How are women's health apps shaping the way we think about natural rhythms?
Back in 2014, Apple released its health-tracking app, HealthKit, with a seemingly obvious omission – a way for women to track their periods. It felt like, yet again, women were being shut out of a developing technology, with no females in the room when the idea of digital health was discussed.
Apple quickly rectified the situation and, a few years on, there's an increasing number of apps to choose from that are angled towards the rhythms of women's bodies. They claim to be able to let women track their period; keep watch over fertility; and even avoid contraception altogether, but whether they are any good – or, indeed, necessary – is cause for debate.
One such app is Natural Cycles. Having been approved in the EU as a contraception method in 2017, reports have since suggested it has led to a spate of unwanted pregnancies. Academic research reveals mixed results for fertility and menstrual tracking apps, with one paper by German researchers saying such apps failed to consider different cycle lengths and were, therefore, “not suitable to indicate the most fertile days”. Another study, on the use of apps to avoid pregnancy, suggested most aren't based on any scientific evidence and shouldn't be relied upon.
Sarah Homewood, a researcher in interaction design at the IT University of Copenhagen, suggests the design of such apps reflects “how the menstruating body is viewed in society”. We're not simply talking about overly feminine pink colour schemes, but wider assumptions around periods being something that we “conceal and control”, she tells me.
Predicting the unpredictable
I installed a tranche of period cycle tracking apps in December, but stopped using them within months. Some were merely frustrating to use, others send far too many notifications about how I should be feeling, given my hormones, but overall there was one problem: each treated my cycle like an unchanging thing. Either it assumed it would be 28 days each and every month, or used an algorithm to decide on an average number of days.
That's just not how women's bodies work. Sometimes, it's four weeks to the hour; other times, it arrives days early or late. Stress, long-distance travel and illnesses can alter menstrual cycles. “Most people don't have regular menstrual cycles,” notes Homewood. “But that's the basis of all menstrual cycle predicting technology that's using predictive analysis algorithms.
“Somebody thought: they're predictable, we can put an algorithm onto that. The fact that they're believed to be predictable, it's not true.”
(Screenshot of the Clue app. Credit: Clue)
To pull in enough information to learn what does and doesn't impact my cycle would require a terrifyingly constant degree of self-surveillance. The best of the apps I tried, Clue, has 31 different tracking categories, from your period and pain level to PMS and exercise. But what's the benefit? Contraception and fertility aside, what are women supposed to do with the knowledge their period is set to (maybe, if their cycle is regular) arrive on a certain day? Change their holiday? Cancel a first date? Step counters are designed to encourage us to walk more – what is a period tracker going to change?
“You can see these apps as trying [to] make women's bodies like male bodies"
“You can see these apps as trying [to] make women's bodies like male bodies, to conceal menstruation so women make sure to have tampons in their bag on the right day so they don't bleed on the bus seats, and know when they have PMS so they can regulate their own emotions,” says Homewood.
There are benefits to paying attention, though. Clue's CEO and founder Ida Tin tells me there's value in simply paying attention, saying the app was created to give women “awareness of the unique patterns in their bodies and cycles”.
“When you are able to identify patterns that are unique to you, you feel more in control of your own body, and better able to manage the changes that are taking place within it,” she argues.
(Clue CEO and founder Ida Tin. Credit: Clue)
And, of course, some women are regular as heck, and an app is likely handier than tracking dates on a calendar (or my technique of searching WhatsApp conversations with my husband to see the last time I told him my period had arrived). Plus, all that data could well be useful for women's health. Clue, for instance, is working with renowned sexual research centre The Kinsey Institute to survey users about everything from technology to endometriosis.
“I think that's the way forward,” says Homewood. “Instead of keeping data secure and shut away, we should use it for something positive – but still keep in mind not to reduce the body to a normative ideal that everybody is going to be compared against.”
Keeping your privates private
Sharing such data requires attention to ethics. Much of that work has been so far limited to questions about privacy and security, notes Deborah Lupton, research professor at the University of Canberra and leader of the Smart Technology Living Lab.
She advises anyone using a health app to take the time to research it first, looking at “whether there are bona fide women's health experts involved in the app”.
“Many health app developers lack these kinds of credentials,” she adds. “Potential users should check out the app developer's website to see what the medical background is before using the app.”
Understanding women's bodies
So how can future women's health apps do better? Homewood points to menopause tracking apps. There's, as yet, no way to predict the onset of menopause, so such apps merely track and share symptoms. “I do think there's a next generation of apps that's less about predicting and more about sharing symptoms or communities,” she says, suggesting it could be a better way for women to study their own bodies without the design-embedded suggestion of control and change that comes with existing menstrual trackers.
Whether or not apps have the potential to improve women's health, their growth has the scope to reframe how women's bodies are perceived. In plenty of areas, women's health has traditionally taken a back seat to men's. For example, pharmaceutical developers often test on men but not women, despite hormonal and other differences changing how well drugs work. Crash test dummies used to be designed on the average male frame, leaving women less protected by safety equipment during car accidents.
Indeed, Clue's Tin says she started her app because there was so little other work happening in the area. “I thought it was insane that we were able to put a man on the moon, but we didn't have a tool that would help us understand our body's own patterns.”