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Article: Thursday, 29 May 2025

In a striking example of interdisciplinary research innovation, two PhD candidates collaborated to address ethical concerns about algorithm-driven period and fertility tracking technologies and attracted widespread media attention. Maria Carmen Punzi and Tamara Thuis from Rotterdam School of Management, Erasmus University (RSM) carefully examined and described period-tracking technologies that they say could do more to empower rather than discriminate against users if ethical risks are taken seriously. They mapped a way forward for more research and outlined what this means for technology companies. Their paper Mapping ethical concerns in algorithm-driven period and fertility tracking technologies reveals complexities that go beyond the usual privacy issues – these include the biases and societal influences that affect the quality of advice from algorithms. The research has been published in the reproductive health journal Contraception and their work has been featured in the Netherlands’ AD newspaper.

Algorithm-driven period and fertility tracking apps provide an alternative to hormonal birth control and provide insights about menstrual cycles. The debate around period-tracking apps tends to stick to data privacy and falls into two extreme camps: social media influencers promoting them as perfect hormone-free alternatives to birth control, or critics blaming women for ‘naively trusting’ technology when unplanned pregnancies occur. The researchers noticed these conversations lacked nuance and failed to address the role of the organisations creating the apps.

“We found it striking that the media focused their attention on the societal and individual consequences when the algorithm fails – like more unwanted pregnancies, abortions, and potential misuse of users’ data in locations where reproductive rights are restricted. There was not so much attention paid to the organisations developing and implementing the algorithms and the apps”

“As passionate and engaged researchers in the fields of menstrual health and AI ethics in organisations, we felt a strong drive to combine our fields of expertise and engage in this conversation.”

Ethical concerns revealed

Maria Carmen and Tamara identified, mapped and analysed ethical concerns in period and fertility tracking technologies driven by algorithms. 

In the article in AD, the researchers point out that app predictions are based on averages and not users’ own cycles and that an app can never really know what’s going on in your body; cycles change with age, with stress or through pregnancy. Natural variations can be interpreted as abnormalities by the apps, and these interpretations can cause uncertainty for the user.

They had three concerns about the evidence used by the apps to generate recommendations:

 

Inconclusive evidence

Recommendations are based on uncertain, incomplete or probable information

Inscrutable evidence

Lack of transparency about how and what type of input data is used

Misguided evidence

Potential biases in the input data reflecting tracking behaviors or societal, historical patterns

And two concerns about how recommendations from the apps affect behaviour:

 

Unfair outcomes

Outcomes can generate particular risks for marginalised populations

Transformative effects

The technologies can change how users perceive their bodies and take action around them

Finally, the researchers had a general concern about traceability and the difficulty in identifying who is responsible when algorithmic recommendations cause harm: is it the user herself, the app developers, or the organization behind the app?

 

There needs to be more caution about developing products or services that reflect cultural and societal norms in their technical designs and features.

Societal beliefs ‘seep in’

What the researchers found shows the importance of being careful with making claims about algorithms that involve assumptions, knowledge that’s opaque, or information that’s unknown. 

“There needs to be more caution about developing products or services that reflect cultural and societal norms in their technical designs and features. Technologies are not neutral, so societal beliefs seep into companies and products when they deal with topics that are societal taboos such as menstruation, sex, or contraception. These norms must be challenged.” =

The researchers say it’s important for app makers to acknowledge the diversity and contexts of the circumstances of every user, and how these might influence the quality of data that users input  and the recommendations that are generated as a result. Companies behind these apps should be transparent about the risks and limitations, privacy policies, and how data is used so users can make properly informed choices. 

Contributing to health equity

The ethical concerns raised in the paper are more subtle than those normally discussed in mainstream media. ““Ethical concerns came to the surface about what the tech organisations do, how users interact with the technology in the app, and how apps reinforce and shape beliefs about menstruation, fertility and the body. Studies have not yet looked at the implications of these technologies where they intersect individual, organisational and societal levels. We have exposed the risks and the necessary actions for an ethical, forward-looking evolution of these technologies and show that organisations developing the apps must ensure they contribute to health equity rather than reinforcing existing biases and discrimination.”

Recommended actions for users, makers and society

The researchers recommended action on three levels: 

1. Individual app users need clear education about limitations and risks of these technologies
2. Organisations – such as companies developing these technologies – must scrutinise their products for biases, and be transparent about the way the data is used
3. Society should challenge the taboos and biases around menstruation that influence product development and user experiences.

What this means for technology companies

The researchers made recommendations for organisations developing period-tracking technologies:

  • Be cautious about claims involving assumptions and incomplete knowledge made in an algorithmic context
  • Acknowledge how cultural norms influence technical design
  • Consider the diversity of user circumstances and how these affect data quality
  • Provide (in-app) education about risks and limitations
  • Recognise that technologies reflect (and can reinforce) societal biases about taboo topics like menstruation
  • Take data privacy seriously to protect users’ anonymity.

“We live in a time when reproductive rights are at risk and women are increasingly looking for alternatives to hormonal birth control. It is essential that we pay attention to the ethical development and implementation of innovation when it applies to contraception. The influence of algorithms on users’ experience of their menstrual cycle and fertility is sometimes invisible but can still change behaviour related to it,” said the researchers.

 

 

M.C. (Maria Carmen) Punzi MSc
PhD Candidate
Rotterdam School of Management (RSM)
Erasmus University Rotterdam
Photo
Maria Carmen Punzi
T. (Tamara) Thuis
PhD Candidate
Rotterdam School of Management (RSM)
Erasmus University Rotterdam
Photo
Tamara Thuis
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