Post-Roe, How Safe Are Period-Tracking Smartphone Apps?

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Following the US Supreme Court’s overturning of Roe v Wade in 2022—and ending an individual’s constitutional right to an abortion—those advocating for privacy warned women and others against using smartphone applications that track menstrual cycles. The call was made because of concerns that the data collected from users would put them at risk of prosecution in states where abortion became illegal. Over 2 years later, US women continue to remain hesitant about their privacy when using these apps; however, some women are taking steps to ensure their protection.¹

According to a survey, nearly a third of US women reported using apps to track their menstrual cycles, plan and prepare for menstrual symptoms, and identify the days they are most fertile. In addition, users are able to report in the apps whether they are trying to have a baby, if they are pregnant as well as what their symptoms are, if they miscarry, or sexual activity.¹ It is also important to note that period-tracking apps are not covered under federal data privacy laws—including the Health Insurance Portability and Accountability Act—and there is no law that prevents private companies from sharing user information with third parties (eg, advertisers or insurance companies), or sharing it with law enforcement.¹

In a May 2024 study, a total of 183 women aged 18 years or older across the US with differing beliefs on abortion were enrolled and surveyed on period-tracker apps. Women were asked to specify their level of concern toward the data practices of tracker apps and provide reasons behind their responses. Additionally, participants were also asked about how frequently they used tracking apps and what their concerns and risk mitigation practices were—if any—when using apps. Participants were surveyed on their knowledge on the tracking apps and their data practices.²

In another part of the survey, participants were polled on the overturning of Roe v Wade. Participants were asked to report their understanding and familiarity with Roe v Wade being overturned as well as what concerns they have. Participants then elaborated further on their individual beliefs on how the decision would influence their privacy, data practices relating to period-tracking apps, and their habits and practices. Additionally, patients provided their rationale for these responses.²

According to the study findings, participants reported that their desire to download period-tracking apps varied depending on who was recommending them, such as health care professionals (74%, n = 136) or family members (53%, n = 98). Participants also reported being unlikely to download and use apps at the recommendation of government and law enforcement officers (82%, n = 150), employers (75%, n = 137), insurance companies (54%, n = 99), and even romantic partners (39%, n = 72). Survey takers also reported being most concerned about their privacy when posting about fertility- and reproductive health-related topics on social media, and had relatively low concern regarding searching for period tracking-related information online or discussions through messaging platforms.² The authors note that this particular observation is noteworthy because that is typically the strategy law enforcement relies on to criminalize those seeking out abortion.²

Overall, participants expressed the most concern toward data being shared with government and law enforcement officers, and when asked to provide explanations on their concern, approximately 37% of participants (n = 67) expressed their personal data being shared with these parties is “unacceptable” in their view, particularly when it comes to sensitive information, such as menstrual cycle data and symptoms. In addition, 33% of these participants (22 of 67) were confused why law enforcement or the government would need their menstrual cycle data. Only 8% (n = 14) of the surveyed population expressed their privacy concerns were specifically related to the overturning of Roe v Wade. Further, the survey respondents also reported concerns that third parties would have access to their data (31%, n = 57) and how that information would be used by insurance companies or advertisers.²

Despite these concerns, only 9% of participants (n = 16) reported taking active steps to better manage their privacy, such as deleting period-tracking apps (38%, 6 of 16) or seeking out additional information about the apps’ data practices (31%, 5 of 16). Further, 13% of this subgroup (n = 2) reported that, despite their concerns, they continued to use an app for health purposes. Conversely, 13% (n = 2) of participants who lived in states where abortion is legal reported that they felt safe and did not feel the need to take further action. Further, the majority of participants reported familiarity with the overturning of Roe v Wade and its implications, with 60% (n = 110) reporting that it impacted their perceived concerns toward period-tracking apps’ data practices. These participants suspected that the data could be used to detect potential abortions and even criminalize users if deemed necessary.²

Interestingly, the investigators found that women who identified as Republican tended to be significantly more concerned about the period-tracking apps’ data practices compared to their Democratic counterparts. About half of the participants who identified as Republicans were also living in states where abortion was banned, suggesting that a higher level of concern is a result of those states’ legal landscapes.²

This survey follows a 2022 study that assessed the privacy practices of the 23 most popular women’s mobile health apps.³ All of these apps, according to the authors, allowed behavioral tracking and approximately 61% (n = 14) of the apps allowed location tracking. A total of 16 apps (70%) had displayed a privacy policy for users to read or access, 12 (52%) requested users’ consent to privacy, and 1 (4%) had a pseudoconsent. Additionally, 13 (n = 3) of the apps had collected data prior to obtaining users’ consent. Further, most of the apps (87%, n = 20) had shared user data with third parties, and data sharing information was unable to be obtained for the remaining 13% (n = 3). The investigators also determined that 13 apps (57%) provided users with information on data security.³

“This is really a call to action that we need to provide more awareness and education,” said research leader Pardis Emami-Naeini, PhD, assistant professor of computer science, Duke University, in a news release. “The majority of women are concerned but they don’t do anything about it because they don’t have the knowledge. They don’t know what to do.”¹

Although some participants may resort to deleting the app, doing so doesn’t necessarily make the data disappear from the developer’s servers or stop it from being shared and sold. In some instances, companies continue to store that data for years, long after a consumer stops using the app.¹ Simply deleting the app is not enough, and according to authors of a New York Times article, further actions will need to be made and users must be more aware of the data they are recording.⁴

“We should start with the types of data that have already been used to criminalize people,” said Cynthia Conti-Cook, civil rights lawyer and technology fellow at the Ford Foundation, in the article. “The text to your sister that says, ‘Expletive, I’m pregnant.’ The search history for abortion pills or the visitation of websites that have information about abortion.”⁴

To help mitigate these concerns, the study authors call on period-tracking app companies to be transparent about what data they are recording, and whether it is being shared with outside parties. The authors also note that future work can evaluate the privacy implications of integrating artificial intelligence chatbots, such as ChatGPT, into period-tracking and other health care apps.^1,2

“Whatever your views about abortion, this is a moment to reflect on what we have given up to the hungry maw of America’s unfettered data collection economy,” said Shira Ovide, writer for The New York Times’ On Tech newsletter, in the article. “The implications of surveillance capitalism just got a lot more complicated.”⁴

References

1. Duke University. Two years post-Roe: Many women still concerned about privacy on period trackers, but few take action. News release. May 8, 2024. Accessed July 16, 2024. https://www.eurekalert.org/news-releases/1043932

2. Cao J, Laabadli H, Mathis CH, Stern RD, Emami-Naeini P. “I deleted it after the overturn of Roe v. Wade”: Understanding women’s privacy concerns toward period-tracking apps in the Post Roe v. Wade Era. CHI. Published online May 11, 2024. doi:10.1145/3613904.3642042

3. Alfawzan, N, Christen, M, Spitale, G, Biller-Andorno, N. Privacy, Data Sharing, and Data Security Policies of Women’s mHealth Apps: Scoping Review and Content Analysis. JMIR Mhealth Uhealth. 2022;10(5):e33735. doi:10.2196/33735

4. Sorkin, AR, Giang, V, Gandel, S, Hirsch, L, Livni, E, Gross, J. Reconsidering Privacy Risks After Roe. The New York Times. June 30, 2022. Accessed July 16, 2024. https://www.nytimes.com/2022/06/30/business/dealbook/abortion-privacy-risks-data.html#:~:text=Period%20tracking%20apps%20have%20become,their%20next%20period%20is%20coming