In 2014 Rose Eveleth wrote a lively article on how self-tracking apps exclude women. She bases this conclusion on many cases in which women’s needs have fallen short. A famous example thereof is Apple’s HealthKit app, which did not include a function for tracking menstruation upon its first launch. The justified outcry that followed this omission eventually led the company to add the feature to log the start and the end of to the app in 2015. But more importantly, the incident boosted the conversation of integrative designs in health apps.
Not long after, five researchers (four female, one male) published a crushing study on the state of menstrual tracking apps. Out of 1116 apps they found, only 20 apps remain after excluding duplicates, priced, non-english, non-menstrual cycle apps as well as apps that did not meet the criteria of inclusion and accuracy.
The estimated download volume of menstrual apps has reached 200 million by 2016. By conducting a quick survey (n=38) around SOAS, I found out that roughly 85% of the participants keep track of their cycle. And still, many of the available apps were not accurate enough, primarily focused on pregnancy as a target or were just generally designed in a too stereotypical manner. Making it frustrating to use those apps.
While Eveleth’s points the finger to male biases in design, I believe there is more to the story why essential features so often get omitted for the sake of democratisation in design.
Menstrual tracking is a complicated thing, to be honest.
In 2007 when the term “quantified-self” was first introduces, it was used to refer to individuals who are interested in the automation of data collection. By far the main reason to engage in self-quantification, is to achieve behaviour change. We track our calories to change our eating behaviour, get motivated when we see how much more we can lift than just one month ago and feel so much more productive with every bit less screen time. In this scenarios the self-tracking app is – to put it simple – used as diary to log an activity and to display the progress in achieving a certain goal.
Menstrual tracking, on the other hand, is classifies as a completely different type of self-tracking.
While with “normal” self-tracking, tracking follows a certain desired action, menstrual tracking is often done for the sake of itself. It is like a preliminary stage that captures the status quo and may provide a basis to define an action step or to simply reflect on the lived experience.
Multiple studies (e.g. 2017 and 2018)have investigated the various reasons. In an attempt to reproduce the studies findings I asked my survey participants for their reasons. The survey (n=26) has shown that the main reason for conducting menstrual tracking is to be prepared / plan ahead (71%). Other reasons for tracking are to understand the own body (42%), to avoid getting pregnant (26%) and inform conversations with health care providers. Getting pregnant (5.3%) places last amongst these reasons, which is considerable, especially since so many menstrual tracking apps are geared towards fertility tracking.
The duration of a menstruator’s cycle is completely individual and can change over time or due to certain events (e.g. stressful exams, new birth control method) or may generally be irregular. This alone is not the simplest prerequisite for a product that is primarily intended to convince by its predictive accuracy. Not to mention all the physical and psychological reactions of the body that differ based on the stage of the cycle which a menstruator may or may not experience. It is not unusual that headaches, bloating, cramps, changing thinking pattern or energy levels as well as ups and downs in sexual activities may be tracked back to the menstrual cycle But also, sometimes they have other causes.
When I asked fellow SOAS students, 68% of the survey participants stated that they track the duration of their period and cycle. Additionally, metrics such as the intensity of bleeding, menstruation-related physical discomforts and sexual activity are tracked by approximately 25% each. Some also state that they keep track of events that caused their cycle to change (16%), their mood / energy level / thinking patterns during the cycle (16%) and their sleep quality (11%).
The complexity of the menstrual experience paints the picture why menstrual tracking is for many an indispensable part of life and also explain why many apps tackling this topic are a disappointment. There is simply no such thing as an optimal or universal condition to provide self-evident orientation for app designers and users alike.
“I haven’t found an easy app that helps me understand my cycle” – Survey Participant
So the question is: Where do we stand in 2020? Is the solution to put away with apps and go back to paper diaries?
Well no, not if you ask me.
I would have wished there was a device that helped me understand myself better when I was younger. I like the thought that there are devices that support self-understanding for upcoming stages in my life. If an app helps figuring out myself in order to be healthy and happy, I will gladly use it.
An app is still a powerful tool “to raise awareness […] and give younger people an idea of what could be useful to track (Survey Participant) ” especially because it has the power to reach millions of people.
“I think this could help guys be more sensitive and informed to support or be more sensitive to [their] girlfriends’ needs.” – Survey Participant
A study done by eight researchers (of which seven are female) has acknowledged the need for more integrative and careful apps. They define the following design requirements for menstrual tracking apps:
“Designs should avoid gendered coloring, iconography, and text to both be discreet and inclusive of people’s gender identities and sexual orientations. Designs should support the varied reasons people track their menstrual cycles, and should support migration between tracking goals or tools. Women rely on accurate predictions emphasizes from their menstrual trackers. Our research the importance of designing for inclusion, acceptable accuracy, and discreetness in personal informatics.”
So, it is safe to say, that we came a long way since the Apple HealthKit incident of 2014. It is a good thing that menstrual activism has risen to fight stigma and cycle-related illiteracy and that scholarly attention has been drawn to periods as well.
That being said, we have still a long way to go until menstruation is no longer a taboo.
What are your questions or concerns regarding menstrual self-tracking? Leave a Comment below!
Link to my survey. Please participate 🙂
Epstein, D.A., Lee, N.B., Kang, J.H., Agapie, E., Schroeder, J. Pina, L.R., Fogarty, J., Kientz, J.A., Munson, S.A. (2017). Examining Menstrual Tracking to Inform the Design of Personal Informatics Tools. CHI ’17: Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems. (pp. 6876-6888). Denver, ACM.
Eveleth, R. (December 2014). How Self-Tracking Apps Exclude Women. Retrieved on January 24, 2020 from https://www.theatlantic.com/technology/archive/2014/12/how-self-tracking-apps-exclude-women/383673/
Levy, J. & Romo-Avilés, N. (2019). “A good little tool to get to know yourself a bit better”: a qualitative study on users’ experiences of app-supported menstrual tracking in Europe. BMC Public Health, 19, 1213-1223.
Maltseva, K., & Lutz, C. (2018). A quantum of self: A study of self-quantification and self-disclosure. Computers in Human Behavior, 81, 102-114.
Moglia, M.L. Nguyen, H.V, Chyjek, K., Chen, K.T., Castaño, P.M. (2015). Evaluation of Smartphone Menstrual Cycle Tracking Applications Using an Adapted APPLICATIONS Scoring System. Obstetrics and Gynecology 127(6), 1153-1160.
Perez, S. (June 2015). Apple Stops Ignoring Women’s Health With iOS 9 HealthKit Update, Now Featuring Period Tracking. Retrieved on February 1, 2020 from https://techcrunch.com/2015/06/09/apple-stops-ignoring-womens-health-with-ios-9-healthkit-update-now-featuring-period-tracking/