Abstract / Summary
Abstract Background 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‐related posts. We systematically analyzed Instagram posts to identify key themes, assess engagement patterns, and determine factors influencing the reach and impact of CPC‐related content. Methods We conducted a mixed‐methods 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‐transformed 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. Results Service Promotion & Outreach was the most common theme (49%), followed by Emotional Appeals (23%), Ideological Messaging (18%), and Misinformation & Misrepresentation (10%). Posts containing misinformation or misrepresentation received significantly higher engagement, with a 46% increase in predicted likes compared with Service Promotion & Outreach posts (β = 0.38, p < .05). Log followers was strongly associated with engagement (β = 0.68, p < .001). Reels received substantially more likes than still‐image grid posts. Certain posting months and wellness‐ or location‐based 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. Conclusions On Instagram, CPC posts containing misinformation and misrepresentation received disproportionately higher engagement compared to service‐oriented 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.