28 votes

Period-tracking apps are not for women

26 comments

  1. [15]
    patience_limited
    (edited )
    Link
    While some readers may not care about lady parts, the article provides useful insight into the divergence between what app users want, and what they're getting. It's also a grim look at just how...

    While some readers may not care about lady parts, the article provides useful insight into the divergence between what app users want, and what they're getting. It's also a grim look at just how much privacy invasion is hidden under the hood.

    Period and fertility apps seem to represent the worst of user-exploitive design. They're intended to gather the most intimate data, designed with little care, largely by people whose intent, experience, and knowledge differ drastically from the end users'. If you want a Newspeak word guaranteed to alienate, try "femtech".

    [I've been using the freemium Android app, Ovuview, for years. It was the best designed period tracker circa 2011 (dark theme!), before venture capital discovered the rich monetization possibilities of womanhood. I used to be quite sanguine (pun intended) about privacy in the paid version, but Ovuview seemingly hasn't kept up with the times: https://www.orcha.co.uk/Review/4819/]

    Edit: As I browse through the Orcha reviews, and as suggested in the article, there's no standard for clinical relevance in most "healthcare" applications. There's no stopping snake-oil promises, and you can't sue if an app gives you bad advice leading to an adverse outcome, like unintended pregnancy or unnecessary PCOS testing.

    Can you imagine a glucose-tracking app laid out in Candy Crush aesthetics? How about a blood alcohol content tracker shouting out its users as “bro” each time they opened the app? Of course not! But you’re just tracking your period symptoms for fun, or to avoid being caught on a long car ride without a tampon, right? Why not decorate it?

    The ways in which period-tracking or fertility-tracking apps are different reveal the ways most designers think of them: as products that provide information that’s not actually very serious or important medically, and that should exist mostly to convince a woman to spend as much time as possible looking at ads, while supplying the owner with as robust a data set as possible, so they can better target more ads.

    “It’s good enough” is the refrain Wachter-Boettcher says she hears from women. “It does what I need, but I don’t know why it’s making this assumption or that assumption.”

    The University of Canberra’s Deborah Lupton — a researcher focused on what she terms “quantified sex” — told the Atlantic in 2014 that the way period-tracking and fertility-tracking apps are lumped together shows you everything you need to know about how developers think of women. “When you look at these types of apps, they’re completely about the surveillance of pregnant women,” she said, “making them ever more responsible and vigilant about their bodies for the sake of their fetus.”

    The data they generate can also be shared with developers, advertisers, researchers, and data brokers. Patient Privacy Rights founder Deborah Peel told the Washington Post in 2016 that reproductive health data is uniquely valuable to marketers — knowing that someone is preparing to become a parent means knowing that someone is about to enter one of the very few life stages in which they’re likely to get “hooked on new brands.”

    The commercialization of pregnancy is not exactly a new concept, but it’s reached a fever pitch in the digital age, when marketing to someone based on the hormones and genetic material swimming in their abdomen is as simple as pulling a few key pieces of easily trackable data.

    “WHEN YOU LOOK AT THESE TYPES OF APPS, THEY’RE COMPLETELY ABOUT THE SURVEILLANCE OF PREGNANT WOMEN”
    In some cases, this data is not even in anonymized formats. In 2016, Consumer Reports found security vulnerabilities in Glow so severe that user profiles could be accessed by “someone with no hacking skills at all.” That might sound like an exaggeration, so let me put it to you another way: The way Glow was set up in 2016, all you had to know in order to see a user’s full profile and account information was their email address, which is what led reporter Kelly Weill to dub the app “a jackpot for stalkers.” (Glow quickly fixed the issue and commented, “There is no evidence to suggest that any Glow data has been compromised.”)

    Today, the app has 15 million users, and this type of scale is its own pressure: Glow is now the only HIPAA-certified reproductive health app, and its 2016 panic was followed by a third-party security audit. That’s great! Unfortunately, scale is also what allows a tech company of this size — and with this obligation to investors — to open a whole other can of worms. With a wealth of fertility data at its disposal, Glow has expanded into the trendy business of IVF and egg freezing, equipped with a marketing strategy I don’t really think we should even try to get into without some light sedation, but we have no choice.

    If the goal of tech-enabled health tracking is to empower users to make informed medical choices, Glow is a great example of how not to do that. It takes its millions of users on a well-designed, user-friendly, fertility-obsessed road that ends in promises that egg freezing is a logical thing to pursue in your mid-20s. CEO and co-founded Mike Huang has also said that Glow data may be used to make “more accurate risk assessments … which will ultimately result in better health insurance,” an interesting comment given that the major North American life insurance company John Hancock announced last month that it will only sell “interactive” policies that track health via smartphones and wearables.

    21 votes
    1. [8]
      PopeRigby
      Link Parent
      I've seen a few period tracking apps on F-Droid. The apps on F-Droid are usually pretty high quality compared to Google play apps and they're always open source. I haven't personally checked them...

      I've seen a few period tracking apps on F-Droid. The apps on F-Droid are usually pretty high quality compared to Google play apps and they're always open source. I haven't personally checked them out because I'm a guy, but if you have an Android you could give them a try.

      13 votes
      1. [7]
        patience_limited
        Link Parent
        Unfortunately, open-source isn't necessarily a guarantee there won't be any non-consensual data use or leakage. Yes, it's possible to review the code, but that seems like a high barrier to entry....

        Unfortunately, open-source isn't necessarily a guarantee there won't be any non-consensual data use or leakage. Yes, it's possible to review the code, but that seems like a high barrier to entry. Also, if you've input years of data, non-portability is an issue.

        7 votes
        1. [5]
          cfabbro
          (edited )
          Link Parent
          Sure, but it makes it significantly less likely there is non-consensual data collection or leakage going on... and you don't have to personally do code review, other people who contribute do that...

          Unfortunately, open-source isn't necessarily a guarantee there won't be any non-consensual data use or leakage. Yes, it's possible to review the code, but that seems like a high barrier to entry. Also, if you've input years of data, non-portability is an issue.

          Sure, but it makes it significantly less likely there is non-consensual data collection or leakage going on... and you don't have to personally do code review, other people who contribute do that just by virtue of needing to understand the system before they can. And often times simply looking at who created it, how open they are about decision making and willing to interact/answer question they are, as well as who else/how many other people are contributing is just as valuable for gaining insight into how trustworthy a particular piece of opensource software is.

          9 votes
          1. [4]
            patience_limited
            Link Parent
            I'm not knocking open-source in general, but the only period tracking app I could find on F-Droid, Periodical, isn't a highly-active project, and most of the recent commits seem to be cosmetic,...

            I'm not knocking open-source in general, but the only period tracking app I could find on F-Droid, Periodical, isn't a highly-active project, and most of the recent commits seem to be cosmetic, bugs, or localization. Google Play only shows 5,000 downloads.

            The problem with community review is that you need an adequate-sized, involved community.

            4 votes
            1. [2]
              unknown user
              Link Parent
              Looking through that app (rather superficially; and I'm no Java or Android expert), it doesn't seem to connect to the Internet or load any libraries that can connect to the Internet anywhere,...
              • Exemplary

              Looking through that app (rather superficially; and I'm no Java or Android expert), it doesn't seem to connect to the Internet or load any libraries that can connect to the Internet anywhere, except in HelpActivity.java it loads and uses a WebView, but only to load a static asset, an HTML page included in the app itself. And even that does not include any links, internal or external, nor any JS. The other HTML asset, about.html, links to GPL license on GNU web site, and includes a single one-liner JS function that is unused and benign.

              I think the app looks safe privacy-wise, although someone who actually knows Android to some actual depth may give a better review. I don't think this sort of projects needs to be very actively maintained once the actual important features are in place. It's just bugfixes and and random little touches from there on, especially in this case where it's about 2000-3000 LoC of Java (i.e. what I mean is that the drop in maintainer activity is expected IMO).

              14 votes
              1. patience_limited
                Link Parent
                Thank you for taking the time - I've looked at the app and on a personal basis, it would meet my needs. However, it seems to be lacking a considerable amount of functionality that other current...

                Thank you for taking the time - I've looked at the app and on a personal basis, it would meet my needs. However, it seems to be lacking a considerable amount of functionality that other current commercial apps have available.

                There's a danger of losing the forest for the trees here. It's not that open-source development can't do far better in terms of security and privacy than the commercially available products.

                Unfortunately, the fact that only a single developer is attempting to meet this particular need, where commercial interests see a potential $50 billion market, says something about the interests, rewards and composition of the open-source community.

                5 votes
            2. cfabbro
              (edited )
              Link Parent
              Fair enough, and also very true about the community requirement. However the Periodical dev does seem pretty open about himself and still reasonably active on the project. Here is his blog:...

              Fair enough, and also very true about the community requirement. However the Periodical dev does seem pretty open about himself and still reasonably active on the project. Here is his blog:
              https://arnowelzel.de/ (German) - https://arnowelzel.de/en/ (English)

              2 votes
        2. PopeRigby
          Link Parent
          Definitely. I wouldn't trust it just because it's open source. Although being on Tildes, I'm fairly sure someone could take a look at the code if you asked.

          Definitely. I wouldn't trust it just because it's open source. Although being on Tildes, I'm fairly sure someone could take a look at the code if you asked.

          2 votes
    2. [2]
      Michibun
      Link Parent
      I'm curious if the new EU data protection regulations will have an impact on this. I'd imagine they'd run into trouble both with collecting and retaining this health information without consent,...

      I'm curious if the new EU data protection regulations will have an impact on this. I'd imagine they'd run into trouble both with collecting and retaining this health information without consent, and then with turning around and using it to market to women. Maybe it's naive of me but I'd hope that with the push towards data protection, privacy, and consent, they'll slowly move more away from surveillance/advertising based platforms and more towards user functionality.

      5 votes
      1. patience_limited
        Link Parent
        I haven't any special insight on what GDPR and other EU regulations might have to say about personal health apps - are there any experts in the house?

        I haven't any special insight on what GDPR and other EU regulations might have to say about personal health apps - are there any experts in the house?

        1 vote
    3. Catt
      Link Parent
      This was a really interesting article, thanks for posting. It echos pretty much all the reasons why I don't use an app tracker. I find in general, anything to do with a woman's period/fertility...

      This was a really interesting article, thanks for posting. It echos pretty much all the reasons why I don't use an app tracker.

      I find in general, anything to do with a woman's period/fertility and such are just so poorly understood, including by other women, that I don't believe there'll ever be a good technical solution until we address the underlining issue of how woman's health is treated.

      As for the privacy and ad issues, I find this is just true for any app. You get a free product, you become the product.

      2 votes
    4. [3]
      teaearlgraycold
      Link Parent
      Shouldn't this information be covered by HIPAA?

      Shouldn't this information be covered by HIPAA?

      1 vote
      1. [2]
        patience_limited
        Link Parent
        As noted in the original article, Glow had to apply for HIPAA-compliance certification independently. There's a rarefied distinction made between "protected health information" (which an app might...

        As noted in the original article, Glow had to apply for HIPAA-compliance certification independently.

        There's a rarefied distinction made between "protected health information" (which an app might share with a HIPAA-covered entity), and "consumer health information", which a person collects, manages and maintains for themselves.

        Technically, consumer health information isn't subject to HIPAA unless the data is intended for use by a HIPAA-covered entity. https://www.truevault.com/resources/compliance/what-is-the-difference-between-protected-health-information-and-consumer-health-information.html

        9 votes
        1. Gaywallet
          Link Parent
          A good cautionary tale to any health data collection entities (like apps) that aren't reporting data to your doctor or other healthcare entity. No HIPPA laws means they aren't required to encrypt...

          A good cautionary tale to any health data collection entities (like apps) that aren't reporting data to your doctor or other healthcare entity. No HIPPA laws means they aren't required to encrypt the data, send it securely, etc.

          5 votes
  2. [5]
    nsz
    Link
    Could a solution be to integrate period tracking options with just a normal calendar app. Probably the least unassuming way to go about it, they don't have any skin in the fertility game or really...

    Could a solution be to integrate period tracking options with just a normal calendar app. Probably the least unassuming way to go about it, they don't have any skin in the fertility game or really an agenda that is so focussed around fertility. Just from a design standpoint I can kind of see why period tracking apps would see it as their core mission or purpose to focus around fertility, and consequently it's highly focused user group become the product. They then have incentives to push users into these easy to categorise advertising targets. It kind of seems like the absurd deign choices and assumptions are made because that's the only thing the app does so a focus on it seems natural.

    Idk though if google calendar, outlook or whatever apple has would do any better as custodians of such personal information.

    3 votes
    1. [3]
      patience_limited
      Link Parent
      Part of the issue with this strategy, aside from the data mining, is that there's deeper functionality expected than marks on a calendar and date calculations. I don't think calendar APIs can...

      Part of the issue with this strategy, aside from the data mining, is that there's deeper functionality expected than marks on a calendar and date calculations. I don't think calendar APIs can easily accommodate device interfaces for thermal or other monitors.

      I mean, you could do basic period/fertility tracking with an Excel spreadsheet and some macros, too, but accurate health monitoring generally depends on availability and consistency of use.

      The accessibility of an alway-on-hand mobile device is what made it so compelling to use an app for the purpose - presuming you're someone in need of period/fertility tracking.

      4 votes
      1. [2]
        nsz
        Link Parent
        Fair enough, I don't know very much about what is wanted and had no idea sensors could be used. As for the availability, I meant it to be part of the calendar suit that comes with any...

        Fair enough, I don't know very much about what is wanted and had no idea sensors could be used.

        As for the availability, I meant it to be part of the calendar suit that comes with any android/apple device, so availability/ease of use should be there along with the neutral unassuming design approach common to the standard apps. It seems like something like this should be part of default app suite when half of their users are likely to need it at some point.

        1 vote
        1. patience_limited
          Link Parent
          You'd think it would be logical to include it - I use my app more often than I use ringtones or change UI skins, for sure. At the same time, I don't trust Google, in particular, and who knows what...

          You'd think it would be logical to include it - I use my app more often than I use ringtones or change UI skins, for sure.

          At the same time, I don't trust Google, in particular, and who knows what Samsung or some of the other skinned OS vendors would do about security. I haven't looked closely at data leakage vectors in the Apple ecosystem.

          3 votes
    2. roboticide
      Link Parent
      Well, with Google and Apple at least, it's probably a question of how indifferent you are to being in that ecosystem already. I mean, if you have an iPhone, use iTunes, and are already giving them...

      Well, with Google and Apple at least, it's probably a question of how indifferent you are to being in that ecosystem already. I mean, if you have an iPhone, use iTunes, and are already giving them access to tons of your data, then period and fertility tracking kinda seem like a weird place to draw the line, unless you've already been really careful with what data you specifically give them. But from what I've seen, most people are really all or nothing. They have some degree of trust for Google or Apple that they'll share everything, or they don't trust them at all and won't share anything.

      I've seen new health-type initiatives popping up on my Google Pixel for beta testing. I'm kinda surprised they haven't done something like that already that integrates with Google Calendar (although then again, as a guy, maybe they have and I just haven't noticed).

      3 votes
  3. eladnarra
    Link
    Very interesting! I sort of knew about some of this from my experiments with various apps to find one I liked, but the privacy and advertising aspect is one that hadn't occurred to me. (I bought...

    Very interesting! I sort of knew about some of this from my experiments with various apps to find one I liked, but the privacy and advertising aspect is one that hadn't occurred to me. (I bought an app for extra features and to get rid of ads, and I don't plan on being pregnant.)

    The fertility reminders are pretty creepy if you're not looking to get pregnant (and obviously upsetting to people who are infertile but wish they could have kids). When the FitBit's period tracking came out, I input a few of my previous cycles and the dashboard tile immediately informed that it was "4 days until fertile window." Um... not exactly something I need reminding of every time I open the app and log my exercise.

    You can now turn off fertile window predictions, but I'm sticking with my current app - no fertility/ovulation reminders or popups if I don't want them, just optional icons in calendar view so I take a look I can go, "Oh, I'm ovulating today or tomorrow, that's why I feel weird." My tracker also has the ability to ignore cycles over a certain length (which you set yourself) when calculating predictions.

    2 votes
  4. [5]
    Cliftonia
    Link
    Society told her she was bad so she was offended by a poorly designed app? Okay, it's safe to ignore this one.

    Society told her she was bad so she was offended by a poorly designed app? Okay, it's safe to ignore this one.

    1. [4]
      eladnarra
      Link Parent
      It was poorly designed because the designers didn't consider that people using it might have pregnancies (and abortions) that would render subsequent predictions inaccurate. That seems like a...

      It was poorly designed because the designers didn't consider that people using it might have pregnancies (and abortions) that would render subsequent predictions inaccurate. That seems like a pretty big oversight, and one worth talking about. In fact, it's not an issue with a single app; when FitBit finally introduced period tracking, plenty of folks complained on the forums that it was useless because their pregnancies and/or outlier cycles messed everything up.

      While it's true that there are better period tracking apps out there, even well-known companies take ages to add the feature to their apps/platforms (like FitBit and Apple) and don't include basic features.

      3 votes
      1. patience_limited
        (edited )
        Link Parent
        My fav app isn't dealing with perimenopause well, either, and I have no idea if any of them do. There's not much predictive power when cycles can be anywhere from 15 - 60 days, though at least...

        My fav app isn't dealing with perimenopause well, either, and I have no idea if any of them do.

        There's not much predictive power when cycles can be anywhere from 15 - 60 days, though at least Ovuview isn't congratulating me for getting pregnant. I'm mostly using it for symptom tracking and doing my own prediction at this point - "hey, three consecutive days of bloating and backache? Better pack the Diva cup."

        [Actually, the data for pubescent, post-pregnancy/lactation, and perimenopausal cycle timing are nearly non-existent.
        It's like peak fertility years are the only ones that count in medicine in general, irrespective of whether the changes are meaningful for health and well-being. It's not exclusively an app problem. Though you'd think the big data from health monitoring could help address the issue, if someone bothers to look at female troubles.]

        Edit: Shame on me for not doing my homework first - http://www.cemcor.ubc.ca/resources/topics/ovulation-and-menstrual-cycles
        looks like a legitimate medical resource, though I'm not sure how their research might translate into app development.

        2 votes
      2. [2]
        Cliftonia
        Link Parent
        They didn't consider it but she took it way too hard, like she has PTSD or something. I don't play that pity me game.

        They didn't consider it but she took it way too hard, like she has PTSD or something. I don't play that pity me game.

        1. eladnarra
          Link Parent
          Wait, what? I confess I'm really baffled that you thought she "took it way too hard." She calls it silly, not devastatingly upsetting. (And the part about being a "bad" woman feels flippant, since...

          Wait, what? I confess I'm really baffled that you thought she "took it way too hard."

          There was no way to explain to it that something out-of-the-ordinary had happened to my body, and while this wasn’t a huge inconvenience, it did strike me as wildly silly. I mean, the culture I live in had already done a thorough enough job prompting me to codify myself as a “bad” woman, and now some poorly designed app was telling me I was also bad data.

          She calls it silly, not devastatingly upsetting. (And the part about being a "bad" woman feels flippant, since it's put in quotes.) It was just an anecdote used to introduce to a discussion of a variety of issues with period tracking apps, not a plea for pity.