These algorithm-driven apps are often tailored to one 'standard' type of woman. As a result, women with different body patterns may receive inaccurate or misleading advice. Moreover, the companies behind these algorithms are entering a market that capitalizes on a lack of sexual education, a desperate need for answers among women, and a relationship with the medical system that is increasingly less based on trust and transparent communication. This can lead to undesirable situations, for example when the apps are used as contraception, resulting in unwanted pregnancies.
In recent years, there has been a noticeable shift where women trade traditional contraceptives, like the pill, for cycle-tracking apps. More and more women are having doubts about the pill or other hormonal contraceptives, seeking natural alternatives to feel more connected to and aware of their own bodies and cycles. Thuis and Punzi are mapping the invisible ethical concerns surrounding this algorithm-driven technology. "We are moving from a highly regulated medical method, such as taking a pill, to a situation where we rely on algorithmic predictions and our own interpretation," says Thuis. Although these apps provide many users with a sense of control and insight, the researchers emphasize that users often do not sufficiently realize that algorithms are neither flawless nor objective.
Falling outside the standard algorithm
One of the most striking preliminary findings of the research is that the data models of these apps are anything but inclusive. "Even the little that medical science knows about women's health is based on a specific type: the white, affluent, and healthy woman," Punzi explains. Consequently, women with irregular cycles, chronic pain, or from different ethnic backgrounds often fall outside this algorithm. Designers who turn a blind eye to this reality are essentially building a digital replica of the inequality that already exists in healthcare. Punzi: "If you think you can design a completely neutral app, you are simply reinforcing the system we already have. And that system is fundamentally unfairly distributed".
Furthermore, the app actively influences how you view your own body. By using labels like 'abnormal' or 'irregular', these programs force you into a box unasked. For instance, do you suddenly get a notification that your premenstrual symptoms (PMS) are approaching? Then the so-called 'nocebo effect' can cause you to unconsciously feel worse or grumpier, purely because the app says so.
Regulatory gap
The researchers also sound the alarm about the faceless companies behind the apps and the lack of adequate regulation in Europe. Because most menstrual apps use a legal loophole to avoid being officially classified as 'medical devices', they are allowed to advertise indefinitely and without warnings on platforms like Instagram and Facebook. This is in stark contrast to non-profit organizations like Rutgers, the national expertise center for sexuality. Due to strict rules for medical products, they cannot simply run large awareness campaigns for contraception, as these are immediately viewed as advertising campaigns. As a result, these app companies can make unregulated medical claims and collect intimate data. Nevertheless, the rapidly rising number of users of these apps reveals a deeper need among women to receive information about their bodies, menstruation, and fertility, a gap currently left open by the medical and educational systems.
Therefore, Thuis and Punzi are calling on governments and developers to take action, but they also point to the responsibility of the user. Thuis: "Algorithm literacy is essential. Users need to understand that an app does not speak the absolute truth. Ultimately, the question is not whether it is good or bad to use an app, but how and why you use it".
Read the full publication by Thuis and Punzi here.