How Health Apps Let Women Down

How Health Apps Let Women Down

Banana icons with condoms. A heavy focus on moods. Fetuses the size of grapes. Women have long had to deal with sexist features in health apps. A running joke for a while was that it’s not hard to spot a fertility-tracking app designed by a man. While these apps serve a simple function in theory—to track things—the story of how they came to be biased toward men’s interests is yet another that makes the underrepresentation of women in tech so apparent.

With pink floral backdrops and weight-tracking features in apps that congratulate people for losing weight, developers have made it clear what they think about women. A full year after Apple Health was launched, the company realized it had left out a key feature: a period tracker. Sexist health apps like Glow and Eve have not only failed to accommodate women in the various stages of our lives, but they have also caricatured women’s bodies and reinforced negative concepts about menstruation and pregnancy.

Women were tracking their cycles long before we could ever monitor and record our health with personal devices. As the researcher Whitney Boesel has told the writer Rose Eveleth in 2014, “So many regular facets of being a woman in a Western culture are highly likely to make one track.” Whether it’s calories or menstruation, they’ve kept track using paper, spreadsheets, online calendars, and now apps. And they keep track for a variety of reasons: to monitor any irregularities in their cycle, to know when to pack sanitary supplies, to plan important events, to help them conceive, and more.

But when menstrual- and fertility-tracking apps first hit the app stores, they were all lumped together with a narrow focus on pregnancy. The app Glow, launched in 2013, framed all of its users’ goals in terms of pregnancy, making users decide between whether they wanted to avoid pregnancy, attempt to conceive, or use fertility treatments.

When half of users reported they were using the app to avoid getting pregnant, the male founders, including PayPal entrepreneur Max Levchin, had to consider the idea that some people want to track their cycles simply to know how “normal” their period is. With this information, they put their $17 million in new funding toward reforming Glow to be an ovulation calculator and launched a separate app, Eve by Glow, for period tracking and sexual health.

While these separate apps make it easier to track on their own terms, Eve is still problematic for many users. In-app redeemable gems offer tips to inform users about their bodies, telling them to “get to know your body for real” and answering where “the seemingly mythical” G-spot is. Eve makes assumptions about its users, calling them all “girls” regardless of their age and uses slang like “hookups.” If users want to keep track of their sexual activity, they are given the options to choose the icons of a banana with a condom, a banana without a condom, or no banana. This feature frames sex only in terms of a penis and excludes anyone whose partner doesn’t have one. And taking a look at the period flow tracker, the heaviest option appears with the label “crime scene,” making an attempt at a humorous description, but it reinforces a negative association of violence with menstruation.

Fertility apps like Glow help people work through fertility issues. Once your status changes to “pregnant” though, there’s a finality to this. Some Glow users in the community forum have reported all their previous data being deleted by default as soon as they change their status to “pregnant,” making it inconvenient when they still found that previous information useful. Many pregnancy apps have also not been gracious to users who might experience problems bringing their pregnancy to term. Apps sell personal data to baby brands—regardless of how successful pregnancies are—that can then target ads toward people who have just experienced tremendous loss. One woman, Kim McAuliffe, had a miscarriage and received emails for weeks advertising formula for, as she put it in a Medium post, “a baby you’ll never have.”

Pregnancy apps have gamified getting pregnant. Once you’re pregnant, the goal is achieved with little nuance. These apps operate on the assumption that all users want to get pregnant, can become pregnant, and have a partner. On the other hand, fitness-tracking apps whose primary focus is not on pregnancy, completely leave out the possibility that its users can be pregnant. Just as there was no period-tracking feature in Apple Health, there is no “pregnancy mode” to take into account changes in activity, weight, and other factors. People have been asking Fitbit for a pregnancy mode for years with no luck.

Many women have had to abandon using an app that fails to take into account all aspects of their health. But if they try to push past the apps’ limitations so they can still track other factors, apps can start to encourage unhealthy behavior. Swapna Krishna remembers her Apple Watch badgering her during her third trimester to “close her rings,” and she couldn’t adjust the settings. “I couldn’t tell the app, ‘Hey, this is actually what is healthy for me right now,’” she wrote in Engadget, adding:

Developers don’t head into the office planning to translate a sexist assumption into a health app. They also don’t base their design parameters on the premises of excluding people with conditions like pregnancy, much less injury or illness. Even health apps for the general public have gendered design. These design blunders happen when designers and technologists don’t take time to understand people’s needs.

It’s no easy job designing for personal context, but “businesses ignore it at their peril,” argues Gina Neff, a sociology professor at Oxford University, and Dawn Nafus, a research scientist at Intel in their book Self-Tracking. Businesses “treat other factors within the individual context of use as ‘noise,’ too hard to account for in the design, or defend as a good way to spend resources. That ‘noise’ of personal context, though, makes or breaks technology adoption,” Neff and Nafus argue.

Designers are still struggling to understand how women’s lives affect their interactions with health apps. We have seen how sexist features or, in some cases, the blunt omission of features to accommodate everyone have been harmful to women users, even encouraging unhealthy behavior by failing to account for conditions like pregnancy. While they have gotten better over the years with newer options like Clue’s science-based approach, there are still many areas for health apps to be improved in order to help women in the various stages of our lives.

How Health Apps Let Women Down

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