Trusting Tracking: Examining Black Women’s Perceptions of Menstrual Cycle Tracking Applications in a post-Roe v. Wade World

 

Naomi Washington

Journalism, Elon University

Submitted in partial fulfillment of the requirements in an undergraduate senior capstone course in communications

Abstract

Women are anxious about their menstrual cycle tracking application data getting them into legal trouble. Following the Supreme Court’s decision to overturn Roe v. Wade, women no longer have the constitutional right to choose whether to continue or end a pregnancy in every state. Conspiracy theories and fears spread through videos and posts on social media to the 50 million women worldwide who use menstrual cycle tracking applications. This caused trust in health data security among women to change drastically. While studies have investigated women’s newfound lack of trust in health data security in a post-Roe world, Black women are often excluded in these research samples. This study solely examines Black college-age women’s perceptions of health data security in the context of using menstrual cycle tracking applications after the overturn of Roe v. Wade. Through eight semi-structured interviews, a connection emerged between Black women’s trust in healthcare providers and menstrual cycle tracking applications. Almost every participant changed the way they used their menstrual cycle tracking application or stopped using one altogether. The findings show Black women’s anxiety about what could happen to personal data from menstrual cycle tracking applications is another layer on top of their preexisting mistrust of the healthcare system.

Keywords: trust, data, menstrual cycle tracking applications, Roe v. Wade, healthcare providers
Email: nwashington3@elon.edu

I. Introduction

The days of women using a wall calendar and a marker to keep track of their period are long gone. Menstrual cycle tracking applications are downloaded on the phones of 50 million women worldwide to receive predictions on menstruation, future cycles, fertility windows and other logged symptoms (Kelly & Habib, 2023). Among the hundreds of applications, the most popular are Flo Period & Pregnancy Tracker, Clue Period Tracker & Calendar, Clover — Period Tracker ⋅ Calendar and Cycles: Period & Cycle Tracker. The drawing factor for most women is the convenience of having past, present and future period dates stored in a smartphone they already use for everything else. The trust in this tracking form has been under question since the increasing United States government interference in women’s health.

The 1973 ruling in the Supreme Court case Roe v. Wade established the precedent that an individual has the right to choose whether to continue or end a pregnancy rather than the decision being made by the government. After almost 50 years, in 2022, the Supreme Court of the United States ruled that abortion is not a right protected by the Constitution through the case Dobbs v. Jackson Women’s Health Organization. This opened the door for state governments to create legislation to protect or ban abortion and other Planned Parenthood services. According to Nash and Guarnieri (2023), as of January 2023, 12 U.S. states had near-total bans on abortion and miscarriages, with very few exceptions. Women can be taken to court and charged for having a miscarriage or performing an at-home abortion in states that have regulations. Doctors who perform abortions in states with bans can be charged with a crime. Prosecutors and police do not have to rely solely on medical data or testimonies from doctors, nurses and others as evidence because of the emergence of digital tools that store digital information. The companies responsible for menstrual cycle tracking apps sell this data often to advertisers (Conti-Cook, 2023). Data from a health app is not enough on its own to prove criminal intent in a court in states where abortion is criminalized. Internet search history, social media activity, purchases and the involvement of third parties — such as hospital staff or relatives — are the main sources of successful prosecutions (Conti-Cook, 2023).

This research aims to expand on previous studies about women’s comfort using mobile menstrual cycle tracking applications after the overturn of Roe v. Wade by focusing on Black, college-age women’s perceptions. Drawing on eight one-on-one interviews with Black women ranging from 18-23 years old, this study will unveil the history of why Black women have less trust in the American healthcare system than other demographics and how that translates to their use of menstrual cycle tracking applications.

II. Literature Review

Previous scholarship explored the efficiency of menstrual cycle tracking apps for women of all backgrounds. A particular survey conducted after the overturning of Roe v. Wade showed women now have concerns about using mobile applications to track their menstrual cycle, given the possibility of third parties being able to access their data (Salvatore et al., 2023). There is fear that data collected by menstrual tracking apps can show pauses in a person’s normal cycle, which can indicate pregnancy and its end. Furthermore, women perceive the danger in apps that include a location tracking feature capable of showing if a user is present at an abortion clinic. The health data that mobile apps store is not protected by the Health Insurance Portability and Accountability Act, which is also known as HIPAA. The ethics of using menstrual cycle tracking application data against women in legal settings are unclear because state-specific abortion laws are still relatively new.

Apps for Healthcare

The World Health Organization Global Observatory for eHealth defines mHealth as medical and public health practice supported by mobile devices (Rowland et al., 2020). Before the rise of mHealth, women tracked their menstrual cycle on paper. Now, approximately one-third of women in the United States use a menstrual cycle tracking mobile application (Krumbholz et al., 2024). Over 50 million people worldwide use app-based self-triage; the interactive symptom checkers within mHealth apps are studied most (Rowland et al., 2020). Rowland et al. (2020) describe the functions of mHealth apps as supporting a clinical diagnosis or decision-making, acting as a digital therapeutic, delivering disease-related education and improving clinical outcomes through suggested behavior changes and compliance with treatment.

The number one health app in the Apple Store is Flo Period & Ovulation Tracker; downloading the app is free, but upon making an account, it asks women for information such as name, email address, weight, menstrual patterns, and fertility plans. Apps are not transparent about what they do with the data they store, and people do not tend to read the fine print. According to Healy (2021), it is common for app developers to sell the “intimate and intricate micro-data bites” that women log every day in the apps to large companies so they can create marketing strategies that target them and “subtly remind them of their reproductive uses in society.” If menstrual cycle tracking apps become more transparent about their data-sharing policies, women can decipher what advertisements are being targeted at them (Healy, 2020). One survey indicates users are generally more concerned that health data from these apps could be sold or accessed by law enforcement to establish a timeline or criteria for pregnancy. Only 7.3% of respondents from that study were African American, so this research will focus solely on that demographic because of the historical distrust in the healthcare system that Black women had before the overturn of Roe v. Wade.

Black Women’s Distrust in American Healthcare

The myth that biologically Black people feel less pain than White people was used to justify slavery and cruel treatment in past medical research (Hoffman et al., 2016).  A significant event in the formation of this mistrust was the Tuskegee Syphilis experiment that began in 1932. Doctors from the U.S. Public Health Service (PHS) promised 600 Black men in Macon County, Alabama free medical care if they participated in their experiment to find a cure for syphilis, a contagious venereal disease (Nix, 2017). At the start, 399 men had latent syphilis, and 201 didn’t have the disease; most of the participants were sharecroppers who never visited a doctor before. According to Nix (2017), the participants monitored by health workers were “only given placebos such as aspirin and mineral supplements, despite the fact that penicillin became the recommended treatment for syphilis in 1947, some 15 years into the study.” The local physicians stopped treating the men so PHS could track the disease’s “full progression” (Nix, 2017). The untreated syphilis caused the men to die, go blind, go insane or experience other severe health problems. Years later, in the 1960s, investigators and reporters exposed the PHS for the unethical experiment, and in July 1972, the study was officially shut down. Many participants died by this point, and it passed to spouses and children. The surviving participants and the heirs of the people who died received a $10 million court settlement after going through Congress hearings about the experiment in 1973 (Nix, 2017). After this, guidelines such as the Institutional Review Board process — better known as IRB — formed to protect human research subjects. The aftermath of the Tuskegee Syphilis Experiment spread as one of many cautionary tales in the Black community.

Black women suffer from pregnancy complications and maternal mortality at a disproportionately higher rate than other racial and ethnic groups. Specifically, Black women are “at least three times more likely to die due to a pregnancy-related cause when compared to White women” (Njoku et al., 2023). If a previous medical condition that can negatively influence the pregnancy is not present, the woman becomes a victim of racial disparities. During the COVID-19 pandemic, the maternal mortality rate for Black women increased even more due to the additional strain on health resources and socioeconomic stress (Njoku et al., 2023). According to Njoku et al. (2023), due to healthcare facilities being understaffed and overworked, patients might feel neglected while healthcare professionals might experience burnout. Furthermore, there is a scarcity of obstetricians, nurse midwives, and well-women nurses in low-income, racially, and ethnically diverse communities, which could have a significant impact on the outcome of pregnancy. Many Black women say they would rather risk the unpredictability of potential illness in the future than see a healthcare provider who might not understand their needs and cultural nuances (Murray, 2015). These unfavorable trends explain why the usage of menstrual cycle tracking applications may not feel like a safe space for Black women.

The Effectiveness of Healthcare Apps

Mobile phone ownership among youth is growing. Therefore, the adaptation of mHealth is increasing. Cell phone usage rates are highest in college students, so they are a target population for mHealth. Heron et al. (2019) note that mHealth is a way to target young people to care for their health between visits to a health provider. Furthermore, their results show that more women use health and lifestyle apps than men. There is a dominance of White women used in mobile health application visuals, which implies whiteness is the norm for defining health (Doshi, 2020). More specifically, the predominantly featured women are White with brown or blonde hair and skinny bodies. This implies that Black women may be hesitant or choose not to use health apps because they are concerned about how the trends found in other demographics will translate to their experiences.

Women’s health apps commonly provide a space for people to anonymously or openly disclose health information with others on the app in exchange for emotional or social support. There is a difference between mobile apps being scientifically effective (in self-care and self-diagnosis) and being personally effective. For a healthcare app to be personally effective, users feel it meets their expectations and provides the community they need. Cultural and environmental influences affect Black college women’s willingness to use mHealth apps (Krumbholz et al., 2024). Black women value access to culturally competent information from providers who also identify as Black women. Beyond access to the proper healthcare providers, knowing what dangers Black women are afraid of regarding their data privacy can create a potential action plan for forming more trust between Black women and the American healthcare system.

While previous research explored women’s comfort with using menstrual cycle-tracking apps after Roe v. Wade, this research will put Black women at the center of the conversation by focusing primarily on their perceptions. The thoughts Black women have on using menstrual cycle tracking apps connect to the common distrust in the American healthcare system. The doubts Black women have when it comes to interacting with the healthcare system have existed for decades. This research will fill the gap by putting Black women at the center of the conversation about trust in menstrual cycle tracking applications’ ability to secure health data. Looking at the historical mistrust in the American healthcare system is also crucial because this topic is related to pregnancy, and Black women suffer disproportionately from childbirth mortality.

Research Questions

The research will answer the following questions:

RQ1: How do young Black women describe their relationship with healthcare providers?

RQ2: To what extent do Black college-age women trust menstrual cycle tracking applications?

RQ3: Why do they see issues using menstrual cycle tracking applications?

RQ4: What are the specific dangers or issues they perceive when using menstrual cycle tracking applications?

Research question one helps establish a foundation for the subsequent three questions about their trust in apps and the issues they see with them. Without understanding where the interviewee stands on getting help from human healthcare providers, connecting that and their level of trust in health-based mobile apps will be challenging. Question two will reveal if the participants have any level of confidence in menstrual cycle tracking applications and if there are certain ones they trust more than others. The last two research questions aim to pinpoint concerns and dismantle perceptions not factually supported for future applications and research to consider.

This research is important because it plays a small role in bridging the large gap between Black women and trust in the American healthcare system. With the overturning of Roe v. Wade, women fear menstrual cycle data that indicate fertility and pregnancy can be used against them legally in states where abortions are criminalized. Menstrual cycle tracking app data is not currently enough evidence on its own to prosecute women, but the indicated fears make this a part of reality (Conti-Cook, 2020). Apps will continue selling user data to third-party companies to create more influential targeted advertising. What makes this research significant and necessary is the sole focus on Black women. Previous studies exclude or include a deficient percentage of Black women in their profile sample. For many women, questions about whether they can trust American healthcare institutions is a new feeling, but Black women have carried the anxiety of mistrust since the beginning of slavery.

III. Methods

This research uses semi-structured one-on-one interviews to identify the dangers and issues Black women perceive from using menstrual cycle tracking applications. Rosenberry and Vicker (2021) define this interview style as having an agenda and set list of questions but maintaining an informal approach by exploring new topics and perspectives during the conversations if it adds to the research. Conducting interviews is the best way to gather personal accounts of how individuals navigate a social setting; face-to-face interviews have a better response rate than surveys, even though the method is more time-consuming (Rosenberry & Vicker, 2021). Another benefit of using this research technique is that it allows both the participant and interviewer to learn.

Practical insights were gathered through eight one-on-one interviews with Black women on Elon University’s campus. The profile of the interviewees were females between the ages of 18 and 23. To ensure a range of experiences and knowledge, the researcher used convenience sampling to select a sample of participants: two freshmen, two sophomores, two juniors, and two seniors. Each was asked the same 10 questions, with follow-up questions to clarify unfinished narratives. This method fits the research because the in-person conversations gathered the young women’s perceptions. The questionnaire couldn’t be done effectively through secondary research, surveys or focus groups. Each interviewee was protected under Institutional Review Board guidelines and signed an informed consent waiver promising confidentiality, so their names will not be mentioned in this paper. The researcher located participants in GroupMe messenger chats for Black students at Elon University. Then, the student’s class year at Elon was verified through the university student directory. No incentive was offered to the participants for the information they provided. The interviews were conducted in April 2024. All the questions were purposefully open-ended and vague to prevent leading on the interviewees to reference the history of Black women being mistreated in the American healthcare system and the overturn of Roe v. Wade. Having open, intentional conversations about how these Black women navigate the American healthcare system and the healthcare mobile app space provided a comprehensive understanding of what dangers they perceive.

Participants answered these open-ended questions:

  1. When you have to go to the doctor for a general physical or specific reason, what is your attitude?
  2. Do you request a provider of a certain demographic or someone you know? Or do you just like to be seen by whoever is available at the most convenient time?
  3. Generally, do you feel like your health providers listen to you when you express concerns about your health?
  4. What mobile health application do you use to track your menstrual cycle? When and how did you discover the app?
  5. What method were you using before this?
  6. Did you read the app’s terms and conditions when you signed up for this application? If not, was it clear to you what data it stores?
  7. As a result of current events in the United States, have you ever reconsidered using a menstrual cycle-tracking app? If so, what events made you reconsider?
  8. Do you sense any health data security issues when it comes to tracking your health through app(s)?
  9. On a scale of 1-10, how much would you say you trust your menstrual cycle tracking application’s ability to keep your data secure? One being ‘not at all,’ 10 being ‘complete trust with no doubts.’

At the conclusion of each interview, the researcher asked the participant to fill in the blank verbally: “My healthcare experience in America is/has been (blank).” This invited respondents to share their lasting thoughts or talk about other experiences that influenced their answers to the earlier questions. In a few instances, new subjects and personal anecdotes came up. The researcher took handwritten notes and recorded the audio on the Otter Transcription application. The recordings and notes were solely for the researcher to keep information organized. The transcriptions and notes were destroyed six months after the interviews.

IV. Findings

The eight interviews aimed to understand how young Black women feel about the American healthcare system and using menstrual cycle tracking applications after the overturn of Roe v. Wade. The conversations revealed three primary findings: the participants carry mixed feelings about seeing healthcare providers, most participants have low confidence in menstrual cycle tracking applications’ ability to keep their health data secure, and most participants’ menstrual cycle tracking application usage changed in some way after the overturn of Roe v. Wade. Each theme is discussed in greater detail in the sections that follow. Throughout the findings, the respondents will be referred to by assigned labels to protect their identity. There are two interviewees from each class year at Elon University, and the labels are consistent with those year classifications.

Black Women and Healthcare providers

To assess general trust in the healthcare system, the first question in every interview was: When you have to go to the doctor for a general or specific reason, what is your attitude? The answers ranged from “nervous” and “scared” to “positive” and “willing.” All the participants are between 18 and 23 and have not encountered serious health issues that make them see a doctor for more than physicals and need-based urgent care visits. Many still see the same primary care physician from their hometown with whom they’ve grown comfortable. “I’m pretty positive when I go to the doctor, mainly because I’ve known the doctor I’ve had since I was six or eight. So, I feel like she knows me very well and with that, I feel comfortable,” Freshman 1 said. “I guess when I go to the new doctors though, I’m a little bit more nervous just because that’s a new person and I feel like a doctor’s office is a very vulnerable place,” she added. Sophomore 1 expressed their intimidation goes beyond the nerves about visiting healthcare providers without the full guidance of her parents for the first time:

I have read the stories where black women are not treated correctly in the healthcare system. And to go into it alone, or to finally face the fact that I have to go into it alone and have that potential factor is what scares me — even if it’s as simple as a physical. There’s the potential of having a pain and then somebody being like, ‘Oh, well, it’s okay. It’ll go away,’ when it could be something severe.

Senior 1 remedies these types of feelings by getting ready mentally before seeing doctors; she believes, “the more closed off you are, the more uncomfortable it is for them.” She acknowledges this is a people-pleasing mechanism that puts her healthcare providers’ comfort above her own.

Half of the participants said they regularly request a provider of a certain demographic or gender, while the other half of the participants do not so they can be seen right when they want to. Requesting a specific healthcare provider can limit appointment availability. Sophomore 1 likes to see “mainly whoever is available because of how busy I am when I do go.” Respondents who request particular healthcare providers describe their preferences as “all female doctors,” “all Black, female doctors” and “the same person every time.” Among these answers, one respondent found she’s bonded in the healthcare setting with a specific nurse practitioner whom she prefers seeing for appointments because of his sexuality. “He’s always very understanding no matter what I’m going there for,” she added. All interviewees responded “yes” to the question asking if they feel like their healthcare providers listen to them when they express concerns about their health. This positive observation could be attributed to each person’s healthcare provider preferences, even if they just see “whoever’s convenient.”

Despite the fears indicated throughout the interviews about seeing a doctor and using menstrual cycle tracking applications, when asked how they would describe their healthcare experience in America most respondents initially replied, “Good,” “Okay,” and “Average.” Then, after some silence, new anecdotes emerged. One woman opened up about a bad experience visiting a healthcare provider alone in North Carolina (which is not her home state). “I was told something isn’t actually going on. ‘It may just be my imagination,’ or they told me what it was and it wasn’t actually that, and it got worse,” she said. The same respondent anticipates her experience seeing healthcare providers will worsen as she gets older. Her previous bad experiences and health trends based on Black women led her to make a major personal declaration:

I don’t think I’m going to have kids because I’ve seen one too many cases and definitely have some personal cases where Black women just aren’t treated correctly when it comes to pregnancies. There is also the power of age. People think, ‘Oh, you’re young, you don’t know what’s going on with your body’ and things of that nature. I definitely think it could get worse, especially with [abortion] policies being put in place. It’s not really caring about womanhood it’s more of just ‘Well, this shouldn’t happen because this is what our country was founded on.’

The experiences Black women have with healthcare providers will determine the decisions they make about their health in the future. Respondents indicated anxious feelings about seeing healthcare providers partly from cautionary tales spread about traumatizing medical research done using the Black community in addition to nervousness from their own past experiences or the experiences of Black women close to them. Junior 1 believes the relationship between Black women and healthcare providers could improve if more doctors followed diversity, equity and inclusion (DEI) protocols and had knowledge pertaining to treating communities of color.

Low Trust in the Tracking

All study participants have experience with or currently use a menstrual cycle tracking application. The combination of the convenience of having their menstrual cycle information on their phone where everything else already is and persuasion from their female friends drew them to use an app. The diffusion of innovation theory (DOI) is people’s adoption of new information and technology through a series of stages (Rosenberry & Vicker, 2022). The theory is relevant to this finding because these young women adopted a new technological practice through peer persuasion. Diffusion of innovation happens in multiple steps: knowledge of the innovation, persuasion, the decision to accept or reject it, the implementation stage and the confirmation stage (Rosenberry & Vicker, 2022). In the context of this research, the use of menstrual cycle tracking mobile apps started as an innovation or alternative to other menstrual cycle tracking methods. Women likely learned about it through word of mouth — which would be other women who adopted the innovation already — news and marketing to the target demographic. Considering 50 million women worldwide use a menstrual cycle tracking app on their phones (Kelly & Habib, 2023), the theory is pertinent to understanding how technology spreads through society. Freshman 1 recalled her thought process when she downloaded the Flo at age 12:

Right when I started my period, the day of, I downloaded it. I just remember talking to other girls in my grade at the time, and then they were all like, ‘Oh, I use Clue. I use this, that and the other.’ So then when I got my period, I just knew I was like, ‘Okay, I guess everyone else uses the app. So I guess you’re just supposed to use an app.’ Then I did.

While the peer persuasion was likely unintentional, it caused Freshman 1 to adopt the practice of using a menstrual cycle tracking application. Among participants, Flo is the most-used app. Most women started using a mobile app when they started their menstrual cycle at a young age. However, a few women learned to predict their period’s arrival using a calendar before switching their tracking method to an app. Only one of the eight participants read the app terms and conditions upon signing up. Everyone attributed their lack of reading the terms and conditions to their young age – it didn’t matter to them then. Generally, the participants assume the app can only store the information they provide directly to it. Choosing to be anonymous when signing up for an account on these apps is also an option instead of using personal information.

Regarding the second research question about the extent to which Black women trust menstrual cycle tracking applications, the respondents indicated a relatively low confidence level. The table below shows the current menstrual cycle tracking application they use beside a column with their answer about how confident they are, on a scale of one to 10, that the app can keep their data safe.

Table 1: Participants’ Current Menstrual Cycle Tracking Application Versus Their Confidence in its Health Data Security

Participant Current Application Confidence Rating on a Scale of 1-10
Freshman 1 Clue 8
Freshman 2 Flo 7
Sophomore 1 None 4
Sophomore 2 Flo 4
Junior 1 Flo 3
Junior 2 Clover 7
Senior 1 None 3
Senior 2 Flo 7
Table: Naomi Washington –  Source: Primary Research by Naomi Washington

The confidence levels vary and are lowest in women who stopped using a menstrual cycle tracking application recently. Sophomore 2, who uses Flo, is one of four participants with a confidence rating below five and admitted, “I use it like I trust it.” However, she explained she is too reliant to stop:

I only use it out of convenience. If I was lucky enough to have my mom be aware of how to do the pen and paper tracking method, and she taught me that at a younger age, I would have never touched an app.

Junior 1 has even lower confidence in apps’ health data security. She believes her information can be “misconstrued or used without her consent” to “affirm preconceived opinions” or make her “an example of a certain political stance.” Senior 2 expressed a much higher confidence rating but said she “would feel violated” if her data ever got into the wrong hands. Junior 2 vocalized she “barely uses” the symptoms tracking feature in her menstrual cycle tracking application Clover — she only uses it to see her period start and end dates and she has an anonymous account — so she doesn’t feel like her data would be useful if it were exposed.

The trust Black women have in menstrual cycle tracking applications is generally low similar to their trust in healthcare providers. Participants expressed a range of levels when they were asked, on a scale of one to 10, how much they trust their app’s ability to keep health data secure. There was a direct correlation present in most participants; those who felt anxious about visiting healthcare providers also had extensive fears about what could be done with their menstrual cycle tracking application data. The Black community would benefit from knowing what credible sources of information to trust about what kind of data specifically is stored and what it means to press “I agree” on the terms and conditions upon signing up for menstrual cycle tracking applications.

Using Menstrual Cycle Tracking Apps Post Roe v. Wade

The fears Black women carried about the American healthcare system intensified after the overturn of Roe v. Wade. Almost every participant changed the way they used their menstrual cycle tracking application or stopped using one altogether. Senior 1 deleted Flo, the app she previously used, off her phone within the same month the Supreme Court of the United States overturned the case despite being an active user since she was in middle school:

There isn’t a law against them pulling that data from the apps. So what’s happening with the Roe v. Wade case is very terrifying just because we’re losing access to a lot of things that women need. The less leverage they have on me, the better. Now, I’d rather keep it in my own personal records.

While the older participants expressed doubt about their menstrual cycle tracking apps following the ended right to abortion, the two youngest participants — Freshman 1 and Freshman 2 — never mentioned the current event. Freshman 1 said she “definitely” senses health data security issues with using apps to track her health but, “there’s risk in putting your information into anything” technology-based. Freshman 2 stated “I personally don’t think a lot of stuff would happen to me [if data leaked] because I don’t put everything in there. I just use it to track the [period] days.” To answer research questions three and four, participants expressed the following specific fears:

  • Seeing their data being “misconstrued or used without consent” (Junior 1)
  • Having their data “be used as a confession” to make them an example out of a certain political stance (Junior 1)
  • Finding out their data was sold which could include date of birth, when their period comes, and symptoms (Junior 2)
  • Not knowing who has access to their data (Senior 1)
  • Experiencing blackmail or someone trying to steal their identity (Sophomore 1)
  • Feeling “violated” from the exposure or leak of data (Senior 2).

None of the participants cited specific sources or provided detailed explanations about who and what organizations authored the information they consumed online about what they thought could happen to their data. These women started using menstrual cycle tracking applications under the influence of their peers, and in the same way, they are reconsidering the apps or stopping because of peer persuasion. Senior 1 described how she felt when she first heard a conspiracy theory about what happens to menstrual cycle tracking application data:

I remember when — and I definitely saw it on TikTok, so how true is it? Who knows? — But I saw a TikTok saying since you log that data, that’s technically public record, and people could go in there and track it in case they wanted to say I had an abortion or whatever. And at that time, I was having a very irregular experience. So that’s when it kind of struck me that I am logging my personal information into a public-wide app.

Of the participants who have similar concerns, most of them cited watching TikToks or seeing an Instagram post as their source of information for these theories. Junior 2 switched from the Flo app to the Clover app after she “read something” that claimed Clover does not track and sell personal data, but Flo does. Sophomore 2 considered deleting Flo and switching back to using paper to track her period. But she worries she will not be able to keep track of it accurately on her own. Meanwhile, Sophomore 1 stopped using Flo and deleted the app shortly after the overturn of Roe v. Wade but not for the same type of reason. The app lacked accurate period date predictions for her body. She believes menstrual cycle tracking applications do not do well at accurately considering women with irregular periods, day-to-day stress and other physical obstacles.

I don’t want this to make it seem like period apps are absolutely horrible because for some people it works. But I hope that people start to realize that it doesn’t account for daily life. It accounts for the perfect person.

The convenience of menstrual cycle tracking applications is almost undeniable. But now that technology has taken over the menstrual cycle tracking space and the safety of women’s personal data is threatened, women feel left with no place to turn other than back to paper and pen.

V. Discussion

Black women’s perceptions align with the overall consensus that menstrual cycle tracking applications are less trusted after the overturning of Roe v. Wade. The stages of diffusion of innovation played a central role in the rise and fall of comfort and trust in these applications. When mobile period applications initially launched years ago, women were most likely skeptical but unknowingly entered into phase one which is knowledge of the innovation (Rosenberry & Vicker, 2022). Then, through women who embraced these apps to track their period and fertility, new women were persuaded to try it, which is phase two. In phase three, more women accepted or rejected it. The last two phases — implementation and confirmation — are when the complete switch from paper to apps is made. The diffusion of technological innovations continues over and over through societies every day. Ultimately, the persuasion and spread of information (whether it is correct or not) to peers infuses people’s thinking and decision making.

Another finding consistent with previous literature is the fear that menstrual cycle tracking application data could be obtained by the government and used as evidence to prosecute women for having an abortion in a state where it is no longer legal. However, Conti-Cook (2020) explains that while internet searches provide “​​a feeling of privacy, internet use is actually easily surveilled” (p. 24). On top of this evidence, messages sent by phone and testimonies from people surrounding the accused are also considered primary evidence in a legal setting. Data from a menstrual cycle tracking application alone does not show “criminal intent.” Unprotected digital trails including online searches, geofencing, location tracking, and purchasing history will be increasingly relied on in states where abortion is illegal (Conti-Cook, 2020). Conti-Cook (2020) notes the following about Black women being at a higher risk:

Young people of color, including girls and women from low-income communities, are surveilled, searched and seized by multiple state authorities at disproportionately higher rates than their White peers, making it more likely that their digital devices will be as well. Black communities specifically have suffered more intrusive levels of surveillance dating back to slavery (p. 29).

People resort to online health information to keep their circumstances “private” and to save money. Conti-Cook’s (2020) assertion that “period trackers are not the primary form of digital evidence likely to be used in abortion prosecutions today” is still valid. Nonetheless, women are anxious about the future realm of possibility with more U.S. states enforcing near or total abortion bans.

Another striking key takeaway from the interviews is that each individual’s discomfort with seeing healthcare providers in general directly correlated with their confidence level rating in an app’s ability to keep their health data secure. Without a person’s trust in one, there likely will not be trust in the other. Finally, this research was limited by factors that should be considered for future research opportunities. The interviewee sample size was intentionally kept small to accommodate the constraints of time and the delicate nature of the questions pertaining to a sensitive topic. This research asked participants questions about a sensitive topic so participants may have been unconsciously reserved in their responses. The research is not generalizable to a larger population.

VI. Conclusion

This study sought to understand to what extent young Black women trust menstrual cycle tracking applications’ ability to keep their health data secure. Research revealed the trust level in these apps connects to their trust level in human healthcare providers. A health trend related to this subject is Black women dying during childbirth at a disproportionately higher rate than women of other racial backgrounds. Cautionary tales of past medical trauma done to the Black community are passed down through generations and, in turn, cause Black people today to feel anxious about situations they did not even experience firsthand. Thus, the findings from this research confirm that making the American healthcare system better for Black women at the root will trickle down to make their perceptions of other healthcare tools, such as menstrual cycle tracking applications better.

To further this study, researchers should investigate the legality of using menstrual cycle tracking data as primary evidence in court. Additionally, studying the criteria this app data has to meet to hold up in a courtroom would bring clarity to the speculations in society. Once this further research is established, it needs to be published under the jurisdiction of credible, accessible websites. This will make it possible for people to read accurate information with clear answers to their questions.

Regarding healthcare, it is important for healthcare providers and researchers to listen to people’s concerns on a frequent basis, not just when conducting research. Feelings are not facts, but they still matter when it comes to improving the institutions people count on. Some women can choose to delete their menstrual cycle tracking application, reopen a paper calendar and be done worrying about their health data security. Black women can do the same, but they will still have to face the lingering anxiety of using the American healthcare system.

Acknowledgements

Thank you God for providing me with the strength and wisdom to complete this research. Thank you to my parents, Mark and Dynita Washington, who provide me with all the love and support I could ever ask for. And, thank you Dr. Daniel Haygood for guiding me through this process and believing in my vision for bringing this valuable subject area to life.

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