When it comes to healthcare, it’s women who have all the purchasing power. It’s them who make 90% of household healthcare decisions, account for 93% of pharmaceutical purchases, and use the Web to get health-related information. Yet,
Healthcare (like many other industries) has a long history of ignoring women’s needs. For a very long time, women have been underrepresented in medical research, which led to blind spots in the understanding of female bodies. There still isn’t enough data on how women react to certain medications, which side effects they experience, and which problems they suffer from. Many of the specifically female health issues, such as menstrual health, sexual health, and birth control, have been tabooed for a long time, resulting in women not knowing enough about how their bodies work and not recognizing problems when they arise.
It would be wrong to say that the rise in women’s health apps, or femtech as it is often called, has changed all that. Femtech has plenty of issues, which we will discuss later in the article. However, it has made and continues to make the lives of many women easier by increasing their understanding of their bodies, bringing attention and demystifying female health issues, and inspiring medical research that focuses on women’s needs.
Today, femtech is in the spotlight. For a while, it remained a rather small part of the world that is mHealth. But fitness trackers, diet and nutrition apps, disease management apps, and other mHealth apps continued to be more popular among women than they were among men. Flurry showed that 62% of heavy health app users (spending 3x the average on health and fitness apps) were female. And as women became more involved in the IT industry, femtech also grew more popular. 2019 is widely believed to have been a turning point for women’s health apps. It is expected to become a $50 billion industry by 2025, and while the whole mHealth apps industry is growing rapidly, women’s health is often believed to be the fastest growing area in the sector.
What do women’s health apps do?
Femtech mostly consists of period calendars or trackers. The most popular apps include, but are not limited to, Natural Cycles, Clue, Eve, and Flo. We’ll discuss some of these apps’ specific features a bit later in the article.
Tracking periods may sound like a simple idea for an mHealth app, but it has been of enormous use to women. Firstly, such apps help women track their menstrual cycles: a sudden stop in a menstruation or an irregular cycle might signal not only pregnancy, but also health issues that require a visit to a doctor. In a doctor’s office, women are often asked when their last period was, and often, they can’t answer this question. An app solves these problems. Secondly, period trackers predict ovulation, helping the ones who want to get pregnant as well as the ones who want to avoid getting pregnant to choose days for sexual activity. Finally, femtech apps educate women about their bodies. They explain the role that hormones play in how they are feeling, provide personalized health information, and remind them to take care of their health (for example, do exercise or get enough sleep). These are the main goals that women’s health apps strive to achieve.
In the meantime, women’s health apps also collect data. We’ll come back to the dark side of this later in the article, but at this point, let’s underline the benefits of data collection. As the New York Times authors point out, women’s health apps’ data unravels some of the “biggest, understudied riddles of female health”. Such apps gather real and authentic data from millions of users, which is very difficult to do. Women don’t trust their doctors like they trust their phones, and even in our age of “too much information” , it is still hard to make anyone tell the researcher all about one’s cervical mucus quality or the intensity of one’s sex drive. Gathering data also doesn’t scare the users that much, if it’s for research. Clue, the period tracker app that we’ll come back to, has a privacy policy that clearly states that the company gathers data for scientific purposes. The company even shares the studies with the app’s users. Clue allows the users to opt out of sharing data or even delete their data if this isn’t something they are okay with.
How do women’s health apps work?
Now let’s look at how specific apps achieve their goals. Let’s take Natural Cycles first ― the first FDA certified birth control app. Natural Cycles marks every day in your calendar as fertile or infertile. It claims to have a 93% accuracy. To find out whether you’re fertile or not at any given day, Natural Cycles pairs an algorithm with basal body temperature that you have to measure every morning at the same time before you get out of bed. Basal body thermometer, which the app provides you with, measures your temperature to one-hundredth of a degree instead of the normal one-tenth. It really is a valid method of determining your fertility, as the temperature usually rises by 0.5 to 1 degree after ovulation. However, as you might imagine, other factors can also affect your basal body temperature and throw off your data.
Another app that’s been highlighted by doctors is Clue ― we’ve mentioned it earlier. It was the top-ranked period and ovulation tracking app per American College of Obstetricians and Gynecologists’s journal, Obstetrics & Gynecology. Unlike Natural Cycles, it doesn’t advertise itself as a birth control app and thus doesn’t require an FDA approval. Instead, it claims to educate you about your body and make sense of your period, fertility, pregnancy, and menstrual health. The app predicts periods, PMS, and ovulation, and also finds unique patterns in the cycle. It helps understand how different health issues correlate and what they depend on. For example, you might learn that headaches struck you during PMS and that a long night’s sleep prevents that from happening. For the app to achieve this wonderful goal of making you more in sync with your body, you’ve got to tell it everything you have to tell about your body (or the things you care about, anyway). This includes data on cramps, emotions, skin, hair, sleep, sex, pain, moods, cervical fluid, and more. You don’t have to share this information with the app, but the more you track ― the more you learn.
The app Eve boasts similar functions of period tracking and predicting ovulation. It also adds fun into the equation, providing the users with mood predictions based on where you are in your cycle, sex quizzes, and a community, where one can discuss all things menstruation and sex with other users and redeem « gems » to get sex tips. Eve was developed by medical data science company Glow. Just as with most other period tracking apps, Eve’s tracking accuracy depends on the data you put in. Its ability to get you annoyed due to the super-excited notification for the upcoming period doesn’t depend on anything.
How do women’s health apps monetize their services?
There are a couple of ways in which period trackers make money. Some apps, such as Natural Cycles, are paid ― and they aren’t cheap. Some, such as Clue, offer paid subscriptions for more features. Others, like Flo, offer tracking features for free but charge for educational content. Free apps, such as Period Diary, are overloaded with ads. Generally, this coincides with how most other apps monetize their services.
What are the main issues with femtech apps?
Femtech has been praised as technology that caters to women ― finally. Can you believe that when Apple Health was released in 2014, and the senior VP of software engineering Craig Federighi told users, “You can monitor all of your metrics that you’re most interested in”, you still could not for almost a year track your periods?
However, many have pointed out that it’s not all smooth metrics and happy women.
The first problem is that some apps still lack the basic understanding of what can happen to a female body. The author of the Vox article, Kaitlyn Tiffany, tells a story of how her app failed to account for her abortion. It simply decided that the user had undergone a cycle more than twice as long as usual and adjusted all the averages, making all future predictions completely useless. In a popular Medium article from 2015, the author Maggie Delano describes how her app Clue simply wouldn’t count a shorter, often irregular cycle as a cycle, and wouldn’t let her remove the algorithmically generated “fertile window” despite the fact that there was no physical possibility of her getting pregnant ― Maggie’s partner is also a woman. The app developers figured they could simply ignore women who are queer, infertile, or unpartnered, or really any woman who tracks periods for pregnancy-unrelated reasons.
The second problem is false advertising. While tracking periods on your smartphone looks hip and modern, this is, in fact, the oldest way of contraception. And it doesn’t have such a perfect score. One Swedish hospital alone reported 37 unwanted pregnancies last year in women who were using Natural Cycles as contraception, out of a total of 668 women who sought abortions at the hospital all year. The app’s method requires perfect use and women who cycle regularly, which excludes a whole lot of women. The app compares its effectiveness with that of a pill; however, it’s much easier to take a pill every day at the same time than it is to measure your temperature the first thing in the morning ― ideally, before any of your muscles even move. This wouldn’t be such a big deal if women’s health apps marketed themselves as what they are: period tracking apps. But some, as is the case of Natural Cycles, go as far as to claim they are as effective as actual medication. And this is simply false advertising: even the Advertising Standards Agency found that Natural Cycles misled its consumers.
Finally, we have data privacy. Or rather, we don’t. The term “menstrual surveillance”, or “intimate surveillance”, coined by Levi in the extensive paper on how intimate surveillance was normalized, have been thrown around ever since the apps got to know the intimate details of our lives better than our partners, doctors, or best friends. And while this feels sort of on the edge (would my partner be okay with the knowledge that my smartphone knows when we had sex?), it still isn’t necessarily wrong or damaging to anyone. Until the data leaks.
Apps generally promise to keep all the sensitive information secret. Period tracker Flo, for example, pointed out that even though it might share some personal data with other companies, it would not disclose details about “cycles, pregnancy, symptoms notes and other information that is entered by you.” Yet, according to the Federal Trade Commission, which filed a complaint, from 2016 to 2019 Flo shared intimate health details with Facebook and Google for “personal health information expansively, including for advertising”. Right now, the home page of Flo Health shows a legal notice regarding the settlement with the FDC. The company admits that they “sent an identifying number related to you and information about your period and pregnancy to companies <..> including the analytics divisions of Facebook, Flurry, Fabric, and Google.” They claim that “We do not currently, and will not, share any information about your health with any company unless we get your permission.” But can you really trust them?
Flo is just one of the many cases. In 2018, Privacy International, a nonprofit group in Britain, tested 36 popular women’s health apps. They found that 61% automatically transfer data to Facebook the moment a user opens the app. Some of them routinely send Facebook incredibly detailed and sensitive personal data. You might think you’re safe if you don’t use Facebook, but this is not the case ― data is shared even if you don’t have an account. Following the Privacy International’s revelations, two thirds of the companies they exposed updated their apps. In 2019, PI researched seven more apps ― this time, the ones that were less popular. Only one of them, Period Tracker, did not appear to share any data. Other six apps shared their data extensively with the third parties. Following this, in 2020, four out of those six apps updated their data sharing practices or launched internal investigations. The hunt continues.
And while data being sold for the purposes of advertising is a regular, albeit illegal, case, there are others that just blow your mind. The Guardian, for example, tells a story about the company Activision Blizzard that encouraged their employees to use Ovia Health ― the app that includes information about your fertility, your menstrual cycle, and follows the progression of your pregnancy. The information collected by the app was then shared with the company, allowing the founders to see how many of their employees are pregnant, trying to get pregnant or facing high-risk pregnancies. Surely, Ovia Health claimed that the data is anonymized ― most companies behind femtech apps stress this point. However, there’s plenty of evidence that “anonymized” data can still easily be cross-referenced with other data and traced back to the source. This case is especially worrisome when we take into account the risks pregnant or about to get pregnant women face at their workplaces.
All these issues have led to women writers claiming that “period tracking apps are not for women”. They seem to be great for marketers, employers, and men who want to track their (multiple) girlfriend’s periods (yes, this, too, exists).
Final words
Whoever the main beneficiaries of women’s health apps are, it’s clear that women’s health is recognized as a huge opportunity and the tech industry is more than happy to jump on it. Femtech is everywhere. For now, it focuses on issues specific to women: period health, fertility, birth control, and so on. But more and more sources wonder: will this go further? With women being more interested in health and health technology, how long till the women’s health apps start focusing on diseases more widespread among women? Will the future femtech include mostly female chronic conditions, autoimmune disorders (that impact women 3 times more often than men), and self-help treatments for depression and anxiety? We will have to wait and see.
What is vital and clear for the moment being is that, firstly, women’s health apps should work on being more inclusive. Secondly, false advertising, misleading privacy policies and other troubling practices will only get you so far. With more and more regulations, as well as lawmakers and state attorneys general going after women’s health apps, it makes more sense to invest in bulletproof security and anonymization technologies. Finally, a new regulatory framework that enables researchers to work with consumer apps is needed ― we still need to know a lot more about women’s health.
