(Not) talking about fertility: the role of digital technologies and health services in helping plan pregnancy. A qualitative study

"UPDATE: I'm pregnant!": Inferring global downloads and reasons for using menstrual tracking apps

Objective

The market for smartphone apps tracking menstrual cycles has expanded in recent years. These apps market themselves as empowering users to achieve their reproductive goals and maximize the chance of pregnancy. This paper presents the first open-access quantification of menstrual tracking app downloads globally, covering both the Global North and South. We also explore macro and micro-level reasons for app usage, testing national associations with downloads and analyzing user reviews.

Methods

We use data on app installations, reviews, and ratings from the Google Play Store and Apple App Store to estimate global app downloads using a Bayesian model. We perform regressions to test for national predictors of use, and multilingual topic models to analyze/cluster reviews left by users to understand individual reasons for use.

Results

We find that the majority of downloads are for three apps: Clue, Flo, and Period Tracker. Higher modern contraceptive prevalence and internet access are associated with more downloads, while low-income countries tend to have fewer. In low-income countries, a higher unmet need for family planning and total fertility rate are associated with more downloads. Individual reviews reveal the most common reasons for use are menstrual cycle tracking, achieving a pregnancy, community engagement, and avoiding pregnancy.

Conclusion

Existing research on menstrual tracking apps is largely confined to the Global North, but our study finds the use of these apps to be as prevalent throughout the Global South. Future research needs to urgently understand the implications these apps could have in a diversity of contexts.

Analyzing User Reviews of the First Digital Contraceptive: Mixed Methods Study

BACKGROUND

People in Western countries are increasingly rejecting hormone-based birth control and expressing a preference for hormone-free methods. Digital contraceptives have emerged as nonhormonal medical devices that make use of self-tracked data and algorithms to find a user's fertile window. However, there is little knowledge about how people experience this seemingly new form of contraception, whose failure may result in unwanted pregnancies, high health risks, and life-changing consequences. As digital contraception becomes more widely adopted, examining its user experience is crucial to inform the design of technologies that not only are medically effective but also meet users' preferences and needs.

OBJECTIVE

We examined the user experience offered by Natural Cycles-the first digital contraceptive-through an analysis of app reviews written by its users worldwide.

METHODS

We conducted a mixed methods analysis of 3265 publicly available reviews written in English by users of Natural Cycles on the Google Play Store. We combined computational and human techniques, namely, topic modeling and reflexive thematic analysis.

RESULTS

For some users of digital contraception, the hormone-free aspect of the experience can be more salient than its digital aspect. Cultivating self-knowledge through the use of the technology can, in turn, feel empowering. Users also pointed to an algorithmic component that allows for increased accuracy over time as long as user diligence is applied. The interactivity of the digital contraceptive supports mutual learning and is experienced as agential and rewarding. Finally, a digital contraceptive can facilitate sharing the burden of contraceptive practices or highlight single-sided responsibilities while creating points of friction in the required daily routines.

CONCLUSIONS

Digital contraception is experienced by users as a tamed natural approach-a natural method contained and regulated by science and technology. This means that users can experience a method based on a digital product as "natural," which positions digital contraceptives as a suitable option for people looking for evidence-based nonhormonal contraceptive methods. We point to interactivity as core to the user experience and highlight that a digital contraceptive might allow for collaboration between partners around contraceptive practices and responsibilities. We note that the user diligence required for the digital contraceptive to provide accurate and frequent data is sometimes not enough. Future research could look at designing (and redesigning) digital contraceptives with primary users and intimate partners, enhancing the experience of tamed naturalness; exploring how trust fluctuates among involved actors and in interactions with the technology; and, ultimately, designing more inclusive approaches to digital contraception.

Comparison of Paper Diaries, Text Messages and Smartphone App to Track Bleeding and Other Symptoms for Contraceptive Studies

OBJECTIVES

Most researchers who study the effects of hormonal contraception on menstrual bleeding rely on self-reported data via paper diaries, for which completeness and timeliness have been shown to be poor. The purpose of this exploratory study was to compare the completeness and timeliness of bleeding data collected via paper diaries, text messages or smartphone application (a.k.a "app").

METHODS

This was a sub-study of a double-blinded, placebo-controlled randomized trial comparing the effects of a non-steroidal anti-inflammatory drug, naproxen, with placebo when using a copper IUD. Participants tracked bleeding and symptoms over 112 days. Participants tracked bleeding daily using a paper diary as well as with either text messages or a smartphone app. Participants who used paper and the app were also able to record non-bleeding symptoms.

RESULTS

Twenty-five participants submitted diaries. Of these participants, 10 completed both paper and app diaries, 7 completed both paper and text messages, 4 completed the paper diary only, 4 completed the app only. Text messages had the most complete data (108 days), followed by the app (96 days) and paper diaries (84 days). The lag time between a bleeding event and the date recording that event was 0.10 days for text, 1.0 days for app, and 4.73 days for paper diaries. Participants using the app reported a median of 33 other symptoms over the study period compared to 7 for the paper diaries.

DISCUSSION

Our findings suggest texts demonstrated more complete and timely bleeding data than either paper diaries, or the app. Compared to paper diaries, the app delivered more complete, timely data, and also collected a large set of symptoms.