Cycles of Control: Private Companies and the Surveillance of Reproductive Health

21 minutes read | First published: February 20, 2023

This article is a companion piece to two Data Detox guides on cycle tracking. Take a look at “Cycles of Influence: Decide Who Knows Your Body” to discover different methods to track your cycle (and also in a private way). Read “None of Their Business: How to Choose a Private Cycle Tracking App” to learn about what tracking apps do with your data and how you can keep it safe.

Content warning: Pregnancy termination, racism, sexism, surveillance, sexual assault

Today more and more people access health information online. This became even more widespread after the COVID-19 pandemic. Many privately owned websites have become people’s first access point when they are sick or need to find out what is happening with their bodies. As a consequence, companies such as Google and Facebook, among others, can track what in the past would have only been discussed between doctors and patients. This puts many people’s health data at risk. When this health data concerns people’s reproductive lives, risks for everyone involved are even higher because reproduction is heavily controlled and restricted by governments worldwide (To read more about people’s struggles to access abortions worldwide, take a look at this article on The Telegraph “Abortion surveillance”).

The surveillance of reproductive health takes a different shape in each context. In Poland, for example, abortion was made almost entirely illegal in 2021 and, one year later, in the government suggested the introduction of a centralised register requiring doctors to report all pregnancies (whether carried to term or ended pre-term). While the Polish government claimed this was part of a larger project of digitising health data, activists feared this register could be used against those who self-administer abortions (Read more about Poland on the Guardian’s article “Poland plans to set up register of pregnancies to report miscarriages”). In Poland, conflicts around reproductive health surveillance concerned state-led development of digital registers. Similarly, in India, surveillance about reproductive health also focused on state digitization programs, even though in 2022 abortion in India had become legally more accessible for all, except for those chronically disenfranchised—such as the Dalit—who can still not afford them.(1) In this article, I do not focus on reproductive surveillance by states, but on the intersections between data collection by private companies and the policing of people’s reproductive rights by states.

Data about reproduction, and especially menstruation, is being tracked and gathered by many different companies,(2) without people’s awareness of the extent or the financial value this data has, nor the possible consequences for them individually or the collective harm.(3)After the right to abortion was struck down in the United States in 2022,(4) conversations about the surveillance of people’s reproductive lives sparked unprecedented public attention, which reverberated through the media globally. These debates were largely focused on data security, period trackers, and abortions but there were significant gaps in this discourse, which I address here. First, the focus on period tracking apps sidelined the systemic ways in which all our online interactions are tracked, datafied, and monetized in Surveillance Capitalism which can also expose people accessing abortions. Second, I outline how data on menstruation is not just sought after by governments and individuals policing people’s reproduction and access to abortion, but this data is valuable for many companies working in advertising. Finally, drawing on a Reproductive Justice framework, it is crucial to consider how the risks and obstacles we face online/offline are not the same. Marginalised groups are more at risk when it comes to surveillance and their reproductive rights have historically been grossly violated. It is crucial to center these histories, solidarity and mutual care in a discussion on pathways out of this overwhelming situation.

It’s not just about period trackers

In June 2022, the United States Supreme Court struck down Roe v. Wade, which had constitutionally protected the right to abortion, and period tracking apps quickly became a focal point in the conversation around surveillance and reproductive rights. Tweets calling on people to delete their period trackers were quickly spread on social media.(5) Articles on whether to delete an app and how to do it proliferated. Alternatives to period tracking apps, such as Google Spreadsheets, were suggested and shared on Instagram and TikTok—often without mentioning that tracking information in a spreadsheet owned by Google would do nothing but shift the problem from one company’s database to another (To read more about different (and safe) methods to track your cycle, take a look at “Cycles of Influence: Decide who knows your body”). Period trackers, fertility apps, pregnancy trackers and ovulation trackers, which are used by an ever growing number of people, declared on social media that they would never share users’ data (even though such promises are legally impossible for an app.(6) (To learn more about what period trackers do with your data and how you can keep it safe, Read “None of Their Business: How to Choose a Private Cycle Tracking App”.)

This tweet is an example of the advice that profilerated on social media, often shared by people such as Elisabeth McLaughlin who is not a privacy expert.

Screenshot taken from Twitter on October 25, 2020

Period apps certainly have information about people’s reproductive lives and could potentially reveal whether someone had an illegal abortion, but there are many other platforms, which are not as easily avoided as period trackers, such as Google search or maps, that can also reveal this information. Those platforms barely received any attention in the post-Roe v. Wade conversation; worse, the focus on deleting period apps might have left people with a false sense of security.(7) Instead, the conversation framed both the problem and solution as one of individual privacy and as choice between an app or a different tracking method. But when we situate the discussion how menstrual data could put people at risk in the broader context of the routine tracking, selling and buying of people’s data, a very different picture emerges.

Today, the business model of most technology or Internet companies—be they period trackers, social media platforms, or data brokers—is deeply connected to a large market for data (To find out more about data brokers and their influence in elections, read “The Influence Industry Explorer”). Most of these institutions, driven by a ‘data imperative,’(8) aim to extract as much data as possible, from anywhere, by any means possible. Data on users is accumulated by different actors who then either sell or share this data or aggregate it and sell access to user profiles or insights into this data. Data is also collected because of its assumed future value: the potential to use data to develop new products, new algorithms or other unknown technologies.(9) This system has been given many different names: Surveillance Capitalism,(10) Informational Capitalism,(11) or data capitalism. Today, this system of corporate surveillance also enables governments to access people’s private information. State institutions—policing people’s reproductive or other rights—can either request access to people’s private information from companies,(12) require them by law to submit information through a subpoena,(13) or even buy data sets on the market.(14) For example, the Texas anti-abortion law enables civilians to seek civil damages in court against anyone assisting in providing abortions—from doctors to even family members (Read more on Planned Parenthood’s website about how the law works). With data being so widely and easily available, this also enables individuals to tap into this data market to target individuals providing abortions. Therefore, a wider focus on how companies collect data and monetize needs to be part of the analysis.

Your period data is valuable

Information on people’s menstrual cycle is very much part of the kinds of data sets that are shared and sold. This might come as quite a surprise to people with or without periods because of the shame, stigma and silence that surrounds menstruation in public discourse, but data about periods are very valuable to many institutions, from governments to researchers, data brokers and advertising companies. How you track your cycle and for what purpose can also reveal a lot about your political convictions and help data brokers develop a more comprehensive profile of you and allow companies working in the influence industry to target you with political ads which have been influencing election outcomes worldwide (To read more about this, take a look at this article “Psychometric Profiling: Persuasion by Personality in Elections”). In addition, the apps and platforms targeted at women—referred to as “FemTech” in the tech industry—have become a booming business, projected to become a USD 50 billion industry by 2025 (read details on Forbes). This poster “The Many Hands on Your Intimate Data” developed for The Glass Room illustrates how different intimate FemTech apps, which are “designed to support women's sexual and reproductive health,” collect and monetize user data. It is ironic that FemTech apps—which promise to fill the gaps in existing knowledge over reproductive knowledge—are also the same apps that make people more vulnerable to surveillance.(15)

Menstrual and other health data can reveal very intimate details about you, your body, and your habits and can be used for many different purposes: to create advertisements that try to exploit (real or perceived) hormonal fluctuations, to determine whether or not someone is pregnant or trying to become pregnant, something advertisers and governments or even potential employers want to know, or to create insights into your overall health. In addition, a practice known as cycle-based advertising seeks to exploit the hormonal changes that take place during the menstrual cycle. Kristina Durante, professor in Marketing, argues that because during ovulation cis-women’s oestrogen levels are high, they are subconsciously more interested in attracting a mate and more competitive vis-a-vis other women (over finding a mate).(16) Consequently, Durante argues that during ovulation, cis-women are more susceptible to advertisements for products that help them with these goals: for example, red lipstick or lingerie. Durante’s arguments are based on evolutionary psychology and she has published extensively on the topic (read her paper “Ovulation, Female Competition, and Product Choice: Hormonal Influences on Consumer Behavior”).

Period tracking applications, for example, facilitate how companies and governments find out about people’s reproductive choices. In a 2019 study by Privacy International, a UK charity working on privacy issues, researchers found that Maya, a popular period tracker with more than 5 million downloads on Google Play, informs Facebook when a user opens the app.(17) This piece of data reveals already a lot about users: that they have a menstrual cycle, and that they possibly might be trying (or avoiding) to have a baby. Crucially, Maya shared data with Facebook before users agreed to the privacy policy. But period trackers are not the only companies in the business of monetizing data about reproduction. Advertising companies who sell location-based information also monetize data about pregnant people and by extension can reveal who has accessed an abortion clinic. One example of these tools is Geofencing, which allows the targeting people at a certain location with specific ads (This article on “Geotargeting: The Political Value of Your Location” explains how this works in more details). This technology has been used by anti-abortion and Christian groups to target people in Planned Parenthood waiting rooms with anti-choice messages.(18) Another example is SafeGraph, a company which has sold information about people visiting clinics that also provide abortions. Even though SafeGraph sold anonymised information about groups of people, they also included the locations people came from, how long they stayed at the clinic, and where they went afterwards. This set of information makes it easier to reverse the anonymisation of the dataset(19) After this was revealed publicly, SafeGraph discontinued this practice.

Data brokers, in general, seek to acquire all kinds of information about people in order to add this information to different user profiles; often this also includes extremely sensitive information. Back in 2016, it was revealed that MedBase 200 purportedly sold lists of rape victims—among other list of survivors of domestic abuse and many different illnesses—on its website. The company removed any reference to such a list after they were contacted by the Wall Street Journal reporting on this.(20) This is part of wider practice of websites hosting medical information that share sensitive information about users with third parties, including information about specific conditions, illnesses or treatments. Tim Liberts’ research explains how a “proliferation of third-party requests makes it possible for corporations to assemble dossiers on the health conditions of unwitting users.” (To find out more about how this works, read Tim Liberts’ paper Privacy Implications of Health Information Seeking on the Web). Since the Covid pandemic, tele medicine has gained even more popularity.

One of the most crucial factors in advertising is knowing whether or not someone is pregnant. Having a baby means that someone’s routines—including where they shop—fall apart and are reshaped for years to come. It is therefore a crucial time for companies to ingrain themselves in the shopping habits of new parents, but especially women, because shopping for essential household items is part of household labor, something women have historically been made responsible for. (Read more here on "the Division of Household Labour"). For example, the North American retailer Target has been in this business for at least 20 years. Target made headlines in 2012 when the company knew about a teenager’s pregnancy before her parents.(21) Being able to identify pregnant shoppers, companies can make millions in profit (Read more about this in How Companies Learn Your Secrets).

In 2014, Janet Vertesi embarked on an experiment and tried to hide her pregnancy from the online advertisement industry; she said it was incredibly difficult and made her feel like a criminal.(22) Vertesi only used VPNs to access websites about pregnancy and newborns, she did not purchase any products related to her pregnancy online or with a credit card, instead her and her partner used gift cards. She did not post or message anyone about her pregnancy on social media, nor did she navigate her way to baby stores with Google Maps (to read a full account of her experiment, read How One Woman Hid Her Pregnancy From Big Data). Vertesi, as a white affluent cis-woman living in the United States, with extensive knowledge about how online activity is tracked, could afford to buy gift cards in cash and to plan her pregnancy. For anyone surprised by their pregnancy or living below the poverty line, such luxury is not an option. While Vertesi’s experiment did not have any criminal consequences for her family, this might not be the case for marginalised people whose everyday activities are much more criminalised and scrutinised than White people’s. After her experience, Vertesi calculated how much more data about a pregnant person is worth compared than data about someone who is not: If an average person’s data is worth USD 0.10, a pregnant person’s data is worth USD 1.50.(23)

While being targeted by advertisements might seem as a benign consequence of companies having access to period data, it is not entirely. These ads will not only be targeted at you to sell you products but can also inform ads promoting political candidates and ideologies. In addition, pregnancy related ads are pervasive and ‘sticky.’ Once identified as expecting parent and female, you see these ads everywhere—even if the pregnancy ends pre-term. There have been reports of women who miscarried but continued to receive ads reminding them about the baby they lost.(24) This information could impact insurance rates, if this data is routinely collected by employers (in the US) as menstrual data can reveal underlying health conditions or if someone is trying to become pregnant. Pregnancy is still a reason why people are not promoted or hired and the collection of cycle related data by an employer could also harm job prospects.(25)

It’s not just about ‘choice’

The commercial drive to monetise data about health, reproduction, and menstruation has created a situation in which many institutions and companies aside from period trackers have access to this information and also make it rather easy for governments to acquire this information. The solution to this problem is often framed as one of individual or consumer choice and privacy and the articles discussing the state of surveillance in a post-Roe v Wade US were no different. While informing individuals of what happens to their data and providing them with alternatives is a crucial step towards a solution, a discussion on how race, gender, class and ability limit what choices people can make must also be part of the conversation. Individuals changing their tracking decisions does very little to mitigate the collective harms and downstream effects of this pervasive data collection of peoples reproductive lives. Even if you find the safest period tracker, that does not sell any data, your data could still be used to harm others.

For example, people living in remote or chronically disenfranchised areas in high-income countries depend even more on online health information.(26) This is also the case for accessing reproductive health care, in areas and countries where physical access to a clinic with access to abortion or contraception is impossible. Making sure that it is also safe to access and search for a website that can provide these services or information is crucial, instead of forcing a pregnant person “to engage with a system that actively collects, stores, and sells their online activity data.”(27) Marginalised communities do not only depend more on smart phones to navigate their lives, they are also under much more surveillance and policing from the state (To read more about this, here is Simone Browne’s book Dark Matters: On the Surveillance of Blackness and Virginia Eubank’s article “Want to Predict the Future of Surveillance? Ask Poor Communities”).

Individual changes to online behaviour also do little to address the potential collective harms that result from this pervasive surveillance of people’s reproductive lives. Instead, the reproductive justice (RJ) movement and framework helps us to articulate a way forward as well as a vision.(28) The framework was developed by Women of Colour activists as critique of the narrow focus on access to abortion and choice by White feminist birth control movements. Instead Reproductive Justice brings into focus how access to reproductive care is shaped by histories of eugenics, sterilization and child removal policies, sexuality, migration status and racialised access to maternity care and contraceptives. Reproductive Justice calls for the right to have a child, to not have a child, to parent children with dignity, the right to control birthing options, to choose sexual partners and to express one’s gender identity and sexuality freely (To read more about reproductive justice and its history, take a look at the website of SisterSong, a non-profit that spearheaded the movement). Because of its comprehensive approach to reproductive rights, this framework also helps build solidarity to other movements that have had to face and resist surveillance—such as People of Colour or immigrants resisting policing—for decades and integrate these lessons into the broader conversations around reproductive rights.

The way we analyse a problem is intimately connected to how we find a solution. The reasons why many solutions to reproductive health surveillance outlined above fall short is because they fail to accurately account for the collective nature of the problem.Thus, it is important to know what happens to your data on an individual level, but any solution that further individualises people navigating data capitalism and reproductive surveillance cannot work. Instead, the way forward lies in collective approaches to both surveillance capitalism and the policing of reproduction.

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Written by Stefanie Felsberger in November 2022. Thanks to Safa Ghnaim and Christy Lange for their comments and reviews. Banner visual courtesy of Anna-Lena Klier.

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Endnotes:

read more about the Dalit struggle to access abortions and take a look at the WHO’s reporting on how "India’s amended law makes abortion safer and more accessible". To read more take a look at this article “Data Infrastructures and Inequities: Why Does Reproductive Health Surveillance in India Need Our Urgent Attention?”.
Levy, Karen. 2015. “Intimate Surveillance.” Idaho Law Review, Vol 15; Privacy International. 2019. "No Body's Business But Mine: How Menstruation Apps Are Sharing Your Data." [Report]; Kregse, Naomi, Ilya Khrennikov, and David Ramli. 2019. "Period-Tracking Apps Are Monetizing Women’s Extremely Personal Data.” Bloomberg, January 24, 2019; Privacy International. 2020. "A Documentation of Data Exploitation in Sexual and Reproductive Rights."[Report].
Green, Leah Shay Notelovitz, Simon Roberts, Joseph Pierce, Ben Kape and Paul Boyd. 2019. “How Your Period is Making Other People Rich.” The Guardian, June 20 2019.
BBC. 2022. "Abortion: What does Overturn of Roe v Wade Mean?" BBC News, June 29, 2022.
Tweet by Elizabeth Cronise McLaughlin, 3 May 2022
Tweet by Clue, 25 Jun 2022
Slupska, Julia and Laura Shipp. 2022. "What You Need to Know about Surveillance and Reproductive Rights in a post Roe v Wade World." The Conversation, July 6, 2022.
Fourcade, Marion and Kieran Healy. 2013. “Classification situations: Life-chances in the neoliberal era.” Accounting, Organizations and Society 38: 559–572. https://doi.org/10.1016/j.aos.2013.11.002.
Thatcher Jim, David O’Sullivan, and Dillon Mahmoudi. 2016. “Data colonialism through accumulation by dispossession: New metaphors for daily data.” Environment and Planning D: Society and Space 34(6): 990–1006. https://doi.org/10.1177/0263775816633195.
Read more about Shoshanna Zuboff’s concept Surveillance Capitalism in Evgeny Morozov’s article “Capitalism’s New Clothes”.
Cohen, Julie. Between Truth and Power: the Legal Constructions of Informational Capitalism. Oxford University Press, 2019
The period tracker Stardust explained in its privacy policy that it would share data with law enforcement without a subpoena (ViceNews).
Torchinsky, Rina. 2022. “How period tracking apps and data privacy fit into a post-Roe v. Wade climate.” NPR.
Sarkesian, Lauren and Spandana Singh. 2021. "How Data Brokers and Phone Apps Are Helping Police Surveil Citizens Without Warrants." Issues.
In this article, I generally use the term “women” to discuss instances where that language has been used to target a certain group of people. When writing about the present, I generally use terms like “people with periods” or “people who can give birth” in order to reflect a range of gender identities and people’s diverse lived experiences. I follow Loretta J. Ross and Rickie Solinger’s approach, who remind us that “”Woman”(a person who presents herself as female and may have a vagina and ovaries) does not describe the identity of all persons who can or will get pregnant and give birth and mother a child. A transwoman generally cannot get pregnant, and transmen may be able to. Further, “woman” does not describe the identity of all persons who decide whether to have an abortion or use contraception.” To read through their thoughtful discussion on language, gender and reproductive justice, take a look at pages 6-8 of the introduction to their book Reproductive Justice: An Introduction.
Durante’s research only focuses on cis-women with a regular menstrual cycle who are not taking any birth control.
Privacy International. 2019. "No Body's Business But Mine: How Menstruation Apps Are Sharing Your Data." Report.
Coutts, Sharona. 2016. "Anti-Choice Groups Use Smartphone Surveillance to Target ‘Abortion-Minded Women’ During Clinic Visits." Rewire News Group.
Cox, Joseph. 2022. "Data Broker Is Selling Location Data of People Who Visit Abortion Clinics." Vice; and Fadilpašić, Sead. 2022. "Locaton data of US abortion clinic visitors sold online." TechRadar.
Dwoskin, Elisabeth. 2013. "Data Broker Removes Rape-Victims List After Journal Inquiry." The Wall Street Journal
Duhigg, Charles. 2012. "How Companies Learn Your Secrets." New York Times.
Petronzio, Matt. 2014. "How One Woman Hid Her Pregnancy From Big Data." Mashable.
Privacy International. 2019. "No Body's Business But Mine: How Menstruation Apps Are Sharing Your Data." Report.
Moss, Rachel. 2019. "This Is What It's Like To Be Targeted By Baby Ads After Miscarriage Or IVF Struggles." HuffPost.
Read more about a US video game company encouraged employees to use family planning apps, which then shared data about employees with the company in this Guardian article There’s a Dark Side to Women’s Health Apps or the Washington Post article Is your pregnancy app sharing your intimate data with your boss?.
Bhatt, Jay and Priya Bathija. 2018. "Ensuring Access to Quality Health Care in Vulnerable Communities" Academic Medicine, 2018 Sep; 93(9): 1271–1275. https://doi.org/10.1097/ACM.0000000000002254.
Conti-Cook, Cynthia. 2020. "Surveilling the Digital Abortion Diary." University of Baltimore Law Review.
Key Readings on Reproductive Justice are Dorothy Roberts’ Killing the Black Body, Angela Davis’ Women, Race, Class and Reproductive Justice: An Introduction Loretta by J. Ross and Rickie Solinger