Dominique Mollet, LLM, BA, PhD candidate and lecturer, Faculty of Law, University of Groningen, s.d.mollet rug.nl, Sophie Kroezen, LLB, BSc, research assistant IT law and LLM student IT law and Legal Research, Faculty of Law, University of Groningen, s.i.c.kroezen rug.nl and Pepijn Tukker, LLM, lecturer and researcher IT law, Faculty of Law, University of Groningen, p.f.t.tukker rug.nl.

Content warning: this blog discusses mental health and suicide, as well as abortion. This may be distressing for readers. If you are thinking of suicide and self-harm, please find more information about help initiatives via the IASP database.

Introduction

The rapid pace at which the digital world is developing brings opportunities, but also poses challenges to guaranteeing human rights protection in the online world, where they equally exist as in the offline world. Marking World Health Day, this blog explores how the right to health might structurally be at stake in the context of increased social media use (SMU), particularly among children, adolescents and young adults.

It does so along the line of three case studies (ranging from individualised to more societal) illustrating SMU’s impact on the right to mental health; the right to sexual and reproductive health rights; and the right to health in the context of non-communicable disease (NCD) prevention. The blog remains limited to these angles, although many more relevant angles exist; as well as to the right to health, as enshrined in Articles 24 Convention on the Rights of the Child (CRC) and 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), despite the relevance of other rights, including the best interest of the child (Article 3 CRC) and the right to information (Article 17 CRC).

The right to mental health

It is widely recognised that SMU may have a negative impact on children’s mental health.  This section discusses the coroner’s report following the tragic death of Molly Russell, a fourteen-year-old girl. Notably, Molly’s intensive SMU was connected to the further deterioration of a depressive illness, which ultimately may have led to her passing.

In the coroner’s Prevention of Future Death’s report following Molly’s passing in 2017, the coroner notes that prior to her death, Molly had viewed content that discouraged discussion with aid providers, promoted isolation, appeared to romanticise acts of self-harm and sometimes depicted ‘self-harm and suicide as an inevitable consequence of a condition that could not be recovered from’ (p. 2). He also highlighted that algorithms may have facilitated binging periods and that some of the content viewed was suggested by the algorithm, rather than directly requested by Molly herself. The coroner harrowingly concludes that ‘[i]t is likely that the […] material viewed by Molly, already suffering with a depressive illness and vulnerable due to her age, affected her mental health in a negative way and contributed to her death in a more than minimal way’ (p. 2, emphasis added).

The right to health extends to both physical and mental health. The entitlement of this right is not limited to the offline world and, especially considering the challenges posed, must be protected online as well. CRC General Comment no. 25 on the rights of the child in relation to the digital environment indicates that States are mandated to regulate against known harms to prevent the spread of materials that may damage children’s mental health (para. 96). Following the obligation to protect the right to health from third parties’ interference, social media platforms’ regulation could be required. This could include restricting the design of algorithms that promotes binging periods and suggests content that may be harmful to the (mental) health of the child. Furthermore, regard should be had to the fact that mental health issues in general, as well as problematic SMU appear to be more prevalent among girls.^[1] In implementing the right to health, the potential differing needs of boys and girls in the context of SMU and children’s mental health should be taken into consideration (CRC General Comment No. 15, para. 9).

Sexual and reproductive health rights: (mis)information

Social media offers new ways to disseminate and retrieve information, but also facilitates the spread of mis- and disinformation. A study by Rutgers, the Netherlands Centre on Sexuality, published in 2024, including 36 TikTok videos, indicates a lack of objective information about contraceptives’ functioning, usage, costs, advantages and disadvantages. Most of the videos investigated were based on personal experiences of users, and more than half of them did not include a source. None of the videos were produced by a medical expert or scientific institute. Additionally, Pointer analysed nearly 400 popular TikTok-videos about contraception, of which 13% contained misinformation about hormonal contraception. Another recent study among 422 women who visited a Dutch abortion clinic indicates that 41% of women did not use any form of contraception in the month preceding the unintended pregnancy. Experiences and/or information shared on social media supported 9% of women in their decision regarding contraception. 

This is happening in light of an increase of Dutch abortion rates in 2022 (35,606) and 2023 (39,332), as compared to abortion rates between 2010 and 2021 (between 30,000 and 32,000) – although the increase may be attributed to new techniques included in the Dutch definition of abortion, which previously did not count as such, thereby inflating the number. Although a connection between the increasing abortion rates, non-use of contraceptives and online misinformation has not been conclusively established, the increased ease with which misinformation can be spread into a large population, including vulnerable groups, is worrying.

Sexual and reproductive health rights are an integral part of the right to health. The Committee on Economic Social and Cultural Rights’ (CESCR) General Comment No. 22 dedicated to this theme indicates that ‘all individuals and groups, including adolescents and youth, have the right to evidence-based information on all aspects of sexual and reproductive health, including [...] contraceptives’ (para. 18, emphasis added). Accordingly, States must protect individuals from the dissemination of misinformation by third-parties (para. 41). Following CRC General Comment No. 25 on children’s rights in the digital environment, States must ensure protection from mis- and disinformation disseminated digitally by, among other parties, content creators, as well as ensure that digital content providers develop and implement guidelines ensuring children’s rights in this context (para. 54).

The right to health in the context of NCD prevention: advertising

Advertising practices are effective tools to increase consumption of the advertised goods: it has a great impact on consumption patterns. Industries, including the tobacco industry, invest in this, sometimes to the detriment of public health. In the case of tobacco and related products, alcoholic beverages and foods and beverages high in sugars, sodium and saturated fats, the WHO has been very clear: strong policies are necessary to protect children and/or adults. This is particularly so given that the consumption of such substances is an important risk factor for non-communicable diseases (NCDs), which are still on the rise and accounted for 75% of all non-pandemic related deaths globally in 2021.

It is well established that the right to health requires regulation of tobacco products, alcoholic beverages and food and beverages’ advertising. In its General Comment No. 14 on the right to health, CESCR states that ‘the failure to discourage production, marketing and consumption of tobacco, narcotics and other harmful substances’ amounts to a violation of the obligation to protect (para. 51). Recognising that States must protect children from alcohol and tobacco, CRC General Comment No. 15 recommends the regulation of the advertising of such products and of their promotion, including in media channels (para. 65). This also extends to due diligence obligations for private companies, which should limit advertising of unhealthy foods and refrain from advertising tobacco, alcohol and other toxic substances to children (para. 81).

For the right to health to be protected adequately, regulatory efforts must extend to the online world. In the digital world, individuals are at a higher risk of being (more frequently) exposed to unhealthy products’ advertising. This is not only due to the increased use of social media, but also due to the challenges associated with regulating the online environment and its effective enforcement. CRC General Comment No. 25 on children’s rights in relation to the digital environment confirms this and requires the promotion of healthy lifestyles and the deployment of digital services to prevent children’s exposure to, among other products, certain food and beverages, alcohol, tobacco and other nicotine products (para. 97).

Concluding remarks

This blog post only reveals the tip of the iceberg: SMU and (the right to) health are connected in many more ways. As we are in the middle of the information age and effective technology sometimes passes us by, it is time to consider the structural impact of technological development, including social media use, on (the right to) health.

Cross-posted from the Human Rights Here blog.

[1] Note that these statistics are not connected, but that they exist besides each other.