Ever heard of fertility and menstrual tracking apps? Over 200 million women use these types of apps (bioRxiv, “Assessment of Menstrual Health Status and Evolution through Mobile Apps for Fertility Awareness,” 08.15.2018). They’re pretty new (though menstruation and fertility aren’t!) and help users track their menstrual cycles and fertile windows, a term that refers to a period in time in the female fertility cycle during which a woman is able to get pregnant. I became interested in researching these apps back in 2017 after attending a medical conference on women’s health, where I heard a physician say that most of the apps on the Apple app store are inaccurate in determining these fertile windows.
While menstrual and fertility apps may seem like a narrow category of research, there is actually a lot to explore within this new field of Femtech, which is short for “female technology.” According to the Global Wellness Summit, a gathering of international leaders in the $3.7 trillion global wellness economy, the Femtech mission is the following: “[T]o identify a health/wellness pain-point for women and crack the code…to disrupt pharma-based contraception and fertility strategies” (Global Wellness Summit, “TREND: A New Feminist Wellness,” 07.11.2018). As a result of their combined efforts, Femtech start-ups are becoming more popular, and the field is viewed as the next growth opportunity for venture capitalists (BV.world, “Femtech finding a place in venture capitalists’ hearts,” 12.21.2018).
These apps are designed to provide women with insights into their bodies. In addition, most Femtech products and services are designed by women. So what’s the problem here? Well, there are several. For instance, there’s the efficacy problem: A recent study by gynecologist Alexander Freis found that most of these apps provided sub-optimal predictive results and were off by more than a couple of days. He stated, “Prediction was insufficient … [and] they failed to predict the highly fertile days correctly, when cycle length and ovulation vary by some number of days. None of the apps tested provided sufficient annotations explaining how potentially disturbing factors of temperature should be handled” (Frontiers in Public Health, “Plausibility of Menstrual Cycle Apps Claiming to Support Conception,” 04.03.2018).
However, the “ultimate problem” stems from the fact that menstrual and fertility tracking technology is built on the basis of “natural methods” like Fertility Awareness Based Methods. These methods include the rhythm method, which tracks and averages the length of your past cycles to predict the next one, and the basal body temperature method, which measures your resting body temperature since temperatures may fluctuate during menstrual cycles (Planned Parenthood, “Fertility Awareness”). These apps are then marketed to supersede and replace hormonal birth control. In fact, the makers of the app Natural Cycles called their product the “First Birth Control App” (Natural Cycles, “The Non-Hormonal Birth Control App,” 09.28.2018). This app doesn’t remind you to take birth control; it is the birth control—or so they claim.
In other words, the apps track your period and your resting body temperature to “naturally” tell you when you can have sex “safely.” Dr. Eric Forman, the medical director for the Columbia University Fertility Center, doesn’t see the point. He argued, “[O]ne of the benefits of contraception was being able to dissociate intercourse from procreation … [Fertility awareness is] in the opposite direction. It’s tying it back together again” (The New Yorker, “The Unlikely Politics of a Digital Contraceptive,” 10.02.2018). Professor of Clinical Obstetrics and Gynecology at Northwestern University’s School of Medicine Lauren Streicher agreed, stating “[These apps are] problematic on so many levels. This isn’t science; this is craziness. We’ve already developed good, safe, reliable methods of contraception that are available to us. This app is completely taking women back in time”
(Vox, “The FDA just approved a “digital birth control” app for the first time: the controversy, explained,” 08.14.18).
For certain individuals, part of the popularity for Femtech stems from the drawbacks of hormonal birth control or other contraceptives. Still, Dr. Mary Jane Minkin at the Yale School of Medicine commented, “I think apps [that make birth control claims] are quasi technology looking for a purpose. Why would you do this? If you don’t want to use hormones, ok, but what about the copper IUD that’s 99% reliable?” (Time, “Can an App Prevent Pregnancy?” 08.15.2018).
Yet these apps might actually be competing with hormonal methods (and the copper IUD). In August 2018, the U.S. Food and Drug Administration approved Natural Cycles as the first mobile medical app that can be used as a method of contraception to prevent pregnancy (U.S. Food & Drug Administration, “FDA allows marketing of first direct-to-consumer app for contraceptive use to prevent pregnancy,” 08.10.2018). What? Hold your horses. First of all, the National Health Service in England have stated, “There is no “safe” time of the month when you can have sex without contraception and not risk becoming pregnant” (NHS, “Can I get pregnant just after my period has finished?” 05.23.2018). After all, sperm stays alive for up to five days. Thankfully, the FDA required Natural Cycles to make it clear that no contraceptive method is 100 percent effective and that another form of contraception—abstinence—must be used on days categorized as “fertile.” In addition, the app must also provide a list of factors that could affect the device’s effectiveness (U.S. Food & Drug Administration, “DEN170052 Trade/Device Name:Natural Cycles,” 09.20.2017).
In my thesis, I take time parsing out the “ultimate problem,” and I discuss the fertility myths put forward by app developers, the rarity of medical and professional development in these apps and various other elements of Femtech. Over the past two decades, both reproductive and mobile technology have made giant leaps and will continue to evolve. In the meantime, I’m asking if these mobile Femtech apps deserve a place in the history of reproductive technology. Are they legitimate? (That’s a
rhetorical question). Still, I’m curious—probably like any other person in awe of tech—to see where and how far the field of Femtech goes.