Period tracking apps and your health as a product

It is becoming more and more common for us to create accounts in different applications to manage different spheres of our life. The menstrual cycle monitoring and control applications come with the promise of giving women greater awareness of their cycles as well as assisting in family planning – whether for the purpose of avoiding or reaching a pregnancy. However, the debate over the use of data provided by users is increasing, as well as the concern with the skills and limits of this type of application. According to the North American consulting and research firm, Frost & Sullivan, the Femtech market (technologies applied to women’s health management, such as the applications discussed here) has the potential to reach the market value of $ 50 billion by 2025. In today’s post, we will discuss the handling and capitalization of these extremely intimate data, and how these applications may be leveraging predictive algorithms and influencing our routine, intimate life, consumption, and reproductive health. 

My health or “your” data?

It is no surprise that the data we provide every day, associated with our accounts and profiles, and the traces we leave when surfing the Internet are stored and used for advertising purposes. If we cross information from different websites and databases, we have something like a caricature, able to reveal consumer and behavioral profiles that can tell more about us than we can measure, and in some cases the data may be more sensitive than others. In 2018, IRIS wrote about the risks of the controversial practice of asking the customer’s CPF number to the pharmacy cashier, without transparency or information as to what that data would serve. In the case of menstrual control applications, algorithms are trained to understand the hormonal phase in which we find ourselves and often suggest patterns of behavior or symptoms that we may experience. In Fernanda Bruno’s book, Maquinas de ver, modos de ser, the author discusses the generalized surveillance scenario in which we live, where vigilance and control devices are diluted in the most distinct instances of personal and collective life. In writing about predictive algorithms, it alerts us to the effect they can exert on our daily lives, inducing behaviors and consumption, for example. In this case, this happens when the application suggests that you routinely do ovulation testing, or that you consume sweets when you are in the pre-menstrual period. By 2015, the Glow application could notify the user’s partner that she would be entering the fertile period, and that it would be convenient to send her flowers (for profiles that used the application as a way to achieve a pregnancy). In the Glow Nurture extension, which is designed for women who want to follow their current pregnancy, in addition to being advised to provide various information about their physical, psychological, diet and health status, the application offers a version of the app so that the companions of those users provide “objective information” about his/her partner’s mood. On the application site the advertisement is as follows: 

“The weather forecast is difficult … but the prediction of the symptoms should not be. Everything new in Glow: a prediction feature that picks up your past data and uses them to show a little of what to expect this week. Are cramps on the horizon? Fatigue? And if so, what can you do about it? Glow knows … ” 

In a paper of 2016 called Intimate Surveillance, author Karen Levy, a professor in the Department of Information Science at Cornell University, warns us that this type of algorithm is always based on some social norms of behavior and understanding about the female body and its functioning, ultimately they have a conception of what it is to be a woman of childbearing age. Based on what? Under whose vision? This means that they are not neutral “councils”, they reproduce a type of common sense that, in most cases, does not carry the plurality and singularity of each female body, transforming complex organisms, unique and crossed by different experiences in data standardized, thus excluding a number of other experiences that will not fit into these standards. 

Application boundaries

Health control through applications and the tendency for individuals to come up with solutions to their issues themselves, is consonant with a transformation in the understanding of the responsibility of oneself as an attribution of individuals. More and more people become entrepreneurs of themselves, working autonomously, responsible for their success. This opens up a new social dynamic that, to some extent, transforms the working relationships we knew, as well as the role we attribute to the specialists. In this sense, subjects can manage their own health through the knowledge of their body taught by applications, another example are the platforms that remind you and teach a routine of exercise, or diet.  

The algorithms are prepared to process the data provided by the users themselves – cycle´s start and end date, frequency of protected or unprotected sex, mood, physical symptoms such as cramps or sinus pain, among several other options available – to prepare predictions and provide predictions about the phases of the cycle. 

A survey of Columbia University Medical Center has studied 108 applications with a free version available from the Apple Store to evaluate its features and functionality. Among the results, 95% of them had a health professional involvement, and in only 5% of them there was literature cited. 

Some of the applications are called contraceptive methods, such as Natural Cycles. In July 2018 The Guardian published a story about a protest movement about the limits of these contraceptive applications, with the report of a woman who interrupted an unwanted pregnancy after using the platform and said:

“I used the application in the same way as I do most of the technology of my life: I do not quite know how it works, but I’m sure it works”.

In January of that year, the Swedish Medical Products Agency began investigating the application after a significant number of women who had resorted to abortion in hospitals, reported using the Natural Cycles application as a contraceptive method. The application responded that the numbers were within the range of the predicted since the number of users had increased, soon the failures also would increase. According to the site, the success rate of the program is 93% for typical use and 99% for perfect use. After the evaluation, the agency judged that the application worked as expected, however indicated that the risk of unwanted pregnancy should be explicit in the instructions for use. 

Who cares about my intimate data?

In April, the portal The Washington Post, talked about the data purchasing practice of reproductive health control applications by companies in order to get information about the health of their pregnant employees. Women also received a one-dollar-a-day incentive to use the application regularly, according to the company, as a way to encourage health care for their employees, by planning better for the upcoming months and reducing the expenses on health. Employers gained access to information about pregnancy and prenatal care, whether the baby was born prematurely, whether there was any complication, and even the plans of returning to work. In addition to the contracting companies, the health insurance industry also purchased access to this data. The fact is that this type of information tells a lot about our living conditions and predisposition to complications and diseases. The treatment of this kind of data, which is extremely intimate and sensitive, can be used in a discriminatory way – have you ever imagined this being taken into account when your boss thinks of a promotion of your position ?, or that you have access to insurers health hampered once they know your health condition? 

Conclusion

We build and feed the most valuable products of these companies: an algorithm that improves the more data we offer and an database extremely interesting for the women’s reproductive health industries, in particular the pharmaceutical industry. The privacy policies are not clear enough so that we know what will be done from the moment we enter the platform. In general, the terms of consent are trivialized, written in small print, and too broad. And even if one day we want to delete our profile, the data will still be available to the company. Some applications have more transparent and responsible terms for the protection of their users, in this matter, the organization Codin Rights makes a reading of the settings of some of the most popular applications. 

The debate over privacy, vigilance, algorithmic governance, has no prospect to stop. On the contrary, every day we are faced with new obstacles and facets of the same problem. As #WomenInGovernance, we will remain vigilant for autonomy over our bodies and also over our data.