 January 2023).
  9. Ginsberg, J.; Mohebbi, M.H.; Patel, R.S.; Brammer, L.; Smolinski, M.S.; Brilliant, L. Detecting influenza epidemics using search engine query data. Nature 2009, 457, 1012–1014. [Google Scholar] [CrossRef]
  10. On the Predictability of Search Trends. Available online: https://static.googleusercontent.com/media/research.google.com/zh-CN//archive/google_trends_predictability.pdf (accessed on 6 January 2023).
  11. Espósito, M.C.C.; Espósito, A.C.C.; Lemos, F.K.; Jorge, M.F.S.; D’Elia, M.P.B.; Miot, H.A. Melasma: Internet search trends around the world (2000–2019). Indian J. Dermatol. Venereol. Leprol. 2022, 88, 675–677. [Google Scholar] [CrossRef]
  12. Ukraine’s Surrogacy Industry Has Put Women in Impossible Positions. Available online: https://www.geneticsandsociety.org/article/ukraines-surrogacy-industry-has-put-women-impossible-positions (accessed on 3 January 2023).
  13. Mosher, W.D.; Jones, J. Use of Contraception in the United States: 1982–2008. Vital Health Stst. 2010, 23, 1–44. Available online: https://www.cdc.gov/nchs/data/series/sr_23/sr23_029.pdf (accessed on 3 January 2023).
  14. Resolution Adopted by the General Assembly, United Nations Millennium Declaration 2000. Available online: https://digitallibrary.un.org/record/422015 (accessed on 4 January 2023).
  15. Resolution Adopted by the General Assembly on 25 September 2015, Transforming Our World: The 2030 Agenda for Sustainable Development. Available online: https://documents-dds-ny.un.org/doc/UNDOC/GEN/N15/291/89/PDF/N1529189.pdf?OpenElement (accessed on 11 March 2023).
  16. SDG Indicator 3.7.1 on Contraceptive Use|Population Division. Available online: un.org (accessed on 6 March 2023).
  17. Alkema, L.; Kantorova, V.; Menozzi, C.; Biddlecom, A. National, regional and global indicators and trends in contraceptive prevalence and the insatiable need for family planning 1990–2015: A systematic and comprehensive analysis. Lancet 2013, 381, 1642–1652. [Google Scholar] [CrossRef]
  18. Podolskyi, V.; Gemzell-Danielsson, K.; Marions, L. Experience and perception of contraception, survey among Ukrainian women. BMC Women’s Health 2018, 18, 159. [Google Scholar] [CrossRef]
  19. Slaymaker, E.; Scott, R.H.; Palmer, M.J.; Palla, L.; Marston, M.; Gonsalves, L.; Say, L.; Wellings, K. Trends in sexual activity and demand for and use of modern contraceptive methods in 74 countries: A retrospective analysis of nationally representative surveys. Lancet Glob. Health 2020, 8, 567–579. [Google Scholar] [CrossRef]
  20. State Statistics Service of Ukraine. Population. Available online: Ukrstat.gov.ua (accessed on 2 January 2023).
  21. Muscato, L.; Kidd, R.S. Contraception and abortion attitudes and practices of Western Ukraine women. Eur. J. Contracept. Reprod. Health Care 2003, 8, 80–86. [Google Scholar] [CrossRef]
  22. Barska, J. Condom use with different types of sexual partners in Ukraine: Results of 2007 survey. Tob. Control. Public Health East. Eur. 2012, 2 (Suppl. S1), 65–66. [Google Scholar]
  23. Wesolowski, K. Prevalence and Correlates of the Use of Contraceptive Methods by Women in Ukraine in 1999 and 2007. Eur. Asia Stud. 2015, 67, 1547–1570. [Google Scholar] [CrossRef]
  24. Mogilevkina, I.; Odlind, V. Contraceptive practices and intentions of Ukrainian women. Eur. J. Contracept. Reprod. Health Care 2003, 8, 185–196. [Google Scholar] [CrossRef]
  25. Buhling, K.; Hauck, B.; Dermout, S.; Ardaens, K.; Marions, L. Understanding the barriers and myths limiting the use of intrauterine contraception in nulliparous women: Results of a survey of European/Canadian healthcare providers. Eur. J. Obstet. Gynecol. Reprod Biol. 2014, 183, 146–154. [Google Scholar] [CrossRef] [PubMed]
  26. Regulation (ec) No 1931/2006 of the European Parliament and of the Council. Available online: https://eur-lex.europa.eu/eli/reg/2006/1931/corrigendum/2007-02-03/oj (accessed on 2 January 2023).
  27. Burlaka, O.V.; Vahnier, V.O. Reproductive health and contraception use by Ukrainian servicewomen in the current war zone: Questionnaire survey. Med. perspekt. 2021, 26, 105–114. [Google Scholar] [CrossRef]
  28. Available online: https://data.worldbank.org/indicator/SP.DYN.TFRT.IN? (accessed on 3 January 2023).
  29. International AIDS Society. IAS Calls for Securing Access to Health Services and HIV in Ukraine 2022. Available online: https://iasociety.org/The-latest/News/ArticleID/291/IAS-calls-on-the-safeguarding-of-access-to-health-and-HIV-services-in-Ukraine (accessed on 7 January 2023).
  30. Krotik, O.I. Epidemiology of sexually transmitted infections in Ukraine. Reprod. Endocrinol. 2020, 56, 8–12. [Google Scholar] [CrossRef]
  31. Tsagkaris, C.; Matiashova, L.; Vladychuk, V.; Moysidis, D.V.; Papadakis, M.; Trompoukis, C. Public Health Considerations for Wartime HIV and COVID-19 in Ukraine: Using Modern History to Address Syndemic. Ethics Med. Public Health 2022, 22, 100795. [Google Scholar] [CrossRef]
  32. Awuah, W.A.; Mehta, A.; Kalmanovich, J.; Yarlagadda, R.; Nasato, M.; Kundu, M.; Abdul-Rahman, T.; Deborah Fosuah, A.; Sikora, V. Inside the Ukraine war: Health and humanity. Postgrad. Med. J. 2022, 98, 408–410. [Google Scholar] [CrossRef]
  33. Neal, S.; Cox, P.; March-McDonald, J.; Hutchinson, A. A place of safety? Protecting the sexual and reproductive health and rights of Ukrainian sanctuary-seeking women and young people. BMJ Sex Reprod. Health 2022, 48, 243–245. [Google Scholar] [CrossRef]
  34. War in Ukraine: Situation Report from WHO Ukraine Country Office. Issue No.38, 30 December 2022. Available online: https://reliefweb.int/report/ukraine/war-ukraine-situation-report-who-ukraine-country-office-issue-no38-30-december-2022 (accessed on 6 January 2023).
  35. Operational Data Portal-Situations. Available online: https://data.unhcr.org/en/situations/ukraine#_ga=2.155895355.1801515662.1649249730-1876372715.1649249730 (accessed on 6 January 2023).
  36. UNFPA Ukraine Emergency Situation Report #4. Available online: https://www.unfpa.org/resources/ukraine-emergency-situation-report-4-14-march-2022 (accessed on 6 January 2023).
  37. Abortions in Ukraine: What Does the State Guarantee?—Jurfem. Available online: https://jurfem.com.ua/en/abortions-in-ukraine-what-does-the-state-guarantee/ (accessed on 23 April 2023).
  38. Available online: https://it.comments.ua/ (accessed on 4 January 2023).
  39. Available online: https://ain.ua/ru/2013/02/12/gosstat-schitaet-chto-v-ukraine-5-mln-internet-polzovatelej/ (accessed on 4 January 2023).
  40. Available online: https://focus.ua/ (accessed on 5 January 2023). (In Ukrainian).
  41. Available online: https://www.speedtest.net/global-index/ukraine#fixed (accessed on 4 January 2023).
  42. Nuti, S.V.; Wayda, B.; Ranasinghe, I.; Wang, S.; Dreyer, R.P.; Chen, S.I.; Murugiah, K. Using Google Trends in Healthcare Research: A Systematic Review. PLoS ONE 2014, 9, E109583. [Google Scholar] [CrossRef]
  43. Ryan, P.M.; Ryan, C.A. Mining Google Trends data for health information: The case of the Irish “CervicalCheck” screening programme revelations. Kureus 2019, 11, E5513. [Google Scholar] [CrossRef] [PubMed]
  44. Kow, R.Y.; Rafiai, N.M.; Alwi, A.A.; Low, C.L.; Rozi, N.R.; Siron, K.N.; Zulkifly, A.H.; Zakaria, Z.; Awang, M.S. Malaysian public interest in common medical problems: A 10-Year Google Trends analysis. Kureus 2022, 14, E21257. [Google Scholar] [CrossRef] [PubMed]
  45. Sousa-Pinto, B.; Anto, A.; Czarlewski, W.; Anto, J.M.; Fonseca, J.A.; Bousquet, J. Assessment of the Impact of Media Coverage on COVID-19–Related Google Trends Data: Infodemiology Study. J. Med. Internet Res. 2020, 22, 9611. [Google Scholar] [CrossRef] [PubMed]
  46. Datta, P.K.; Chowdhury, S.R.; Aravindan, A.; Nath, S.; Sen, P.; Chowdhury, S.R.; Nath, S. Looking for a Silver Lining to the Dark Cloud: A Google Trends Analysis of Contraceptive Interest in the United States Post Roe vs. Wade Verdict. Cureus 2022, 14, 27012. [Google Scholar] [CrossRef] [PubMed]
  47. Guldi, M.; Herbst, C.M. Offline Effects of Online Connection: The Impact of Broadband Diffusion on Adolescent Fertility Decisions. J. Popul. Econ. 2017, 30, 69–91. [Google Scholar] [CrossRef]
  48. Kearney, M.; Levine, P. Media influence social outcomes: Effect of MTV 16 and Pregnant on Teenage Childbearing. Am. Econ. Rev. 2015, 105, 3597–3632. [Google Scholar] [CrossRef]
  49. Larki, M.; Manouchehri, E.; Latifnejad Roudsari, R. Using Google Trends for Infodemic Research in Sexual and Reproductive Health Research. J. Midwifery Reprod. Health 2022, 10, 3529–3533. [Google Scholar]
  50. Jun, S.-P.; Yoo, H.S.; Choi, S. Ten years of change in Google Trends usage research: From the perspective of using big data and applications. Technol. Forecast. Soc. Chang. 2018, 130, 68–69. [Google Scholar] [CrossRef]
  51. Cervellin, G.; Comelli, I.; Lippi, G. Are Google Trends a reliable tool for digital epidemiology? Insights from different clinical settings. J. Epidemiol. Glob. Health 2017, 7, 185–189. [Google Scholar] [CrossRef]
  52. Shilo, S.; Rossman, H.; Segal, E. Axes of revolution: The challenges and promises of big data in healthcare. Nat. Med. 2020, 26, 29–38. [Google Scholar] [CrossRef] [PubMed]
  53. Rovetta, A.; Castaldo, L. A new infodemiological approach via Google Trends: A longitudinal analysis of COVID-19 scientific and infodemic names in Italy. BMC Med. Res. Methodol. 2022, 22, 1–14. [Google Scholar] [CrossRef] [PubMed]
Healthcare 11 01541 g001 550
Figure 1. Internet users’ interest in the following keywords: (A) “contraception”, (B) “condoms”, (C) “intrauterine device”. Source: trends.google.com.
Figure 1. Internet users’ interest in the following keywords: (A) “contraception”, (B) “condoms”, (C) “intrauterine device”. Source: trends.google.com.
Healthcare 11 01541 g001
Healthcare 11 01541 g002 550
Figure 2. Internet users’ interest in the keywords (A) “rape”, (B) “HIV”, (C) “syphilis”. Source: trends.google.com.
Figure 2. Internet users’ interest in the keywords (A) “rape”, (B) “HIV”, (C) “syphilis”. Source: trends.google.com.
Healthcare 11 01541 g002
Healthcare 11 01541 g003 550
Figure 3. Internet users’ interest in the keywords (A) ”surrogate motherhood”, (B) “ovulation”, (C) “pregnancy test”. Source: trends.google.com.
Figure 3. Internet users’ interest in the keywords (A) ”surrogate motherhood”, (B) “ovulation”, (C) “pregnancy test”. Source: trends.google.com.
Healthcare 11 01541 g003
Table
Table 1. The list of terms.
Table 1. The list of terms.
All Keywords Subjected to Initial GT AnalysisKeywords That Reached the Threshold Value of Searches in the Analyzed TimeKeywords for Which the Number of Searches Did Not Reach the Threshold Value in the Analyzed Time
Contraception
Emergency contraception
Birth control pills
Intrauterine device
Condoms
Morning-after pill
Pregnancy
Symptoms of pregnancy
Pregnancy test
Gynecologist
Birth
Ovulation
HIV
Syphilis
Gonorrhea
Surrogate
Birthing clinic
Surrogacy
Infertility treatment clinic
Safe abortion
Abortion
Sexual violence
Rape
Childbirth outside the hospital
Abortive measures
Stress and pregnancy
Impact of stress on pregnancy
Period
Tampon
Sanitary pads
Contraceptive implant
Contraceptive patch
Natural contraception		Contraception
Emergency contraception
Birth control pills
Intrauterine device
Condoms
Morning-after pill
Pregnancy
Symptoms of pregnancy
Pregnancy test
Gynecologist
Birth
Ovulation
HIV
Syphilis
Gonorrhea
Surrogate
Surrogacy
Abortion
Sexual violence
Rape
Period
Tampon		Birthing clinic
Infertility treatment clinic
Safe abortion
Childbirth outside the hospital
Abortive measures
Stress and pregnancy
Impact of stress on pregnancy
Sanitary pads
Contraceptive implant
Contraceptive patch
Natural contraception
Table
Table 2. List of terms and peaks of interest according to Google Trends for individual terms.
Table 2. List of terms and peaks of interest according to Google Trends for individual terms.
KeywordNative Language PasswordsPeak of InterestTest Results (Chi-Squared Test X2)
from 1 January 2021 to 23 February 2022
(before the War)		from
24 February 2022 to 1 January 2023 (after the War Outbreak)
Birth control pillsпрoтизапліднітаблеткиPeak date4–10 July 202120–26 November 2022X2 = 0.529; df = 1; p = 0.4670
GT scale89100
Intrauterine deviceвнутрішньoматкoваспіральPeak date2–8 January 202220–26 November 2022X2 = 23,690; df = 1; p < 0.0001
GT scale10042
CondomsпрезервативиPeak date31 October–6 November 202130 October–5 November 2022X2 = 7006; df = 1; p = 0.0081
GT scale65100
Emergency contraceptionекстренакoнтрацепціяPeak date4–10 July 202124–30 July 2022X2 = 2235; df = 1; p = 0.1349
GT scale79100
Morning-after pillтаблеткипісляPeak date28 February–6 March 20213–9 July 2022X2 = 0.187; df = 1; p = 0.6658
GT scale10093
ContraceptionКoнтрацепціяPeak date25–31 August 202116–22 October 2022X2 = 0.000; df = 1; p = 1.0000
GT scale100100
Pregnancy testТестнавагітністьPeak date24–30 October 202124–30 July 2022X2 = 11,165; df = 1; p = 0.0008
GT scale58100
OvulationОвуляціяPeak date7–13 November 20216–12 November 2022X2 = 13,831; df = 1; p = 0.0002
GT scale53100
Birth НарoдженняPeak date31 January–6 February 20217–13 August 2022X2 = 3273; df = 1; p = 0.0704
GT scale76100
Pregnancy ВагітністьPeak date24–30 January 2021 3–9 July 2022X2 = 1790; df = 1; p = 0.1809
GT scale81100
Symptoms of pregnancyсимптoми вагітнoстіPeak date3–9 October 20213–9 July 2022–20–26 November 2022X2 = 0.000; df = 1; p = 1.0000
GT scale10099
Gynecologist ГінекoлoгPeak date18–24 July 202130 October–5 November 2022X2 = 1054; df = 1; p = 0.3046
GT scale86100
PeriodМенструаціїPeak date26 September–2 October 202112–18 June 2022X2 = 0.000; df = 1; p = 1.0000
GT scale99100
TamponТампoнPeak date26 June–2 July 202225–31 July 2022X2 = 1771; df = 1; p = 0.1833
GT scale83100
HIV ВІЛPeak date28 November–4 December 202122–28 May 2022X2 = 6964; df = 1; p = 0.0083
GT scale66100
SyphilisСифілісPeak date7–13 November 202113–19 November 2022X2 = 6095; df = 1; p = 0.0136
GT scale68100
GonorrheaГoнoреяPeak date24–30 January 202119–25 June 2022X2 = 1391; df = 1; p = 0.2382
GT scale10084
Surrogate СурoгатPeak date9–15 January 202218–24 December 2022X2 = 3273; df = 1; p = 0.0704
GT scale10076
SurrogacyсурoгатнематеринствoPeak date7–23 October 202120–26 March 2022X2 = 1391; df = 1; p = 0.2382
GT scale84100
Abortion АбoртPeak date10–16 January 2021 26 June–2 July 2022X2 = 1054; df = 1; p = 0.3046
GT scale10086
Sexual violenceсексуальненасильствoPeak date9–15 January 202224–30 July 2022X2 = 0.766; df = 1; p = 0.3815
GT scale88100
Rape зґвалтуванняPeak date28 February–6 March 2021 and 10–16 October 202110–16 April 2022X2 = 11,165; df = 1; p = 0.0008
GT scale58100
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Błajda, J.; Kucab, A.; Miazga, A.; Masłowski, M.; Kopańska, M.; Nowak, A.; Barnaś, E. Google Trends Analysis Reflecting Internet Users’ Interest in Selected Terms of Sexual and Reproductive Health in Ukraine. Healthcare 2023, 11, 1541. https://doi.org/10.3390/healthcare11111541

AMA Style

Błajda J, Kucab A, Miazga A, Masłowski M, Kopańska M, Nowak A, Barnaś E. Google Trends Analysis Reflecting Internet Users’ Interest in Selected Terms of Sexual and Reproductive Health in Ukraine. Healthcare. 2023; 11(11):1541. https://doi.org/10.3390/healthcare11111541

Chicago/Turabian Style

Błajda, Joanna, Anna Kucab, Aldona Miazga, Maciej Masłowski, Marta Kopańska, Anna Nowak, and Edyta Barnaś. 2023. "Google Trends Analysis Reflecting Internet Users’ Interest in Selected Terms of Sexual and Reproductive Health in Ukraine" Healthcare 11, no. 11: 1541. https://doi.org/10.3390/healthcare11111541

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop