April 11, 2019 • 26 mins
On this episode of Prognosis, we'll meet the Bloody Health collective – a group of feminist coders in Berlin who are looking for a safer way to track their periods. Targeted advertising, third-party data sharing and tracking make most menstruation apps just as problematic as they are popular, privacy activists argue. For the women of Bloody Health, the sure way to keep control is to build their own open-source app.
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Speaker 1 (00:00):
I think it's a it's a problem that we have
become used to having free digital services and free in
quotation mark because of course we've been really paying without
private data. These days, there seems to be a smartphone
app for just about everything. One of the more popular
categories are apps that track menstrual cycles. More than a
(00:23):
hundred million women around the world already use them. Some
are trying to get pregnant, others are trying to avoid
getting pregnant, and many just want to better handle on
what their bodies are doing. But these free apps have
trade offs. Some use sensitive health information to place targeted ads.
(00:44):
The apps all need to make money, and that might
mean in a big picture sense, their main product is
actually their users data. Welcome to Prognosis, Bloomberg's podcast about
the intersection of health and technology and the unexpected places
that is taking us. I'm your host, Michelle fe Cortes.
(01:06):
For most of us, giving away our data is just
the deal we make when we're using a free app.
But a growing number of women are saying no, thank you,
and some are taking matters into their own hands. Bloomberg's
Naomi Kraski went to meet a group of feminist coders.
Our story starts at the Rainbow Factory, a community space
in Berlin's hot spot for startups, the Kreuzburg neighborhood. I'm
(01:33):
standing in the cafe at the community space. It's packed
with about two dozen people crammed around mismatched schoolroom style
tables and shares. Someone just popped open a bottle of
East Germans sparkling wine behind the bar, and they're handing
it out for free. People are here to celebrate. Everyone
(01:55):
stops hosting each other and settles down, turning their attention
to a project and screen. Next to that screen is
Marie cox Seek, a thirty year old sociologist and software developer.
She pulls up a slide with a grid of logos
for different period tracking apps. Don't get me wrong, I
don't think pink is a bad color. I just think
(02:17):
it's not the only one. And I also think flowers
or the herd, or what butterfly? Or this this very
cute girl with these big eyes. They don't really represent
represent me, They don't really represent us. Marie is one
third of the leadership team for Bloody Health, the coding
(02:39):
collectives that just released the first female developed open source
menstrual cycle tracker. In English, it's called DRIP. And this
is the launch party. Now after all these things, oh no,
there's like no privacy, no security, black box algorithms, Genno stereotypes.
Now this is DRIP. The seats for the project were
(03:01):
sewn back in when Marie got her first smartphone. It
was an Android. She was a bit of a late
adopter on the smartphone, but she knew what she wanted
to download right away. I looked into the play store
and I found a period app, um, and I just
took like the first one. Yeah, I think it was Womanlock,
(03:22):
which is also the icon with a pink flower on
the black screen, and it was. It was the first
app that I've seen. And the very same day, I
met with a friend of mine and I was very
excited and I told her, oh my god, I just
found this cool period app. It's so useful. I love it.
(03:42):
If you have ever had a period, you know why.
Marie was so happy at first when she found that app.
Periods can turn up at the most annoying times. They
can ruin your sheets and your Tinder dates. But period
apps promised to do more than just help you keep
act of bleeding. The broader pitch is that if you
(04:03):
give the app and of details, you can get a
heads up on all the others, sometimes frustrating changes that
come with your cycle. Why am I feeling depressed? What
the heck is going on with my digestion? Could I
be pregnant? The desire to connect the dots between the
period and everything else has helped make the apps so popular.
(04:24):
They're consistently in the top ten most downloaded in the
app Store. Just about every commercial period app lets you
do more than just click a calendar day so you
remember when your last one happened. They also make predictions
about when your next period will come. They let you
track everything from sex and boozy nights out to ovulation tests,
(04:48):
vaginal discharge, and resting body temperature. But apps don't necessarily
have to meet the privacy standards of say, doctor or
hospital records. In fact, as one of Marie's friends told her,
the commercial apps can use your data for plenty of
things that do not have anything to do with keeping
(05:09):
track of your period. This first looked at me. She
was a very close friend, so she looked at me
and said, like, Marie, have you read the privacy policy?
Of this app, and um, I was a bit annoyed
at her because she kind of took away my joy
in that moment um. But the following day I deleted
the app. All of that data can be used for
(05:32):
the same type of business that Facebook, Instagram and other
major apps use it for. Facebook is already controversial, but
here we're talking about even more personal data than what
most people share with social media. Joanna Baron, a Brazilian
researcher and digital rights activists who leads the group Coding Rights, explains,
(05:53):
so it's a lot, a lot, a lot of information
that is collected and the information that you get back
it's a when's your period and when's your fertile moment.
It doesn't need to ask all those questions to have
this outcome as an information. So of course this is
going somewhere else. And then if you go and look
(06:15):
at the terms of services, they say we might give
it to the data to third parties for advertisement purposes
and for whatever purpose that's not the purpose of the app.
Joanna's group did a study of period apps called Menstrue
Apps how to turn your period into money for others.
(06:37):
They found that information users give the apps can be
shared with third parties, including social media platforms, marketing agencies,
research institutes, employers, and Google Analytics. Flow, the biggest period
app in the US, has collected more than thirteen billion
data points about its users. Flow says the day helps
(07:00):
women monitor irregular periods and has helped a lot of
its users get pregnant. The app, based out of Mintsk
in Belarus, got into hot water recently over sharing some
user data with Facebook. After an uproar, the company said
it was only using Facebook analytics to improve the user
experience and that it would stop. But in China, where
(07:23):
the biggest period apps in the world are based, companies
have gone much further. Diema, one of the market leaders there,
said it crunches its users data to find out whether
to show them ads for tampons or ads for ovulation kits. Still,
Joanna's group found that when it comes to privacy policies,
(07:43):
not all commercial period apps are created equal. They cited Clue,
a Berlin based period app that's especially popular in Europe,
as an example of a clear privacy policy. Clue also
lets you store your health tracking data on your phone
without sharing it with the company, as long as you
do not set up a user account. I wanted to
(08:06):
get an industry perspective on this open source backlash against
commercial period apps, so I went to visit Clue CEO.
I'd a ten. I never started this company because of
wanted to build a business. I wanted to solve a problem,
and so I think there are definitely many nasty ways
that you can be commercial in this industry, and that
(08:28):
is happening. I do understand their sentiment. I still believe
that there must be a different way. I think it's
an it's the problem that we have become used to
having free digital services and free incuptation mark because of course,
within really paying without private data. Cluse terms of service
allow user data to be shared with academic researchers, and
(08:51):
it doesn't explicitly rule out commercial use. However, i'd just
said she does not want to run targeted at or
sell user data. But Clue has thirty million dollars in
capital from investors, and she's wrestling right now with how
to turn her period app into a sustainable business. She
(09:12):
wouldn't talk about exactly how that might work, except to
say that she has three concrete ideas that she's working
on right now. Clue has already experimented with a subscription model,
charging women about one dollar a month for more data analysis.
Marie started seriously thinking about period apps after doing a
(09:34):
study of Clue. She was working on her master's thesis
and sociology and early and she interviewed ten women about
how they used the app and what they were getting
out of it. Some more bisexual, some heterosexual, Some wanted
to get pregnant, and some did not. They were all
getting something different out of the app. At some point,
(09:56):
I had like nine different period apps on my phone
and I was trying to track see how different they are.
And that's where we get back to the idea of
a black box. Murray had all these different apps on
her phone, but she could not see into any of them.
She didn't have access to any of the code. Even Clue,
with it's easy to understand privacy policy didn't let her
(10:19):
see what was going on behind the screens. If we
use technology, um and we think it's useful and we
think it makes her life easier, but at the same
time we can't look behind the scenes, We can't understand
what is actually happening with the data we generate. What
is the code actually about? It became more and more
(10:42):
important to me UM to uh, to rely on open
source software. UM and so I was in a way
like unsatisfied with period apps and with I think with
health trekking apps in general. By September teen, Marie was
toying with the idea of writing her own open source
(11:04):
period app. She had already linked up with one potential collaborator,
a thirty year old mathematician named Tina Baumant. Marie turned
to Twitter to see if anyone else was interested in
making it a more serious project. She tweeted in German
something along the lines of who wants to fiddle around
with an open source menstrual cycle app? With me? She
(11:28):
included a gift of a little girl with a lot
of attitude. Yeah, it's just a gift showing UM a
small girl UM throwing very confidently giving away three tampons.
I guess I just thought, in this moment, Okay, let's
just give it a try, and let's see what happens
if I tweet about it, UM and I got um
(11:52):
quite a few retweets, quite a few likes. More than
a dozen people responded. Among them was Julia Frazel, a
thirty four year old software developer. She became the third
member of the team and brought the coding experience they needed.
But there was one important thing. They were still missing money.
In order to work full time on the period app project.
(12:15):
They needed some other way to pay the rent. In
early they got a German government grant called the Prototype Fund.
It's designed to promote open source technology and public interest projects.
And it felt like, um, okay, this is it. We
really was super motivated by this fund and we thought, okay,
(12:36):
this is our chance, now or never. Marie and her
team already had a list of ways they knew they
wanted their period app to be different. Some of them
had to do with design things like no gendered colors, pictures,
or text. Some had to do with making the tech
open source, and some had to do with how the
app itself would work and what kinds of predictions it
(12:59):
would make or not make. Beyond the privacy issues, predicting
when women might get pregnant is probably the most controversial
thing about period apps. Most of the commercial apps you'll
find in the app store will show you a few
days or a week when you should be most fertile.
(13:20):
Some even give the likelihood of whether you'll get pregnant
on a certain day down to the tenth of a percent,
based purely on when your last periods started. But everyone's
cycle is slightly different and some irregularity is common. Cycles
can last anywhere from twenty one days to forty days.
Period apps do not come close to being fail proof
(13:43):
as contraceptives. The Drip team decided they needed to base
their app on science. They turned to Patre Frankermen, a
gynecologist at Heidelberg University Hospital. PIT is an expert on
what's called FAB or fertility awareness based methods for determining
(14:04):
when women can get pregnant. Recently, she has become interested
in period apps since more than thirty years, I'm doing
research on the fertile window of the female cycle and
on FAV methods, and of course I'm very interested in
app supporting women in using those methods. And my second
(14:24):
motivation was is that as a gynecologist, I meet young
women and teens, or I met already young women and
teens who experienced unplanned pregnancies with those apps, even the
daughter of a close friend of mine. Page Cluss surveyed
a dozen apps that were already on the market last
(14:44):
year and which claimed to help women choose the best
time of the month to have sex in order to
get pregnant. She graded then on a thirty point scale
based on how they determined the fertile window, what study
results existed to back up that less it, what study
results they had to show the app works, and whether
(15:05):
they offer any counseling to users. All the calendar based
apps she reviewed, including Clue and Flow, got zero out
of thirty points. Even Natural Cycles, a Swedish app that
asks women to input their resting body temperature or basil
body temperature for better accuracy, got only two out of
(15:27):
thirty points in the survey. Part of the reason PA's
team graded all the apps solo is that there's not
much independent research to show whether they work. The other
reason is that when it comes to periods, past performance
is no guarantee of what will happen in the future.
Most of the apps to predictions, even if they use,
(15:50):
for example, parameters like the temperature. This is for example,
the apt Natural Cycles. It does predictions as well, and
in our opinion, therefore they are useless for contraception. When
you say predictions, do you mean making predictions based on
past cycles? Past the predictions on fertile days on the
(16:15):
basis of past scientists. Okay, and that is is not
going to help you not get pergnant yes, or get
pergnant yes. Yes, due to the variation of O eolation
and day and fertile face even in women with fairly
(16:35):
regular scientists think that's something that a lot of women
don't realize. Yes, yes, that's true. This is this is
the point. So do you think people should be trusting
their family planning to these apps? Um? No, because most
apps are lacking scientific standards or they showed poor results
(16:56):
up to now. Your body can actually tell you more
about when you're likely to get pregnant. There's a method
that's been around for decades called the Symptoms thermal method.
It involves taking your resting body temperature every morning and
checking your vaginal secretions to see when the cervical mucus
(17:16):
turns clear and stretchy like rag whites. It's a lot
more work than taking off days on a calendar, but
it fits the ethos of the project, which is helping
when and learn about their own bodies and take control
of their own fertility. I think that's the point that
you can't really predict anovulation will happen, but you can
(17:38):
only like watch your body symptoms to see when it happened,
and so you can only be sure after it happened.
But like I don't know, bodies are defended. Also depends
on your stress level or yeah, I think time zones, traveling, sleeping.
There's so much it can influence of relation. At the
(17:58):
time of relation. That was Tina, the mathematician on the
DRIP team. Before the team could start work on the
project in Earnest, something ironic happened. Tina got pregnant. I
was kind of afraid to tell them because I didn't
know if this would mean like the end of the
project for me. I was sitting down the kitchen, like
(18:20):
I have to tell you something. Um no, I pricked
it in, like oh how cool, And I'm like, yeah,
I don't know what this means for the project, and
they're like, oh, we make it work. The team finally
started work on their app in April of last year.
In late June, Tina had her baby. A few weeks
after that, they were back to weekly meetings at Tina's apartment,
(18:44):
working on the project while she breast fed. But the
prototype funding from the German government was only good for
about six months of work, and the team knew that
they would not be able to finish the entire project themselves.
They needed the open Sore part of the app to
really come into play. They needed a bigger team of
(19:04):
people to help code, and so we actually organized events,
I think three at least. We said, hey, if you're
interested in contributing, or if you like, if you want
to see what the project is all about, you can
meet us and we will set up the project together.
Because it's a little bit of a pain and I
think sometimes it even took two hours from like saying
(19:26):
hello to the first person having the app running on
their phone. But I think it was like it's kind
of nice to get people over this sometimes painful step,
like not sitting at home and you're like, oh, why
do I get this error message? Um, and then maybe
quitting but you're sitting there all together like talking a
(19:46):
little bit, but also important person might be already a
step ahead and they can tell you, like what they did.
The Drip team won another fellowship from the Mozilla Foundation
and that help them get the word out about the
project and they joined some programming workshops called Code and Cake.
(20:06):
The workshops are run by a group of programmers who
use the coding language Ruby on rails, and they helped
teach newcomers to code. They found a lot of interest.
A designer helped figure out the user interface. Another designer
made a logo It's not Pink and Curly, and over
the course of a few months, they created an app
that lets users track population and other symptoms while keeping
(20:31):
their personal data privates. Along the way, the number of
code contributors grew from three Marie, Tina and Julia to seventeen.
Here are two of the volunteers, Sophia and Maria, a
Russian couple who live in Berlin, talking about how they
got involved. We were standing outside the Rainbow Cafe during
a break in the Drip launch party. So, okay, I
(20:53):
will reveal the secret. So I'm my older they working
this programmer and they is my wife and she was
really curious about programming. She actually has a degree in programming.
But it's never gonna yeah, yeah, So we decided to
make something real, like to find some project to work
(21:13):
on it on, something grills that we can potentially also use.
Sophia doesn't even have an Android phone, so she cannot
use drip herself, but Maria does. She had been using Flow,
the Belarusian app that came under fire for sharing data
with Facebook. So which from this ink and faery floor
(21:35):
and try to drip out for iditon at clue. The
Bloody Health Collective and the Drip app are a sign
of the times. She thinks people are caring more and
more about what health apps and the rest of the
tech industry do with their data. When a group of
people get together and say, hey, let's just build this,
(21:56):
I think that's great. I mean, it's the same that
I did, right and and very years to talk to
them because I think we have, you know, very much
on the same mission. And I would be very curious
also to ask them, like, what is it that you
feel that we are doing that doesn't meet your requirements?
Why did you feel that there is a need for this.
Widea argues that for lots of users, having their data
(22:16):
stored somewhere else than their phones is actually a really
good thing. It helps ensure they don't lose years worth
of period tracking data if they lose their phones. It
could help researchers use aggregated data from lots of different
users to learn more about periods themselves. And finally, because
clues developers can see how users are interacting with the app,
(22:40):
it's a lot easier for them to fix things that
go wrong. And then maybe they have something also to
learn from me. Who have you know, maybe seen the
limitations of what happens when you don't have a back end,
when you don't like well, maybe they want to do
something different. Now, I don't know. I don't haven't spoken
to them, but I'd be very curious to the bad sekend.
All the parts of the app that users don't really
(23:03):
see will be a bigger challenge for Marie and Tina's group.
They are dependent on users telling them what's working with
the ab and what isn't they cannot see it themselves.
And another challenge is that for now, Drip is only
available on git lab and Open Source Software Forum. It's
not in the app stores where most people download new
(23:25):
programs for their phones. To make the first female designed
open source period app a success, Drip first needs a
lot more people to start using it and even more importantly,
to give feedback about how to make it better, and
Marie and the team will eventually need to focus on
(23:45):
other jobs, so they need coders to contribute to it too. Yes.
One important step in creating that team was the launch
party at their Rainbow factory. The initial response was good.
Here Tam Eastley, a Canadian developer who has lived in
Berlin for years. The first thing that I was really
(24:05):
excited about is normally, when you download an app, it
says this app is going to have access to like
your camera, your location. You're like this random folder you
didn't even know existed, and then you you have to
agree otherwise you can't use it, and you're so rarely
aware of what you were agreeing to and you just
end up saying okay because you want to use it.
But with this app, it was like, this app will
(24:27):
not have access to anything on your device, and I forget.
I assume you had to say okay to this, but
I was just like, I've never ever seen this before
and an app this is so cool. They will need
to find a lot more users like Tam to make
drips self sustaining and to ensure that the work they've
put into it so far won't be in vain. A
(24:47):
few weeks after the launch, Marie told me that about
fifty beta testers had downloaded the app and suggestions for
tweaks to the code we're pouring in. Marie is optimistic.
It's also about switching the role of this passive user
to an active contributor, if you want to see it
like that, So being like, do I actually like that?
(25:10):
Did I expect something else? And this is kind of
the question that everybody can answer. Next month, the team
is planning to add Drip to f Roid, an app
store for free and open source software. They hope that
will increase their user base. To Marie, the small community
that's developing around the app is its biggest strength. It's
(25:31):
also a sign of how people are thinking more and
more about not just how the software they use helps,
but also what it takes from users and whether that
trade off is worth it. And that's it for this
week's prognosis. Thanks for listening. Do you have a story
(25:56):
about healthcare in the US or around the world, We
want to hear from you. We're on Twitter at the
Cortes or at Naomi Kresky. If you were a fan
of this episode, please take a moment to rate and
review it. It really helps new listeners find the show.
This episode was produced by Lindsey Craterwell. Our story editors
were Drew Armstrong and Rick Shine, Francesco Levia's head of
(26:19):
Bloomberg Podcasts. We'll be back on April twenty five with
a new episode
I think it's a it's a problem that we have
become used to having free digital services and free in
quotation mark because of course we've been really paying without
private data. These days, there seems to be a smartphone
app for just about everything. One of the more popular
categories are apps that track menstrual cycles. More than a
(00:23):
hundred million women around the world already use them. Some
are trying to get pregnant, others are trying to avoid
getting pregnant, and many just want to better handle on
what their bodies are doing. But these free apps have
trade offs. Some use sensitive health information to place targeted ads.
(00:44):
The apps all need to make money, and that might
mean in a big picture sense, their main product is
actually their users data. Welcome to Prognosis, Bloomberg's podcast about
the intersection of health and technology and the unexpected places
that is taking us. I'm your host, Michelle fe Cortes.
(01:06):
For most of us, giving away our data is just
the deal we make when we're using a free app.
But a growing number of women are saying no, thank you,
and some are taking matters into their own hands. Bloomberg's
Naomi Kraski went to meet a group of feminist coders.
Our story starts at the Rainbow Factory, a community space
in Berlin's hot spot for startups, the Kreuzburg neighborhood. I'm
(01:33):
standing in the cafe at the community space. It's packed
with about two dozen people crammed around mismatched schoolroom style
tables and shares. Someone just popped open a bottle of
East Germans sparkling wine behind the bar, and they're handing
it out for free. People are here to celebrate. Everyone
(01:55):
stops hosting each other and settles down, turning their attention
to a project and screen. Next to that screen is
Marie cox Seek, a thirty year old sociologist and software developer.
She pulls up a slide with a grid of logos
for different period tracking apps. Don't get me wrong, I
don't think pink is a bad color. I just think
(02:17):
it's not the only one. And I also think flowers
or the herd, or what butterfly? Or this this very
cute girl with these big eyes. They don't really represent
represent me, They don't really represent us. Marie is one
third of the leadership team for Bloody Health, the coding
(02:39):
collectives that just released the first female developed open source
menstrual cycle tracker. In English, it's called DRIP. And this
is the launch party. Now after all these things, oh no,
there's like no privacy, no security, black box algorithms, Genno stereotypes.
Now this is DRIP. The seats for the project were
(03:01):
sewn back in when Marie got her first smartphone. It
was an Android. She was a bit of a late
adopter on the smartphone, but she knew what she wanted
to download right away. I looked into the play store
and I found a period app, um, and I just
took like the first one. Yeah, I think it was Womanlock,
(03:22):
which is also the icon with a pink flower on
the black screen, and it was. It was the first
app that I've seen. And the very same day, I
met with a friend of mine and I was very
excited and I told her, oh my god, I just
found this cool period app. It's so useful. I love it.
(03:42):
If you have ever had a period, you know why.
Marie was so happy at first when she found that app.
Periods can turn up at the most annoying times. They
can ruin your sheets and your Tinder dates. But period
apps promised to do more than just help you keep
act of bleeding. The broader pitch is that if you
(04:03):
give the app and of details, you can get a
heads up on all the others, sometimes frustrating changes that
come with your cycle. Why am I feeling depressed? What
the heck is going on with my digestion? Could I
be pregnant? The desire to connect the dots between the
period and everything else has helped make the apps so popular.
(04:24):
They're consistently in the top ten most downloaded in the
app Store. Just about every commercial period app lets you
do more than just click a calendar day so you
remember when your last one happened. They also make predictions
about when your next period will come. They let you
track everything from sex and boozy nights out to ovulation tests,
(04:48):
vaginal discharge, and resting body temperature. But apps don't necessarily
have to meet the privacy standards of say, doctor or
hospital records. In fact, as one of Marie's friends told her,
the commercial apps can use your data for plenty of
things that do not have anything to do with keeping
(05:09):
track of your period. This first looked at me. She
was a very close friend, so she looked at me
and said, like, Marie, have you read the privacy policy?
Of this app, and um, I was a bit annoyed
at her because she kind of took away my joy
in that moment um. But the following day I deleted
the app. All of that data can be used for
(05:32):
the same type of business that Facebook, Instagram and other
major apps use it for. Facebook is already controversial, but
here we're talking about even more personal data than what
most people share with social media. Joanna Baron, a Brazilian
researcher and digital rights activists who leads the group Coding Rights, explains,
(05:53):
so it's a lot, a lot, a lot of information
that is collected and the information that you get back
it's a when's your period and when's your fertile moment.
It doesn't need to ask all those questions to have
this outcome as an information. So of course this is
going somewhere else. And then if you go and look
(06:15):
at the terms of services, they say we might give
it to the data to third parties for advertisement purposes
and for whatever purpose that's not the purpose of the app.
Joanna's group did a study of period apps called Menstrue
Apps how to turn your period into money for others.
(06:37):
They found that information users give the apps can be
shared with third parties, including social media platforms, marketing agencies,
research institutes, employers, and Google Analytics. Flow, the biggest period
app in the US, has collected more than thirteen billion
data points about its users. Flow says the day helps
(07:00):
women monitor irregular periods and has helped a lot of
its users get pregnant. The app, based out of Mintsk
in Belarus, got into hot water recently over sharing some
user data with Facebook. After an uproar, the company said
it was only using Facebook analytics to improve the user
experience and that it would stop. But in China, where
(07:23):
the biggest period apps in the world are based, companies
have gone much further. Diema, one of the market leaders there,
said it crunches its users data to find out whether
to show them ads for tampons or ads for ovulation kits. Still,
Joanna's group found that when it comes to privacy policies,
(07:43):
not all commercial period apps are created equal. They cited Clue,
a Berlin based period app that's especially popular in Europe,
as an example of a clear privacy policy. Clue also
lets you store your health tracking data on your phone
without sharing it with the company, as long as you
do not set up a user account. I wanted to
(08:06):
get an industry perspective on this open source backlash against
commercial period apps, so I went to visit Clue CEO.
I'd a ten. I never started this company because of
wanted to build a business. I wanted to solve a problem,
and so I think there are definitely many nasty ways
that you can be commercial in this industry, and that
(08:28):
is happening. I do understand their sentiment. I still believe
that there must be a different way. I think it's
an it's the problem that we have become used to
having free digital services and free incuptation mark because of course,
within really paying without private data. Cluse terms of service
allow user data to be shared with academic researchers, and
(08:51):
it doesn't explicitly rule out commercial use. However, i'd just
said she does not want to run targeted at or
sell user data. But Clue has thirty million dollars in
capital from investors, and she's wrestling right now with how
to turn her period app into a sustainable business. She
(09:12):
wouldn't talk about exactly how that might work, except to
say that she has three concrete ideas that she's working
on right now. Clue has already experimented with a subscription model,
charging women about one dollar a month for more data analysis.
Marie started seriously thinking about period apps after doing a
(09:34):
study of Clue. She was working on her master's thesis
and sociology and early and she interviewed ten women about
how they used the app and what they were getting
out of it. Some more bisexual, some heterosexual, Some wanted
to get pregnant, and some did not. They were all
getting something different out of the app. At some point,
(09:56):
I had like nine different period apps on my phone
and I was trying to track see how different they are.
And that's where we get back to the idea of
a black box. Murray had all these different apps on
her phone, but she could not see into any of them.
She didn't have access to any of the code. Even Clue,
with it's easy to understand privacy policy didn't let her
(10:19):
see what was going on behind the screens. If we
use technology, um and we think it's useful and we
think it makes her life easier, but at the same
time we can't look behind the scenes, We can't understand
what is actually happening with the data we generate. What
is the code actually about? It became more and more
(10:42):
important to me UM to uh, to rely on open
source software. UM and so I was in a way
like unsatisfied with period apps and with I think with
health trekking apps in general. By September teen, Marie was
toying with the idea of writing her own open source
(11:04):
period app. She had already linked up with one potential collaborator,
a thirty year old mathematician named Tina Baumant. Marie turned
to Twitter to see if anyone else was interested in
making it a more serious project. She tweeted in German
something along the lines of who wants to fiddle around
with an open source menstrual cycle app? With me? She
(11:28):
included a gift of a little girl with a lot
of attitude. Yeah, it's just a gift showing UM a
small girl UM throwing very confidently giving away three tampons.
I guess I just thought, in this moment, Okay, let's
just give it a try, and let's see what happens
if I tweet about it, UM and I got um
(11:52):
quite a few retweets, quite a few likes. More than
a dozen people responded. Among them was Julia Frazel, a
thirty four year old software developer. She became the third
member of the team and brought the coding experience they needed.
But there was one important thing. They were still missing money.
In order to work full time on the period app project.
(12:15):
They needed some other way to pay the rent. In
early they got a German government grant called the Prototype Fund.
It's designed to promote open source technology and public interest projects.
And it felt like, um, okay, this is it. We
really was super motivated by this fund and we thought, okay,
(12:36):
this is our chance, now or never. Marie and her
team already had a list of ways they knew they
wanted their period app to be different. Some of them
had to do with design things like no gendered colors, pictures,
or text. Some had to do with making the tech
open source, and some had to do with how the
app itself would work and what kinds of predictions it
(12:59):
would make or not make. Beyond the privacy issues, predicting
when women might get pregnant is probably the most controversial
thing about period apps. Most of the commercial apps you'll
find in the app store will show you a few
days or a week when you should be most fertile.
(13:20):
Some even give the likelihood of whether you'll get pregnant
on a certain day down to the tenth of a percent,
based purely on when your last periods started. But everyone's
cycle is slightly different and some irregularity is common. Cycles
can last anywhere from twenty one days to forty days.
Period apps do not come close to being fail proof
(13:43):
as contraceptives. The Drip team decided they needed to base
their app on science. They turned to Patre Frankermen, a
gynecologist at Heidelberg University Hospital. PIT is an expert on
what's called FAB or fertility awareness based methods for determining
(14:04):
when women can get pregnant. Recently, she has become interested
in period apps since more than thirty years, I'm doing
research on the fertile window of the female cycle and
on FAV methods, and of course I'm very interested in
app supporting women in using those methods. And my second
(14:24):
motivation was is that as a gynecologist, I meet young
women and teens, or I met already young women and
teens who experienced unplanned pregnancies with those apps, even the
daughter of a close friend of mine. Page Cluss surveyed
a dozen apps that were already on the market last
(14:44):
year and which claimed to help women choose the best
time of the month to have sex in order to
get pregnant. She graded then on a thirty point scale
based on how they determined the fertile window, what study
results existed to back up that less it, what study
results they had to show the app works, and whether
(15:05):
they offer any counseling to users. All the calendar based
apps she reviewed, including Clue and Flow, got zero out
of thirty points. Even Natural Cycles, a Swedish app that
asks women to input their resting body temperature or basil
body temperature for better accuracy, got only two out of
(15:27):
thirty points in the survey. Part of the reason PA's
team graded all the apps solo is that there's not
much independent research to show whether they work. The other
reason is that when it comes to periods, past performance
is no guarantee of what will happen in the future.
Most of the apps to predictions, even if they use,
(15:50):
for example, parameters like the temperature. This is for example,
the apt Natural Cycles. It does predictions as well, and
in our opinion, therefore they are useless for contraception. When
you say predictions, do you mean making predictions based on
past cycles? Past the predictions on fertile days on the
(16:15):
basis of past scientists. Okay, and that is is not
going to help you not get pergnant yes, or get
pergnant yes. Yes, due to the variation of O eolation
and day and fertile face even in women with fairly
(16:35):
regular scientists think that's something that a lot of women
don't realize. Yes, yes, that's true. This is this is
the point. So do you think people should be trusting
their family planning to these apps? Um? No, because most
apps are lacking scientific standards or they showed poor results
(16:56):
up to now. Your body can actually tell you more
about when you're likely to get pregnant. There's a method
that's been around for decades called the Symptoms thermal method.
It involves taking your resting body temperature every morning and
checking your vaginal secretions to see when the cervical mucus
(17:16):
turns clear and stretchy like rag whites. It's a lot
more work than taking off days on a calendar, but
it fits the ethos of the project, which is helping
when and learn about their own bodies and take control
of their own fertility. I think that's the point that
you can't really predict anovulation will happen, but you can
(17:38):
only like watch your body symptoms to see when it happened,
and so you can only be sure after it happened.
But like I don't know, bodies are defended. Also depends
on your stress level or yeah, I think time zones, traveling, sleeping.
There's so much it can influence of relation. At the
(17:58):
time of relation. That was Tina, the mathematician on the
DRIP team. Before the team could start work on the
project in Earnest, something ironic happened. Tina got pregnant. I
was kind of afraid to tell them because I didn't
know if this would mean like the end of the
project for me. I was sitting down the kitchen, like
(18:20):
I have to tell you something. Um no, I pricked
it in, like oh how cool, And I'm like, yeah,
I don't know what this means for the project, and
they're like, oh, we make it work. The team finally
started work on their app in April of last year.
In late June, Tina had her baby. A few weeks
after that, they were back to weekly meetings at Tina's apartment,
(18:44):
working on the project while she breast fed. But the
prototype funding from the German government was only good for
about six months of work, and the team knew that
they would not be able to finish the entire project themselves.
They needed the open Sore part of the app to
really come into play. They needed a bigger team of
(19:04):
people to help code, and so we actually organized events,
I think three at least. We said, hey, if you're
interested in contributing, or if you like, if you want
to see what the project is all about, you can
meet us and we will set up the project together.
Because it's a little bit of a pain and I
think sometimes it even took two hours from like saying
(19:26):
hello to the first person having the app running on
their phone. But I think it was like it's kind
of nice to get people over this sometimes painful step,
like not sitting at home and you're like, oh, why
do I get this error message? Um, and then maybe
quitting but you're sitting there all together like talking a
(19:46):
little bit, but also important person might be already a
step ahead and they can tell you, like what they did.
The Drip team won another fellowship from the Mozilla Foundation
and that help them get the word out about the
project and they joined some programming workshops called Code and Cake.
(20:06):
The workshops are run by a group of programmers who
use the coding language Ruby on rails, and they helped
teach newcomers to code. They found a lot of interest.
A designer helped figure out the user interface. Another designer
made a logo It's not Pink and Curly, and over
the course of a few months, they created an app
that lets users track population and other symptoms while keeping
(20:31):
their personal data privates. Along the way, the number of
code contributors grew from three Marie, Tina and Julia to seventeen.
Here are two of the volunteers, Sophia and Maria, a
Russian couple who live in Berlin, talking about how they
got involved. We were standing outside the Rainbow Cafe during
a break in the Drip launch party. So, okay, I
(20:53):
will reveal the secret. So I'm my older they working
this programmer and they is my wife and she was
really curious about programming. She actually has a degree in programming.
But it's never gonna yeah, yeah, So we decided to
make something real, like to find some project to work
(21:13):
on it on, something grills that we can potentially also use.
Sophia doesn't even have an Android phone, so she cannot
use drip herself, but Maria does. She had been using Flow,
the Belarusian app that came under fire for sharing data
with Facebook. So which from this ink and faery floor
(21:35):
and try to drip out for iditon at clue. The
Bloody Health Collective and the Drip app are a sign
of the times. She thinks people are caring more and
more about what health apps and the rest of the
tech industry do with their data. When a group of
people get together and say, hey, let's just build this,
(21:56):
I think that's great. I mean, it's the same that
I did, right and and very years to talk to
them because I think we have, you know, very much
on the same mission. And I would be very curious
also to ask them, like, what is it that you
feel that we are doing that doesn't meet your requirements?
Why did you feel that there is a need for this.
Widea argues that for lots of users, having their data
(22:16):
stored somewhere else than their phones is actually a really
good thing. It helps ensure they don't lose years worth
of period tracking data if they lose their phones. It
could help researchers use aggregated data from lots of different
users to learn more about periods themselves. And finally, because
clues developers can see how users are interacting with the app,
(22:40):
it's a lot easier for them to fix things that
go wrong. And then maybe they have something also to
learn from me. Who have you know, maybe seen the
limitations of what happens when you don't have a back end,
when you don't like well, maybe they want to do
something different. Now, I don't know. I don't haven't spoken
to them, but I'd be very curious to the bad sekend.
All the parts of the app that users don't really
(23:03):
see will be a bigger challenge for Marie and Tina's group.
They are dependent on users telling them what's working with
the ab and what isn't they cannot see it themselves.
And another challenge is that for now, Drip is only
available on git lab and Open Source Software Forum. It's
not in the app stores where most people download new
(23:25):
programs for their phones. To make the first female designed
open source period app a success, Drip first needs a
lot more people to start using it and even more importantly,
to give feedback about how to make it better, and
Marie and the team will eventually need to focus on
(23:45):
other jobs, so they need coders to contribute to it too. Yes.
One important step in creating that team was the launch
party at their Rainbow factory. The initial response was good.
Here Tam Eastley, a Canadian developer who has lived in
Berlin for years. The first thing that I was really
(24:05):
excited about is normally, when you download an app, it
says this app is going to have access to like
your camera, your location. You're like this random folder you
didn't even know existed, and then you you have to
agree otherwise you can't use it, and you're so rarely
aware of what you were agreeing to and you just
end up saying okay because you want to use it.
But with this app, it was like, this app will
(24:27):
not have access to anything on your device, and I forget.
I assume you had to say okay to this, but
I was just like, I've never ever seen this before
and an app this is so cool. They will need
to find a lot more users like Tam to make
drips self sustaining and to ensure that the work they've
put into it so far won't be in vain. A
(24:47):
few weeks after the launch, Marie told me that about
fifty beta testers had downloaded the app and suggestions for
tweaks to the code we're pouring in. Marie is optimistic.
It's also about switching the role of this passive user
to an active contributor, if you want to see it
like that, So being like, do I actually like that?
(25:10):
Did I expect something else? And this is kind of
the question that everybody can answer. Next month, the team
is planning to add Drip to f Roid, an app
store for free and open source software. They hope that
will increase their user base. To Marie, the small community
that's developing around the app is its biggest strength. It's
(25:31):
also a sign of how people are thinking more and
more about not just how the software they use helps,
but also what it takes from users and whether that
trade off is worth it. And that's it for this
week's prognosis. Thanks for listening. Do you have a story
(25:56):
about healthcare in the US or around the world, We
want to hear from you. We're on Twitter at the
Cortes or at Naomi Kresky. If you were a fan
of this episode, please take a moment to rate and
review it. It really helps new listeners find the show.
This episode was produced by Lindsey Craterwell. Our story editors
were Drew Armstrong and Rick Shine, Francesco Levia's head of
(26:19):
Bloomberg Podcasts. We'll be back on April twenty five with
a new episode
Host
Jason Gale
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