Images of post-mastectomy scarring on Instagram: An evaluation of content moderation ad the implications for public health

This paper presents the results of a pilot study examining the moderation of images depicting post-mastectomy scaring on Instagram by skin tone darkness and the presence or absence of tattoos. It focuses on Instagram given widespread concerns that images of women’s bodies are arbitrarily moderated on the platform, and on depictions of post-mastectomy scarring, one of few explicitly allowed categories of content on Instagram, because mastectomies have important ramifications for women’s self-image and identity worldwide. After using an input/output method of black box analytics, in conjunction with content analysis, preliminary data show potential false positives (n = 31/74 images). While these results are not statistically significant, there is a strong argument for further in-depth investigation as there appears to be differences in removal rates by presence of tattoos and by skin tone darkness. Specifically, a logistic regression suggests that the odds of an image being removed increase by a factor of 1.21 for every unit increase in skin tone darkness. Potential arbitrariness is concerning in this context for many reasons, including that content takedowns can have negative effects on the well-being of women seeking to share their experiences with, or learn from the experiences of, others who have undergone mastectomies. This research ultimately aims to make valuable contributions to the growing body of literature on the moderation of female forms on Instagram and contribute to ongoing debates around the transparency and accountability of platform governance more broadly.