Medical and Ethical Analysis of Menstrual Apps [26I

Abstract

INTRODUCTION: The recent explosion of digital health applications includes emergence and growing popularity of smartphone apps for women’s health, most commonly menstrual tracking apps. Meanwhile, monetization of women’s sensitive health data has led to public outcry and ethical concerns. Greater understanding of medical and ethical aspects of menstrual app use is needed. METHODS: We survey women’s menstrual app use, highlighting issues related to beneficence, autonomy and justice. RESULTS: These technologies may benefit women by empowering better control over contraceptive intentions or pregnancy desires and greater insights into reproductive health, however harms may occur when technology fails, most notably in the case of unintended pregnancies among women using apps with flawed ovulatory prediction algorithms. Autonomy may be compromised if women cannot control third-party use of highly sensitive reproductive health data (e.g., when, where and who they have sex with), particularly when ability to use apps is conditioned on “accepting the cookies” and potentially misleading small-print notice/informed consent regarding reasonable expectations of privacy and potential data uses. These apps normalize a new frontier for ubiquitous data surveillance, gathering health-relevant data outside of the traditional healthcare contexts where it is not afforded appropriate legal or ethical protection. Menstrual apps may promote commodification of women’s bodies by harnessing personal data to generate advertisement revenue. CONCLUSION: Current menstrual apps raise concerns regarding their effectiveness for promoting women’s health, expectations of privacy and appropriateness of monetization of inherently sensitive health data. Emerging technologies such as blockchain and privacy-preserving computation may support more woman-centric menstrual apps; further research is warranted.