Reliability, security, ethics: what are the risks behind the flaws in menstrual tracking applications?

Depending on the apps, different features are offered. The free versions collect menstrual cycle tracking data: period dates, temperature, appearance of cervical mucus, cycle-related symptoms, pain. Also available are options “premium” fees (€30-50 per year) to refine predictions and advise users. Intimate information is then collected: moods, libido and sexual relations, use or not of condoms, state of health, sleep, weight, diet…

All these applications use third-party services (generally American private companies such as Google, Amazon, etc.) to store their data.

A success that follows the disaffection for the pill

The use of digital technologies for the control of menstruation and fertility is part of a global context of change in contraceptive practices observed in the United States and Europe for more than 10 years. Several significant events have contributed to creating a climate of mistrust regarding the products of the pharmaceutical industry.

The years 1990-2000 saw the revelation of health scandals linked to the side effects of various drugs (Distilbene, Mediator, Valproate…). During this same period, epidemiological studies have reported higher risks of venous thrombosis following the marketing of third and fourth generation contraceptive pills. In France, the use of hormonal contraception has since decreased among women of all social groups.

the rejection of the pill is also part of a context of growing awareness of “global” ecology, where respect for the natural functioning of the body and preservation of the environment in the face of the risk of water pollution by hormones are taken into account.

others reasons for reluctance to medicinal contraception can be explained by a questioning of medicine “classic”experiences of gynecological violence, religious beliefsetc.

It is in this context of a demand for non-medical methods of contraception that developed the market for menstrual tracking apps, which offer natural methods of contraception. In addition, the use of digital technologies to control one’s cycle and fertility is perceived by many young women as a guarantee of reliability, with the advantage of convenience of use and minimal cost.

The apps’ personalized services are also presented by their designers as a vehicle for empowering women: a ” personal diary “, entrusted to an artificial intelligence, which frees them from medical consultations.

Reliability: from promises to reality

Of the recent searches have scrutinized the methodologies offered by the menstrual tracking apps. It turns out that the majority of them (54.4%) use the menstrual calendar to predict fertile period and ovulation date. This finding is alarming because this method, based on the date of ovulation 14 days after the start of menstruation, is widely recognized as unreliable.

Even women with very regular cycles have variable ovulation days. Variations in cycle length of seven days and more concern half of the female population, which removes any prediction capability from these apps.

The only reliable data are physiological: daily temperature measurement (+ 0.2 to 0.4°C at ovulation), change in consistency of cervical mucus as ovulation approaches, urinary concentration of LH (hormone luteinizing) which increases 24-36 hours before ovulation. However, if some of these parameters are recorded in 28.6% of apps, they are not systematically included in the prediction algorithms…

These methodological biases result in reliability flaws. According to comparative studies carried out on a hundred apps, only 9-19% made correct predictions about the fertile window. For the same cycle profile, the predicted ovulation dates varied, depending on the calculation methods, from 2-9 days for 67% of the apps tested.

This lack of reliability, both for contraceptive purposes and for conception, is partly explained by the reality of their use. In a context of “perfect” use, the theoretical efficiency is good… But following the instructions to the letter is a cumbersome task: writing down your period dates, cycle after cycle, and taking your temperature every day requires strict discipline, cervical mucus can be misinterpreted, etc. Thus, even the best prediction algorithms are fallible when fed with incomplete or erroneous data.

It therefore appears that the majority of these apps do not use an adequate calculation method and do not provide sufficiently solid information on the dates of ovulation and fertility to their users.

Worrying flaws in the protection of personal data

Several international NGOs engaged in privacy on the internet (Electronic Frontier Foundation, Privacy InternationalCoding Rights, Consumer Report CR’s Digital Lab) scrutinized the security policies of the most popular apps: information on data sharing, identification procedures, control of personal information by users, methodologies for securing data. The results of the investigations agree to show flaws in the procedures for protecting personal data.

The majority of apps share their data with “third parties” (external partner companies such as Google, Amazon, Facebook, etc.), most often unbeknownst to users.

The consent to collect data, which is included in the terms and conditions notice of the apps, is frequently accepted without being read. However, in concrete terms, “third parties” can identify your smartphone and your applications to send you personalized messages.

In addition, even if your data is anonymized, it can be cross-referenced with other information (geolocation, Internet contacts, loyalty cards, etc.) to trace you. Specialized companies, called “data brokers”, compile this individual information to draw up a detailed profile that they will then sell to companies so that they best target their customers (advertisers, insurance companies, etc.).

In the United States, the menstrual tracking apps are not subject to federal law on health insurance (Health Insurance Portability and Accountability Act, HIPAA) which regulates the conditions for sharing private health information. In 2021, the Senate strengthened the law requiring health apps to allow consumers to verify, modify or delete their health data collected by companies (the Protecting Personal Health Data Act). These measures had already been in force in the State of California since January 2020.

In the European Union, the General Data Protection Regulation (GDPR) protects citizens from the collection and use of their personal data by third parties, public and private: explicit consent from the user is necessary for the use of his data. The GDPR applies to companies designing menstrual tracking apps whose head office is based in Europe.

But for some apps that operate opaquely, the place of registration is not clearly defined… The fact that they are available in European countries is therefore no guarantee of securing private data. For example, in 2020, the Norwegian Consumer Council (consumer advocacy group) scrutinized the algorithms of two very popular menstrual tracking apps and showed that they shared information with dozens of advertising companies in violation of GDPR.

Protect women’s sex life

The uncovering bad practices of menstrual tracking apps calls for ethical vigilance to inform the choice of millions of users.

On the one hand, designers should use reliable prediction methods, based on solid scientific knowledge. This is not the case for a majority of apps which offer the minimum service of the method of calendar rules with proven flaws. One can only deplore the absence of quality control procedures in this area.

On the other hand, information understandable by any public on their functioning is essential to raise awareness of the often concealed reality of the risk of seeing the data of intimate sexual life exploited by third parties for commercial purposes – or otherwise. The economic challenge represented by the menstrual monitoring market poses a threat, that of privileging economic interests to the detriment of women’s intimate lives.

In a desirable future where the reliability of predictions and the security of personal data would be guaranteed, apps represent a potential tool for providing valuable information on sexual and reproductive health: on sexually transmitted diseases, access to IGV, to PMA, care in the event of domestic violence, etc.

In this context, health professionals, family planning and women’s associations would have a central role to play in guiding women in their choices and helping them. It remains to be hoped that, like theemergence of an ethical awareness on the part of certain players in artificial intelligencedesigners of menstrual tracking apps are adopting virtuous practices to reconcile their quest for profit with public health and solidarity objectives.

Catherine VidalNeurobiologist, member of the Inserm Ethics Committee, Inserm

This article is republished from The Conversation under Creative Commons license. Read theoriginal article.

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Reliability, security, ethics: what are the risks behind the flaws in menstrual tracking applications?

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