My own initiation into menstrual apps was an emotional one. Having just gone through an early term miscarriage, I switched from Glow Nurture, a pregnancy tracker, to Glow Eve, a period tracker. The miscarriage had triggered an irregularity in my cycle that had not been there before. Eve didn’t just help me track that change and maintain a detailed health log — it also helped me connect with other women going through the same thing and facing similar emotional and physical fallouts.

In other words, Eve offered a space that helped me heal.

It was months later that I actually started thinking about the details of the health log that I was maintaining on Eve, which ranged from my height and weight to my moods. It was clear to me that much of what I was noting down would never make it to my gynaecologist. However, in the vulnerable state that I was in, it was helpful to just click on options that helped me label my own emotions as anything but grief.

Eve’s How are you feeling? prompt asks users to choose from a variety of emotions. You can be ‘happy, emotional, stressed, calm, tired, in love, angry, sad, energetic, confident, motivated, excited, anxious and FOMO’. Once you tell Eve which emotional state fits your current mood, Eve will ask you to deconstruct your emotions further: Why are you feeling this way? Users can choose from options including love life, friends, family, school, work, PMS, unclear and other.

Screenshot from Eve (2019), Image courtesy Sadaf Khan

Every time I completed a health log on Eve, the application’s algorithms were able to add a little more detail to my health records. Based on these, the app made better, more efficient predictions, and pushed more relevant information, articles and posts to me.

As long as I gave Eve regular updates, every bit of information I received — from the ‘gems’ that Eve selected to the community posts that made to the top of my timeline — were completely customised to my own needs at the moment.

No wonder I felt that Eve was a friend, a therapist and a gynaecologist all rolled into one free convenient bundle.

***

‘It was a nightmare seriously,’ recalls 15-year-old Rimsha, who had her first period when she was 12. ‘I was so stupid. I didn’t know what was happening and I thought I had some kind of cancer and was bleeding to death. My mom is the strict kind, you know. She is a worrier. So I didn’t tell her for a couple of days. I just felt that I am gonna die anyway so what is the use of worrying her. I used tons of tissues. I even hid the used ones and crept out at night to throw them in the kitchen trash, which obviously nobody was going to go through.’

Rimsha eventually told a friend at school and found out that she was menstruating. Her mom explained how to use menstrual pads, and told her that if she stained, she must wash her clothes before anyone saw them. She was told that her period was not something she should talk about. With anyone.

It was only when Rimsha installed Eve on the smartphone she got on her 14 birthday that she realised the cramps and mood swings during her period were not related to an undetected illness. ‘It was a relief to read that cramps are normal and find out that other people are also angry and emotional during periods,’ she tells me. ‘My best friend didn’t experience any of that and had the smoothest periods ever. So I just thought that something was wrong with me.’

In Pakistan, where period talk is still discouraged, it isn’t uncommon to find stories like Rimsha. For many teenage girls, period tracking apps are not just a convenient way to keep track of their cycle — the educational and community features allow them to talk about what they are feeling as well.

Does Rimsha know what kind of data Eve stores and uses?

‘I just put in the start and end date of my periods,’ she says. ‘They don’t really have any other information about me. I just read the community posts and don’t write anything myself. Even my account is under a made-up name. I don’t use my real name on any of the apps I use. And it’s not like I am providing any really personal information, right? I mean, who cares when my periods start and who cares if I am PMSing!’

The made-up name is a permanent fixture of Rimsha’s digital identity: she uses the same name to create email and other accounts. What she hasn’t realised, though, is that applications like Eve collect other data and information that can identify her as a user. Her phone number, for one. And if she signs into Eve via another app like Facebook or Google, Eve can also access any personal data those apps have stored.

***

Whether it is the support or the instant community these services offer, it is easy to see their utility and appeal. Eve, the application I personally prefer, doesn’t just let me track my period, it also allows me to track my health, mood, food and exercises — and connect to a large community of users. If I get pregnant, the app allows me to migrate my data to its pregnancy-tracking sibling, Nurture. With both apps sharing the same users, it is easy to see them as close companions — digital in nature, but trusty confidantes nonetheless.

It also becomes easy to stop thinking about what information I am sharing with Eve or Nurture.

Untitled, by Bratislav Milenkovic (2016), Image courtesy https://www.theguardian.com/technology/2016/mar/23/fitbit-for-your-period-the-rise-of-fertility-tracking

My own ‘health profile’ on Eve includes a whole bunch of things. There’s basic information like my height, weight and relationship status. There’s general health information, like my cycle length, period length and regularity, and the nature and history of my birth control. And as part of its ‘community profile’, visible only to each user, Eve collates every post, comment or reaction I have given on its extensive community groups. It is a bit intimidating to see years of conversations and reactions clubbed together on a platform that I use simply to track my period. Eve also maintains my user history, which I can’t access: articles I read, groups I join, social media accounts through which I sign into the app.

I have a free account on Eve. A paid or premium account would also give Eve access to my banking information. Eve’s parent company, the US-based Glow, runs partnerships with health service providers, including infertility clinics, which means that the app can potentially have access to other health information and interventions.

I like Eve because of its user interface and community features. But the kind of data that Eve collects is no different from any other period tracking app.

***

Feeling frisky? Yeahh you are! Thanks to hormones, your sex drive is ramping up right now.

Since fertility, conception, and contraception — issues at the heart of menstrual apps — are intrinsically linked to action, it isn’t surprising that predictions for the onset of the fertile window are often accompanied by prompts for said action!

An app I have been religiously using in preparation for this article informs me — like every other user — about the onset of my ‘fertile period’. Feeling frisky? Yeahh you are!

Groans one user in the comments section: ‘Thanks Glow! I was happy that he can still get my juices flowing, but thanks for telling me that it is just my bloody hormones.’ Says another: ‘Thank God the husbands doesn’t have access to this information! If he knew he just has to wait for hormones to strike, I can say goodbye to him EVER trying to get me in the mood!’

Do getting prompts about sex take away the fun from sex?

I pose this question to a number of interviewees. ‘It is a bit weird, to tell you the truth,’ says Saira, a relatively new user of Eve. ‘I mean, it used to just be me wanting to be with him, you know. It was sweet. It was personal and romantic and intimate. Now I know it isn’t a matter of heart, just a matter of hormones. Deflates one a bit.’

Not quite, says Hareem, an entrepreneur who is a long-time user of period trackers. ‘It will depersonalise the actual deed only if you allow it to. Are you just looking at the prompts as interesting bits of information or are you taking them as instructions to conduct your love life? I personally don’t think it matters at all.’ Another interviewee responds simply with a shrug and a non-committal ‘Well, you know…’

I do know — I guess.

Every once in a while, images of the screen proclaiming fertile windows and prompting appropriate actions rise unbidden in my mind — a warning bell, reminding me of the everlasting nature of the consequences that impromptu action might bring with it. While the app and its proclamations of heightened fertility do become alarm signals for me, a mother of two children under the age of two, this information doesn’t particularly depersonalise anything.

How could it, when the prompts are based entirely on the extensive, personal information I have been providing to Eve?

(2017), Image courtesy https://www.healthline.com/health/state-of-fertility

***

But how much information is too much information? This is a question I ask myself while researching Clue, one of the most popular (free) period trackers.

Clue includes an extensive list of tracking options: not just dates and details of periods and menstrual cycles, but also cravings, digestion, discharge of cervical fluids, hair, pain, skin, stool, temperature and weight. In a meta-move, Clue gathers data on ‘collection methods’ (pads, tampons, cups etc) to keep track of ‘flow volume’. It also collects data on vitality, by recording information on your emotions, energy levels, mental health, motivation, and sleep patterns. And on your appointments, exercises, parties, and sex life. It keeps detailed notes on your medical history and interventions, including medications, injections, illnesses and various birth-control methods.

Clue also encourages users to use tags: in particular cervix high, soft & open, cervix, low, hard & closed. It states that these tags combined with other indicators may better signal fertility status.

I am no longer surprised at the amount of information these applications collect. But Clue’s suggested tags about cervical status leave me bemused. Despite having had two kids, I have never really had the chance (or the need) to check my cervical status. Even though I am usually tempted to explore subjects I write about, this exploration sounds a bit too strange for my comfort. Even if I were to try to figure out which tags I should be using, I don’t have enough experience to judge whether my cervix is high or low, soft or hard.

Luckily, for those who are inclined to check and record their cervical status (and hesitate just because there’s no good reference point), another popular app, Ovia Fertility offers a great solution. Ovia’s data entry portal includes multiple choices accompanied by illustrative visual aids. It is here that I find out where exactly a low, medium and high cervix would be placed if I were to check with my finger. I also learn that a firm (hard) cervix feels like the tip of one’s nose and a soft cervix feels like pursed lips!

Similar illustrations appear only within other fields where users might struggle to properly define their responses. While there are no visual aids for defining your mood, you can click egg whites, water or a bottle of school glue to illustrate the consistency of your cervical discharge.

Like other apps, Ovia also tracks many other aspects of health. It reminds me of the extensive medical checks carried out in the 2005 movie The Island, which features a colony of unsuspecting clones being bred for organ harvesting. But users need not fear. Ovia claims to ‘care deeply about your privacy’ and reminds you that ‘by logging data about yourself, the app’s algorithms can make better, more customised recommendations for you’.

***

Did you get some? asks Eve.

You can choose your response from various options: with condom, without condom, banana free, makeout sesh, all me and nope. Choosing an option then allows you to qualify the experience to Eve: mind blowing, pretty good, ehh. And that’s not the end of it. To complete this section of your health log, you finally tell Eve whether you orgasmed or not.

Or even if you faked it.

Screenshot from Eve (2019), Image courtesy Sadaf Khan

Given the detailed multiple choice questions and the related articles pushed to users in this ‘sex-positive’ application, it isn’t surprising that the discussion gets a bit racy. ‘Anyone else whose partner doesn’t like it bloody? Why oh why does he have to be so squeamish?’ asks a user. Responses range from intimate graphic stories about period sex, to ‘I feel you’ memes and the puke emoji. There are also multiple declarations from users who are shaking their heads saying this is altogether too much information, or more accurately: ‘SMH TMI’.

The stories are another form of user data that Eve and other similar apps have access to. At times these stories are collated through polls, making it easier for a data analyst to quantify them as information. Since most users are unaware that the stories being shared on the discussion forums also count as data, Eve’s colourful prompts and sex- positive articles continue to elicit detailed responses.

Newlywed Saira uses Eve as her prime method of contraception, and giggles over the intimate details being shared on community boards. ‘You know how it is here (in Pakistan). One can’t really have a conversation about sex openly. Even if I do share something, or have a question, I always have to pretend I am not asking for myself. And if you are not asking for yourself then you obviously can’t include specifics and it is just a generic query that one can Google anyway.’ She goes on to say, ‘On this community, though, I kind of lose my inhibition because so many other women are talking about it as well. And anyway, it doesn’t really feel like I’m sharing intimate details, it feels like I’m talking about just another health-related thing.’

In Community We Thrive (Diptych Right Side), by Meike Aton, https://meikeaton.com

Like many others, Saira’s Eve profile has been created under a pseudonym and she has been careful to create a separate email account to link with the profile. This need for discretion is not surprising. ‘We have this concept of haya (or modesty) embodied in us since birth,’ says 40-year-old Naila, a long-time user of many period trackers. ‘This so called haya is drilled into our minds, almost from the day we are born. I guess the idea is to raise pure little girls, but in the process of ensuring this purity, we shy away from teaching them about their bodies.’

Naila explains that her mom never told her about periods, let alone anything about sex. ‘I wish I’d had the access to information that kids these days have. My own journey of learning about sex was a traumatic and difficult one of trial and error.’

* * *

Educating young girls about periods should be a no-brainer. However, the truth is that the haya Naila mentions doesn’t just discourage sex education, it also keeps mothers from talking to their daughters about their periods. No wonder, then, that teenage girls imagine they’re bleeding to death when they get their first period.

My own first period was traumatic — totally oblivious about menstruation and not too good with biology, the only explanation I could come up with was a disintegration of my kidneys. The accompanying cramps gave strength to this belief, and I kept quiet for a couple of days, hoping to spare my mom the knowledge of my impending demise. When I did tell her, I got an embarrassed, harried explanation, in a tone that told me that she was not comfortable talking about it. Therefore, the onset of periods every month continued to feel like I was losing control of my own body.

I wonder what it would have been like to have had access to something like Eve back then — just being able to log dates, data, moods and pains would have felt like regaining some control over the situation. Despite being well aware of the data and privacy concerns and the potential vulnerability of teenagers sharing sensitive information online, I find myself wishing that Eve could have helped me through my own early menstruation experience.

Untitled, by Isabella Carapella (2019), Image courtesy https://bit.ly/2wEnuBw

Some users feel that period trackers could help them more if data was shared among apps. ‘I have been tracking my periods on Clue since 2014,’ reads a comment on a community group on Eve. ‘Is there any way to import that data to Eve now? It would be a shame to lose all of it, and I don’t want to start afresh.’

Recently, popular wearable fitness tracker FitBit has introduced their own period tracking function under ‘female health tracking’. A user on the FitBit community asks: ‘Is there any chance we can have female health tracking information pulled from the Clue app? PLEASE can we have this — I’ve been tracking in Clue for about 2 years and don’t want to lose all my data.’

Other users support this request, some using detailed arguments to convince Fitbit to allow data integration. ‘Do it. It’d add in a lot of things that are necessary but missing….They are already linked, [because] I know that Clue has done research using FitBits and found that there’s a rise in resting heart rate at ovulation. Right now I’m using Clue but have had to disable the female health tile in FitBit as non-functional. For what it’s worth, I have to use the following extra apps, and wouldn’t have to if FitBit extended its functionality. Water tracking app, sleep tracking app, cycle tracking app, energy pacing app, food tracking app, meditation app.’

The fact that providing these services depends on the acquisition and analysis of user data appears to make all kinds of data collection ‘legit’ in the eyes of users. Most users I interviewed for this piece appear unfazed about data collection; they feel that data is required to provide services to users. What’s more, they believe that linking data across platforms will result in more accurate predictions — something that data security and privacy advocates are alarmed about.

In short, a large community of people have decided that providing and consenting to the use and sharing of all their data and information is a reasonable price to pay for convenience.

***

When I post a poll about using period tracking apps as a contraceptive method, I am not expecting a positive response. Contraception is such a serious issue after all. How many people would actually feel comfortable depending on an algorithm-driven prediction?

Quite a few, it seems.

‘I have used it successfully to conceive and have been using it to avoid conception ever since,’ says Hareem. Saira has also used the apps successfully as her primary method of contraception. While Saira and Hareem have had success so far, most apps make sure that they explicitly warn users against depending on them as a contraceptive method. ‘Eve is not a substitute for natural family planning and should be used along with other contraceptives,’ warns Glow, while Ovia and Clue include similar disclaimers. But a number of users continue to use period trackers to schedule what’s known as the ‘rhythm method’.

While some are lucky enough to get away with it, others find that this ‘contraceptive method’ is fairly unreliable. ‘I had read so much about it and seriously, I was pretty sure about its effectiveness,’ laughs Raania, a young mother of a three-month old. ‘In fact I might have been a little condescending towards others, haughtily telling them that I didn’t have to depend upon methods that include inserting stuff into my body or taking hormones or using condoms that I thought would take spontaneity away from sex. Well, did I pay for my smugness. I was so hung up on the fact that I always had a regular cycle, that I ignored the changes that were occurring post-marriage. I still think it was my own fault for not being very vigilant and entering all the data that I could have entered to help the algorithms make better predictions. But well, I guess in the end I have to admit that it isn’t foolproof.’

AI and human creativity go hand in hand, in an AI self-portrait, by IBM AI (2018), Image courtesy https://www.ibm.com/blogs/research/2018/10/ai-creativity/

Raania’s reluctance to call the app inefficient is not surprising. She is a technologist and believes that technology holds the answer to many things — including women’s fertility. And so, even though she has already had the app fail once, she continues to use it as her main method of contraception. But now she is very careful about entering as much detail as possible. ‘I also add a couple of days at the beginning and end of the predicted fertile period now. Just to be on the safe side,’ she laughs.

***

By now there are a number of questions buzzing around my head, most of them unasked. Are users comfortable with so much of their data being collected? Are there really algorithms that string together all this data into medically-relevant trends? How reliable can these trends be when usage is erratic? Are period tracking apps pioneering, fundamental elements of a future where medical aid is digital and reliable data is inevitably linked to the provision of medical services? And if so, are privacy and health soon to become conflicting rights?

I also want to find out how users understand data collection and privacy before giving apps consent to utilize their data and information as they will. Hareem says she gives apps informed consent. ‘If my data becomes a part of the statistics aiding medical research, why not? There is no harm in it. I am getting a good service, and if my data helps create a better understanding as a part of a larger statistical pool, they are welcome to use it.’

But is she really sure that this information will be used only as anonymised data for medical research? ‘Look at the kind of information that is being collected,’ she answers. ‘Dates, mood, consistency of mucus, basal temperature. What kind of use does one have for this data?’

Naila, in turn, says: ‘Honestly, I have never really thought about what happens to the data the application collects. Obviously I enter detailed information about my cycle and my moods and my sex life. But a), my account is under a fake name and b), even if it wasn’t, who would have any use for stuff like when my period starts and ends and what my mood or digestive system is like at any given moment?’

In fact, this sentiment is shared among all the women interviewed for this piece — what use would anyone have for this data?

BIG Data — Robotnik (2017), by Arthur Schneid, Image courtesy https://en.artoffer.com/Arthur-Schneid/Arthur-Schneid-Technology-Society-Modern-Age-Abstract-Art/325648

As users, we often imagine our own data as anonymised within a huge dataset. But as users, we don’t have enough information about how our data is being used — or will be used in future. The open and at times vague language of a platform’s terms and conditions allows menstrual apps to use data in ways that I may not know of. Some apps continue to hold customer data even after an account is deleted. Even though I may technically ‘agree’ to the terms and conditions, is this fully informed consent?

One of the big concerns around this kind of medical information being collected is the potential for collaborations with big pharmaceuticals and other health service providers. With apps sitting on a goldmine of users’ fertility and health information, health service providers might mine their data for potential consumers and reach out directly to them. While this is like any targeted marketing campaign, the fact that the advertiser is likely to be offering medical services to women suffering from infertility and are at their most vulnerable, raises totally different ethical concerns.

And these apps and their businesses might grow in directions that users haven’t taken into consideration. Take Ovia’s health feature for companies to buy premium services for their employees. While the gesture is packaged as a goodwill one, it also means that an employer has access to extremely private and intimate medical information about their women employees. And while the data set is anonymised, it is still possible to figure out the identity of users based on specific information. For example, how many women in any company are pregnant at any given time?

It is highly unlikely that users of Ovia’s health feature are completely comfortable with their employers having access to information about their sex lives, orgasms, cervical positions and so on. In a world in which women already face gendered discrimination at the workplace, an employer’s access to such information can have an adverse impact on their professional lives.

Eve, Clue, Ovia and other period trackers allow me to sign in through Facebook and/or Google accounts, which means that my data might be directly shared with these networks. The possibility of my data ending up with Facebook or Google makes me really uncomfortable. It is one thing being on a network where periods, sex and fertility is the name of the game. But personal information on these pulled and shared in another network is something else altogether.

Pregnant a year after my miscarriage, I initially downloaded multiple apps in a bid to find a good fit. I don’t know which one of these was in communication with Facebook. But almost immediately, my Facebook timeline started becoming littered with ads for baby stuff — clothes, shoes bibs, prams, cribs, ointments for stretch marks, maternity wear, the works.

It makes me think of those old school clockwork-style videos. You drop a ball and off it goes: making dominos fall, knocking over pots and pans, setting in motion absurd, synchronized mechanisms. Similarly, I drop my data and watch it hurtle into my life, on to other platforms, off to vendors. Maybe to stalkers? To employers? Who knows.

For now, I just watch this modern day magic trick and continue to let the data bleed, knowing that it is not only us tracking our periods, it is also them tracking us. Period.

This work was carried out as part of the Big Data for Development (BD4D) network supported by the International Development Research Centre, Ottawa, Canada. Bodies of Evidence is a joint venture between Point of View and the Centre for Internet and Society (CIS).