How period and fertility apps are quietly taking control

Blindly trusting a prediction

An app that flawlessly predicts when your next period will start, whether you will feel irritable today, and when you are most fertile. Millions of women and menstruating individuals entrust their most intimate data to the cycle tracker on their smartphones every day. What once started as a simple, digital alternative to the paper calendar has grown into a multi-billion-pound industry powered by advanced algorithms. These so-called 'FemTech' apps promise us the ultimate insights and control over our bodies. But who is pulling the strings: you or the app? VU Amsterdam researchers Tamara Thuis and Maria Carmen Punzi delved into the invisible ethical pitfalls of period and fertility apps. 'We risk unknowingly handing over the interpretation of our own bodies.'

Author: Mika Linse

Our perspective on women's health and fertility is changing rapidly. More women are having doubts about the pill or other hormonal contraceptives and are looking for natural alternatives. Tech companies are cleverly capitalising on this need with so-called 'FemTech' (technology aimed at women). Through cheerful, often pink apps, they promise that we can discover patterns in our own bodies. Based on the data you enter, the app predicts your next period, the moment of your ovulation, and even impending mood swings.

Yet, this blind faith in technology is not without its risks, emphasise VU Amsterdam researchers Tamara Thuis and Maria Carmen Punzi. They met during their PhD research at Erasmus University, where they brought together a unique combination of expertise. Thuis immersed herself in the ethics and governance surrounding algorithms and artificial intelligence in organisations. Punzi, on the other hand, investigated how companies are trying to break the taboo surrounding menstruation.

'During dinners together, we got talking about the stories we saw in the media and heard within our own group of friends,' says Thuis. 'We suddenly realised: these apps often run on AI algorithms, yet they are used for highly intimate decisions about our health. That is an environment where mistakes can have massive consequences. It directly touches upon the much wider societal debate about how we deal with menstruation and contraception nowadays.'

'We risk unknowingly handing over the interpretation of our own bodies.'

Blind faith in a prediction Whereas previously the interpretation of our symptoms was primarily in the hands of medical experts – sometimes difficult to reach but trained for years – invisible algorithms have now entered the stage as convenient, readily available alternatives. 'With the pill or an IUD, part of the responsibility is sorted out in advance, meaning users have to think less about it,' Thuis explains. 'When using an app, this responsibility is reshaped and often shifts more towards the user. The only problem is: we often do not understand the underlying method, let alone the consequences of how we use these apps. After all, how precisely and consistently you record data can directly impact their reliability.'

This lack of knowledge is particularly risky in a society where good sex education is far from a given, and women's physical complaints are still too often brushed aside in the consultation room. 'Users are quite simply desperate for answers,' Punzi adds. She specifically warns against the seemingly factual, data-driven appearance of FemTech. 'We know that most women are not satisfied with current contraceptive options. It is therefore not surprising that they place their trust in these apps, even if they do not fully understand the mechanics behind them. They are looking for alternatives, and the companies behind these apps are incredibly good at projecting trustworthiness and making users feel heard. But while the algorithm might give them a "safe" feeling, blindly trusting it can unfortunately still lead to unwanted pregnancies.'

Programmed inequality The creators like to present their apps as purely factual and scientific, but in practice, capturing the menstrual cycle in data and algorithms remains a challenge. The clever tricks behind the scenes (the algorithms) rely on historical data, and this data can be incomplete or unrepresentative of all potential users. Punzi explains: 'It is often rightly said that medical science primarily takes the male body as the standard. But even the little we do know about the female body is based on one very specific type: the white, affluent, and perfectly healthy woman.' If you deviate from this norm – for example, because you have chronic pain, an unpredictable cycle, or a specific medical condition – the app is more likely to miss the mark by making inaccurate predictions.

'By using labels such as ‘abnormal’ or ‘irregular’, experiences are effectively flattened into categories and boxes.'

Designers who turn a blind eye to these differences are essentially just building a digital replica of the inequality that already exists in healthcare. Punzi: 'If you think you can design a completely neutral app, you are simply reinforcing the system we already have. And that system is fundamentally unfair to begin with.'

On top of this, the app actively influences how you view your own body. By using labels such as 'abnormal' or 'irregular', experiences are effectively flattened into categories and boxes. For instance, do you suddenly receive a notification that your premenstrual symptoms (PMS) are approaching? Then the so-called 'nocebo effect' can cause you to unconsciously actually feel worse or grumpier, purely because the app says so. Thuis warns: 'There is a risk that we stop trusting ourselves, and inadvertently surrender the power of our own intuition when it comes to our periods.'

'Ultimately, the question is not whether using an app is good or bad, but how and why you use it.'

A regulatory blind spot Who is responsible when things go wrong? If you used to misread your paper calendar, you knew the fault lay with you. But who do you blame if the app makes a miscalculation and you end up with an unwanted pregnancy as a result? The answer is complicated, especially because the creators often cleverly stay in the background.

'To users, these apps are often like invisible ghosts; anonymous and faceless,' Punzi explains. 'People do not stop to think that they are dealing with a commercial company. With many apps, there is simply a CEO pulling the strings somewhere who wants to make money off you.' This lack of transparency poses major risks to our privacy and patient safety.

Punzi gives a painful example of how skewed the rules currently are in the Netherlands: 'Rutgers, the national centre of expertise on sexuality, is not allowed to just run major advertising campaigns for contraception. The law forbids this because it falls under the strict regulations for medical products.' However, because most period apps use a legal loophole to avoid being officially classified as 'medical devices', they are allowed to advertise limitlessly and without warnings on platforms like Instagram and Facebook. 'There is a massive loophole in the law,' warns Punzi. 'As a result, these companies can go about their business completely unchecked and, in the worst-case scenario, sell your most intimate health data with impunity.'

Making the technology work for us Despite these stern warnings, Thuis and Punzi's message is absolutely not that we should all delete these apps from our phones en masse. If we take the ethical risks seriously, the technology behind these apps can actually be a huge step forward for women. Ultimately, according to the researchers, it all boils down to two simple things: staying in control yourself and understanding how the technology works behind the scenes. Therefore, to build your own body literacy with the help of an app, grasping how algorithms work is essential. Thuis concludes with a clear piece of advice: 'It is truly crucial that we understand how these algorithms operate. The more we grasp about them, the better we can translate the predictions to our own bodies ourselves. We must guard against letting an app dictate what we should do or how we should feel. Ultimately, the question is not whether using an app is good or bad, but how and why you use it.' Finally, the researchers emphasise that the solution must not lie solely with the user. Alongside digital literacy, there is therefore an active role to be played by the companies behind the apps and the government. For instance, they can guide users through how predictions are made, and actively contribute to education on menstruation, contraception, and the use of algorithms.

DEEL DEZE PAGINA