“I Deleted It Aer the Overturn of Roe v. Wade”: Understanding
Women’s Privacy Concerns Toward Period-Tracking Apps
in the Post Roe v. Wade Era
Jiaxun Cao Hiba Laabadli Chase Mathis
Duke University Duke University Duke University
USA USA USA
Rebecca Stern
UNC Chapel Hill
USA
ABSTRACT
The overturn of Roe v. Wade has taken away the constitutional
right to abortion. Prior work showed that period tracking apps’
data practices can be used to detect pregnancy and abortion, hence
putting women at risk of being prosecuted. It is unclear how much
women know about the privacy practices of such apps and how
concerned they are after the overturn. Such knowledge is critical to
designing eective strategies for stakeholders to enhance women’s
reproductive privacy. We conducted an online 183-participant vi-
gnette survey with US women from states with diverse policies
on abortion. Participants were signicantly concerned about the
privacy practices of the period tracking apps, such as data access by
third parties and law enforcement. However, participants felt pow-
erless and uninformed about risk mitigation practices. We provide
several recommendations to enhance women’s privacy awareness
toward their period-tracking practices.
CCS CONCEPTS
• Security and privacy
→
Social aspects of security and pri-
vacy; Usability in security and privacy; • Human-centered
computing
→
Empirical studies in ubiquitous and mobile comput-
ing.
KEYWORDS
Privacy, Period Trackers, Roe v. Wade
ACM Reference Format:
Jiaxun Cao, Hiba Laabadli, Chase Mathis, Rebecca Stern, and Pardis Emami-
Naeini. 2024. “I Deleted It After the Overturn of Roe v. Wade”: Understanding
Women’s Privacy Concerns Toward Period-Tracking Apps in the Post Roe
v. Wade Era. In Proceedings of the CHI Conference on Human Factors in
Computing Systems (CHI ’24), May 11–16, 2024, Honolulu, HI, USA. ACM,
New York, NY, USA, 22 pages. https://doi.org/10.1145/3613904.3642042
Permission to make digital or hard copies of part or all of this work for personal or
classroom use is granted without fee provided that copies are not made or distributed
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For all other uses, contact the owner/author(s).
CHI ’24, May 11–16, 2024, Honolulu, HI, USA
© 2024 Copyright held by the owner/author(s).
ACM ISBN 979-8-4007-0330-0/24/05.
https://doi.org/10.1145/3613904.3642042
Pardis Emami-Naeini
Duke University
USA
1 INTRODUCTION
The overturn of Roe v. Wade in June 2022 has taken away the con-
stitutional right to abortion in the US, leading to varying levels of
abortion limits across dierent states [
3
,
13
,
45
,
61
,
79
,
108
]. This
decision jeopardizes reproductive justice and aects millions of
women in the US [
27
], making abortion services much less accessi-
ble in many areas, including the 15 states where abortion has been
completely banned as of August 2023 [3].
Besides abortion services, women’s use of fertility-related tech-
nologies can be largely impacted as well, including period-tracking
apps—the most popular type of women’s mobile health (mHealth)
apps [
113
], as these apps track and collect a vast amount of sen-
sitive data [
99
], including menstrual cycle data [
56
,
79
,
90
], preg-
nancy [
56
], sex life [
56
,
90
], and location [
56
,
90
], which can all
be used to detect or infer abortions. Worse yet, these highly sen-
sitive personal data are also excessively shared with third par-
ties [
33
], such as advertisers and insurance companies [
56
,
90
].
Other privacy concerns include lack of readable privacy policies
in apps [
5
,
51
,
107
], unnecessarily long retention of data [
67
], and
limited user control [67].
Notably, these privacy concerns toward period-tracking apps
are even aggravated in the post-Roe v. Wade era, as law enforce-
ment can now request fertility-related records from period-tracking
app companies as evidence of crimes [
99
]. For example, a report
suggests that 67% of period-tracking apps share data for “legal
obligations” [
50
]. In support of women’s reproductive privacy, a
term that refers to activities and data relating to women’s reproduc-
tive health (e.g., pregnancy status) [
79
], it is crucial to investigate
women’s privacy knowledge, perceptions, and practices toward
period-tracking apps in the post-Roe v. Wade context.
A small number of women’s health research has focused on men-
strual technologies [
7
,
62
,
86
,
121
,
123
]. Attention in this eld has
been primarily given to menstrual education for adolescents [
62
,
121
,
123
], menstrual tracking design [
48
,
54
,
111
], and user experi-
ence [
43
]. However, despite the increasingly concerning data prac-
tices, work that investigates the privacy factors of period-tracking
apps remains scant, mostly overlooking the impact of abortion-
related laws. For instance, two studies conducted outside the US
suggested people’s lack of privacy awareness when using period-
tracking apps [
12
,
59
]. One small-scale interview-based study has
CHI ’24, May 11–16, 2024, Honolulu, HI, USA Jiaxun Cao, Hiba Laabadli, Chase Mathis, Rebecca Stern, and Pardis Emami-Naeini
specically examined how the overturn of Roe v. Wade has im-
pacted women’s reproductive privacy practices [
79
], suggesting
participants generally did nothing more than delete their period-
tracking app. However, this interview study did not systematically
measure the impact of apps’ privacy practices (e.g., data sharing
stakeholders, type of collected data, and types of user’s control)
on users’ privacy attitudes and concerns. Such feature-level in-
vestigations are critical to inform the design of people-acceptable
privacy-preserving period-tracking apps and policies.
To ll in this gap, this paper seeks to answer three overarching
research questions (RQs):
•
RQ1: What are the factors that inuence women’s privacy
perceptions and practices toward period-tracking apps?
•
RQ2: What are women’s knowledge and attitudes toward
the overturn of Roe v. Wade and its impact on their privacy
concerns and practices of period-tracking apps?
•
RQ3: What are women’s expectations for privacy-enhancing
features, actions, and information from stakeholders, such
as period-tracking app companies?
To address the RQs above, we conducted a vignette-based study
with 183 female participants in the US, evenly distributed in abortion-
allowed and banned states. Our ndings highlight four critical
points: 1) The stakeholders who have access to the period-tracking
apps’ collected data have the most impact on participants’ perceived
privacy concerns, with government and law enforcement being the
most concerning stakeholders (RQ1); 2) Despite showing signi-
cant concerns toward the data practices of period-tracking apps,
participants felt powerless and uninformed about strategies to mit-
igate their privacy concerns (RQ1); 3) Participants were generally
unaware of how the overturn of Roe v. Wade might impact their
reproductive privacy and their use of period-tracking apps (RQ2);
and 4) participants called for app companies and law enforcement
to enhance users’ control over period-tracking data (RQ3).
Our work makes the following contributions:
(1)
Through our quantitative data analysis, we identied the
factors that signicantly impact women’s privacy practices
and concerns toward period-tracking apps post the overturn
of Roe v. Wade.
(2)
Through our qualitative investigation, we surfaced women’s
privacy knowledge and perceptions toward the period-tracking
apps post the overturn of Roe v. Wade.
(3)
We provide actionable recommendations for public educa-
tion, period-tracking app companies, and law enforcement
to raise women’s reproductive privacy awareness and em-
power women to have more control over their reproductive
data.
2 BACKGROUND AND RELATED WORK
In this section, we begin by presenting the background of the over-
turn of Roe v. Wade. In addition, a growing body of research in
human-computer interaction (HCI) has focused on women’s health
and menstrual health technologies such as period-tracking apps.
We summarize this strand of prior research and highlight how our
work can build on existing literature. Last, we dive into how the
overturn of Roe v. Wade impacts women’s privacy concerns and
practices toward period-tracking apps.
2.1 Roe v. Wade and Reproductive Justice
In June 2022, the Supreme Court of the United States decided to
overturn Roe v. Wade with the Dobbs v. Jackson decision [
79
],
taking away the constitutional right to abortion. Due to the overturn
of Roe v. Wade, state governments now have the full right to decide
whether to criminalize abortion or not [
79
]. As of August 2023, due
to political polarization [
13
], abortion has been completely banned
in 15 states [
3
,
45
,
108
], while the remaining states legalize abortion
with varying levels of protection and gestational limits [61].
The overturn of Roe v. Wade is widely considered a decision
that aects the reproductive lives of millions of women in the US
and jeopardizes reproductive justice in many ways [
27
]. For exam-
ple, policies that restricted access to abortion have constrained
reproductive and sexual health services in many ways, includ-
ing removing public money allocated to abortion facilities and
providers [
100
], criminalizing individuals who provided guidance
on self-administered abortions [
117
], etc. These impacts could
be disproportionately more devastating to women from dierent
marginalized and minority groups in the US, such as women suf-
fering from poverty, racism, sexism, etc [
24
,
27
,
100
,
117
]. It is
estimated that there could be a 21% increase in mortality overall,
with a 33% increase for Black women [115, 117].
According to various international human rights organizations,
restricting access to safe and legal abortions severely hinders women’s
rights and health [
82
,
97
]. Unfortunately, while overturning Roe v.
Wade is a decision exclusively eective in the US, its impact will be
global [
27
,
117
]. Roe v. Wade has been an inuential court decision
in other countries that have previously achieved progress in repro-
ductive justice, such as Kenya [
49
]. In Kenya, the High Court of
Malindi arms that abortion access is a fundamental right by refer-
encing Roe v. Wade [
49
]. Presumably, the Dobbs decision could be
as inuential as the Roe decision, thereby enhancing reproductive
injustice globally. Consequently, it is imperative to (re)investigate
protection strategies for women’s reproductive health and rights
in the Roe v. Wade context. Our work aims for this goal by look-
ing into the specic privacy implications and proposing protection
strategies accordingly.
2.2 Women’s Health and Menstrual
Technologies in HCI
Motivated by feminist HCI [
18
,
68
,
102
], the topic of women’s
health has been receiving growing attention in the HCI research
community over the last several years [
7
]. At CHI 2017, a work-
shop on hacking women’s health initiated research discussion
around women’s digital health [
16
]. Since then, a strand of work
has been proliferating, especially related to intimate and menstrual
health [
25
,
86
,
110
,
111
,
122
,
123
], maternal health [
60
,
71
,
85
,
95
],
and sexual well-being [34, 64, 65].
Some research in this area has taken the lens of design to explore
emerging technologies that promote women’s health knowledge
and awareness, such as through exploring and testing a wearable e-
textile in support of breast self-awareness [
6
], a design kit with elec-
tronic textiles to promote bodily literacy [
8
], and an augmented sys-
tem that promotes bodily literacy and pelvic tness for women [
9
].
Besides promoting bodily literacy, a volume of work has focused
on designing for women’s sexual pleasure [
17
,
19
,
34
,
109
]. Other
Women’s Privacy Concerns Toward Period-Tracking Apps in the Post Roe v. Wade Era CHI ’24, May 11–16, 2024, Honolulu, HI, USA
work has investigated technologies to increase empathy from part-
ners [
70
], tools to manage healthcare records across pregnancy [
42
],
and mHealth applications to encourage healthy behaviors for preg-
nant women [71, 93].
More relevant to our work is a signicant focus on menstrual
health in women’s health research [
7
,
86
,
123
]. For example, in men-
strual education, Help Pinky is a game developed by Jain et al. [
62
],
teaching adolescent girls in India about menstrual health. Similarly,
to encourage discussions on menstrual health between parents and
children, Tran et al. [
121
] developed an internet-connected working
model of the uterus. Tuli et al. [
123
] presented empirical ndings
from an inquiry into current approaches to educating adolescents
about menstruation, suggesting gaps between parents’ and teach-
ers’ expectations regarding who will introduce menstrual topics to
adolescents. Besides education, prior work has explored menstrual
tracking [
43
,
48
,
54
,
111
]. For instance, recent studies have investi-
gated using ambient light and color-emitting smart mirrors to track
menstrual information [
48
,
54
]. Similarly, Epstein et al. [
43
] have
examined the practices and motivations of using menstrual tracking
apps in the US, suggesting design drawbacks and the non-inclusive
nature of the menstrual tracking apps.
Although the prior research has shed light on the signicance
and benets of promoting women’s health through various tech-
nologies, work that empirically investigates the concerns, such as
privacy factors of menstrual technologies, remains nascent. How-
ever, menstrual technologies track and collect a variety of sensitive
data such as sexual activities and medical records without many
regulations in the US [
79
], depriving women of their reproductive
rights and freedom [
10
,
11
]. More of such privacy concerns will
be detailed in Section 4.2, where we narrow our focus on one of
the most widely used menstrual technologies – period-tracking
mobile apps, with 26.60 million users worldwide in 2022 [113]. As
a result, to promote women’s reproductive health and justice, it is
equally vital to look into the benets, as well as the potential harms
of these menstrual technologies. While most of the work exploring
menstrual technologies in HCI has been focusing on usability, our
work highlights the privacy harms and how women users perceive
or neglect the harms at a critical historical moment – the overturn
of Roe v. Wade.
2.3
Privacy Concerns of Period-Tracking Mobile
Apps in the Post Roe v. Wade Era
Scholarship investigating the privacy practices of mHealth apps in
general, and period-tracking apps in particular, has more often than
not yielded concerning ndings. For instance, sensitive data, includ-
ing reproductive-related behavior and location data, is collected by
women’s mHealth apps. In a scoping review of 23 popular women’s
mHealth apps, it was found that all apps permitted behavioral track-
ing, while 61% allowed location tracking [
5
]. The same study has
found that a signicant 87% of these apps share the collected data
with third parties [5].
Despite their concerning data practices, prior work has shown
that 30% of period-tracking apps did not display a privacy policy [
5
].
Similarly, a comprehensive analysis of 20,991 general mHealth
apps revealed that 28.1% of the apps provided no privacy policy
at all [
118
]. Even when privacy policies are available, questions
rightfully arise regarding their eectiveness. In most cases, despite
its sensitivity, the reproductive-related data is not covered by the
privacy policies or even completely disregarded [
107
]. In addition,
Fowler et al. assessed that understanding the privacy policy or terms
of service of a period-tracking app typically requires a college-level
education. This suggests that the majority of American users may
not fully understand how their data is being used and shared [51].
That is, if they even read it at all, only a mere 9% of American adults
consistently read privacy policies before agreeing to them [15].
Privacy and data practices of period-tracking apps are especially
concerning as the information collected by health-focused apps is
not covered by the Health Insurance Portability and Accountability
Act (HIPAA) [
103
]. Likewise, in the UK and European Union (EU),
it is unclear whether female-oriented technologies (FemTech) data
is protected under the “special category data” in the General Data
Protection Regulation (GDPR) framework in the EU and if such data
fall under “medical” category or other groups in the UK Medicines
and Healthcare Products Regulatory Agency (MHRA) [
44
,
80
,
81
].
Essentially, women’s health data protection has been poorly dened
in many major privacy and legal frameworks worldwide, and the
responsible stakeholders remain unknown [81].
With the overturn of Roe v. Wade and the resulting constantly
changing legal landscape, interest and concern surrounding the
privacy of period-tracking apps have naturally risen. The number
of articles about the danger of using women’s mHealth apps and
privacy-related reviews has increased [
33
]. Mozilla has labeled 18
of 25 popular period- and pregnancy-tracking tech with a “privacy
not included” warning [
84
]. A report by the Organization for the
Review of Care and Health Apps (ORCHA) revealed that 67% of the
period-tracking apps tested share data for “legal obligations” [
50
],
which is particularly alarming in the current context of the US
abortion laws.
The extent to which these practices represent a real threat re-
mains a topic of ongoing debate. The Electronic Frontier Foundation
(EFF) argues that although anyone may buy certain period-tracking
apps’ datasets, it is not the primary strategy being used to crimi-
nalize abortion seekers, at least not currently [
52
]. Presently, law
enforcement relies on text messages, emails, and browser search his-
tories [
58
]. Indeed, in 2022, a Nebraska police ocer used Facebook
messages to investigate an alleged illegal abortion [
66
]. In another
case, a visit to a web page titled “National Abortion Federation:
Abortion after Twelve Weeks” has been used to prosecute a woman
in Indiana [
128
]. Nevertheless, the fact remains that fertility apps
are not entirely safe to use. The Federal Trade Commission (FTC)
led a complaint against Flo Health Inc. (the most downloaded
period-tracking app worldwide in 2022 [
112
]), accusing them of al-
legedly sharing users’ sensitive health data with Facebook, Google,
AppsFlyer, and Flurry over an extended period of time while they
explicitly told their users they did not [
28
]. The complaint resulted
in a settlement and the app introducing an “Anonymous” mode,
but research shows that de-identication measures are rarely reli-
able [
101
]. More recently, the FTC charged another period-tracking
app, Premom, for deceiving users about their data practices by
disclosing health data to third parties [29].
While considerable attention has been given to user experience
and app practices, little work has been done to understand users’
privacy perceptions surrounding period-tracking apps, particularly
CHI ’24, May 11–16, 2024, Honolulu, HI, USA Jiaxun Cao, Hiba Laabadli, Chase Mathis, Rebecca Stern, and Pardis Emami-Naeini
following the overturn of Roe v. Wade. A study done in New Zealand
revealed most participants regard the data collected by period-
tracking apps as uninteresting and unproblematic [
59
], supporting
the use of their menstrual data in academic research [
59
,
107
]. By
contrast, a poll by the Information Commissioner’s Oce (ICO) in
the UK revealed that women had greater concerns about data trans-
parency and security than ease of use and costs of period-tracking
apps [
1
]. Building on this nding, another UK-based study suggests
that users are not informed of the technological skills to protect
their FemTech data despite the privacy concerns expressed [
81
].
Another study conducted in Germany suggested that the perceived
benets of period trackers outweighed the perceived harms among
users. In fact, while non-users frequently expressed privacy con-
cerns when it came to sharing intimate data with period trackers,
the interviewees who were actively using the apps rarely raised
such concerns themselves [12].
Collectively, these studies have revealed an important fact – the
privacy paradox and calculus phenomenon may widely exist in
period-tracking apps, similar to other mHealth applications [
125
,
129
]. By denition, privacy paradox refers to the contradictory pri-
vacy concerns expressed by users and their actual behaviors, e.g.,
voluntarily giving away information, making little eort in data
protection, etc. [
53
]. One of the widely used explanations for the
privacy paradox is the privacy calculus, which refers to users’ com-
parison between the perceived privacy risks and their anticipated
return for revealing information, e.g., the utility of apps [
47
,
106
].
How users weigh the privacy risks and benets of mHealth apps
depends on various contextual factors, e.g., type of requested data,
type of device, etc. [
46
]. In more sensitive contexts, such as sex-
ual and reproductive health interventions, the condentiality and
privacy of information and support-seeking methods aorded by
mHealth technologies have greatly attracted users’ interest [
46
,
116
].
For instance, in a study of mobile cell phone-based HIV prevention
intervention, Cornelius et al. [
31
] showed that condentiality was
perceived as an advantage of the technology for seeking HIV-related
information.
The majority of existing literature on users’ privacy perceptions
toward period-tracking apps has been conducted outside the US,
where the legal landscape surrounding abortion diers. More re-
cently, McDonald and Andalibi interviewed 15 individuals who may
get or were pregnant in the US to understand how the overturn of
Roe v. Wade impacted their reproductive privacy practices, and they
nearly all reported deleting period-tracking apps without taking
further action [
79
]. They also found that participants’ reproductive
risk, age, location, and experience with oppressive government
could potentially have an impact on participants’ privacy strategies.
Due to its qualitative nature, this study was not able to quanti-
tatively measure the impact of various privacy factors (e.g., type
of requested data [
46
] and users’ data autonomy [
125
]) on users’
attitudes and practices toward period-tracking apps. Such investi-
gation is critical to inform the design of period-tracking apps as
well as policies to protect women’s privacy more eectively when
interacting with such apps.
To shed light on the privacy attitudes and expectations of female
users of period-tracking apps, we conducted a large-scale survey.
Through careful quantitative and qualitative investigation, we iden-
tied the specic factors that have a signicant impact on women’s
privacy concerns and practices toward period-tracking apps after
the overturn of Roe v. Wade.
3 METHODOLOGY
To surface the factors that inuence women’s privacy attitudes,
concerns, practices, and expectations toward period-tracking apps
after the overturn of Roe v. Wade, we conducted an online vignette
study with 183 Prolic
1
participants from the US. We presented
each participant with a consent form at the beginning of the survey.
Our study procedure was approved by our institution’s review
board (IRB).
3.1 Fractional-Factorial Vignette Study
Leveraging short hypothetical scenarios, vignette-based studies
aim to elicit respondents’ considerations and judgments toward
the presented scenarios [
14
,
78
,
87
]. By researching theoretically
important factors and systematically varying these factors [
14
],
multiple vignettes are presented to respondents. In a fractional-
factorial vignette study, each respondent only answers questions
about a subset of scenarios to ensure the response quality within
reasonable survey completion time [14].
Previous privacy research [
36
,
38
,
40
,
72
,
73
,
77
,
78
,
87
,
96
,
127
]
has extensively used the vignette technique to examine privacy
norms in varying privacy-related contexts. As opposed to testing
for a static denition of privacy [
78
], the vignette technique can
help identify the relative importance of each privacy factor that re-
spondents take into consideration when making a privacy decision
within a specic community [63, 126].
3.2 Study Design
3.2.1 Factor Specification. We quantied the impact of four pri-
vacy factors (e.g., Data Storage) in our study. For each factor, we
considered multiple levels (e.g., Data storage: Device, Data Stor-
age: Cloud) to test a hypothesized range of privacy protection,
from low-protective (e.g., Data Storage: Cloud) to high-protective
(e.g., Data storage: Device). We only included privacy factors and
levels, which prior research has identied as potentially important
in users’ privacy attitudes toward period-tracking technologies
(e.g., period-tracking apps, FemTech) (see Table 1). We included the
following four factors in each vignette:
•
Collected Data: The type of data the period-tracking app
collects (ve levels).
•
Data Storage: The location where the collected data is being
stored (two levels).
•
Data Sharing: The stakeholder that the data is being shared
with (ve levels).
•
User Control: The type of controls users have about their
collected data (three levels).
To design vignettes that are realistic and similar to the current
data practices of period-tracking apps, we set the Menstrual cycle
data as the default level (most protective) of the Collected Data
factor. We considered collecting additional data types to be less
protective and hypothesized that participants would become more
1
https://www.prolic.co/
Women’s Privacy Concerns Toward Period-Tracking Apps in the Post Roe v. Wade Era CHI ’24, May 11–16, 2024, Honolulu, HI, USA
Factor Level and Example References
Menstrual cycle data (e.g., days bleeding) [5, 79, 90, 107].
Menstrual cycle data (e.g., days bleeding) & Precise location [5, 32, 56].
Collected Data Menstrual cycle data (e.g., days bleeding) & Mental health data (e.g., moods, feelings) [5, 56, 74, 107].
Menstrual cycle data (e.g., days bleeding) & Physical health data (e.g., body pains, weight) [76, 107].
Menstrual cycle data (e.g., days bleeding) & Intimacy data (e.g., intimate relationships, sexual activities) [99, 107].
Device [94, 99, 120].
Data Storage
Cloud [94, 99, 120].
App company [56, 90, 98, 99].
App company & Law enforcement ocers [79, 90, 107].
Data Sharing App company & Third party advertisers [5, 56, 90].
App company & Health care providers (e.g., OBG-YN, primary care physician) [5, 90].
None
Opt out from data sharing [56, 94].
User Control Data deletion [91, 94].
None
Table 1: Each vignette in the survey included the four factors (e.g., collected data). For each factor, we selected a random level
(e.g., menstrual cycle data) among the possible levels.
concerned if the period-tracking apps collected data types in ad-
dition to menstrual cycle data. To test this hypothesis, we tested
four additional data types (precise location, mental health data,
physical health data, and intimacy data), which have been shown
to impact privacy concerns and practices toward period-tracking
technologies (see Table 1).
Sharing data with the app company is a common practice for
period-tracking apps [
56
,
90
,
98
,
99
]. Therefore, we identied App
Company as the base level of the factor Data Sharing. We tested
three additional data-sharing parties (law enforcement ocers,
third-party advertisers, and healthcare providers), which were shown
to have varied privacy implications (see Table 1). We considered no
data sharing as the most protective level.
Cloud storage could expose people to higher privacy and security
risks compared to device storage, and people are more concerned
about cloud storage as opposed to data being stored on the de-
vice [
94
,
99
,
120
]. To test this in the context of period-tracking apps
post the overturn of Roe v. Wade, we considered the two levels of
cloud and device for the factor Data Storage.
Based on prior research, users would like to have more control
over their data when interacting with digital technologies [81]. In
our survey, we tested participants’ attitudes toward three levels
of user control: opt-out from data sharing, data deletion, and no
control over data. These levels were identied by the prior work
to potentially impact privacy concerns and attitudes toward data-
intensive technologies and apps [56, 91, 94].
3.2.2 Scenario Design. Using the factor levels (e.g., Collected Data
= Menstrual cycle data), there are 150 possible combinations. Af-
ter eliminating unrealistic options, such as scenarios with Data
Sharing = None (“Your data will not be shared with anyone.”) and
User Control = Opt out from data sharing (“You have the option
to opt out of your data being shared outside the app company.”),
75 scenarios remained. In the survey, each vignette presented the
factors in this order: Data Type, Data Storage, Data Sharing, and
User Control. Each participant was presented with four randomly
selected scenarios. We selected four, as our pilot study showed that
having four scenarios would allow participants to complete the
survey in less than 15 minutes. The following is an example of a
scenario that we presented to participants:
Imagine you are looking for a period-tracking app
to install on your phone to keep track of your men-
strual cycle. You see a period-tracking app with the
following data practices: The app only collects your
menstrual cycle data (e.g., days bleeding). This app
will store your data on the device. Your data will
not be shared with anyone. You have the option to
delete your data.
3.2.3 Survey Design. We implemented our survey on Qualtrics
2
.
We started the survey with a consent form. We then presented
participants with instructions on the survey procedure. Participants
were randomly assigned to see four period-tracking apps’ data
collection and use scenarios. At the end of each scenario, we asked
participants some follow-up questions.
First, we asked participants to specify their level of concern
toward the presented scenario’s data practices and the reason(s)
behind their response. Next, to assess participants’ attention, we
presented an attention-check question. The attention-check ques-
tion was a multiple-choice question where we asked either about
the type(s) of data being collected in the presented scenario, where
the collected data is being stored in the presented scenario, with
whom the data is being shared in the presented scenario, or what
data control users have in the presented period-tracking scenario.
For each scenario, we randomly selected one type of attention-
check question. When analyzing the data, we removed participants
who missed more than two attention-check questions from the
database for qualitative and quantitative analysis.
After the scenario questions, we asked participants about their
period-tracking app usage, such as their period-tracking tool usage
2
https://www.qualtrics.com/
CHI ’24, May 11–16, 2024, Honolulu, HI, USA Jiaxun Cao, Hiba Laabadli, Chase Mathis, Rebecca Stern, and Pardis Emami-Naeini
history and purposes of usage. Then, we asked participants about
their concerns and risk mitigation practices toward the period-
tracking apps they are currently using or have been using in the
past. We then asked participants about their knowledge of the data
practices of period-tracking apps.
Next, we asked participants questions focused on the overturn of
Roe v. Wade. We started by asking participants about their familiar-
ity with the overturn and their concerns about the overturn of Roe
v. Wade. Then, we asked respondents to specify how much impact
they believe the overturn of Roe v. Wade has had on their privacy
concerns about the data practices of period-tracking apps and their
rationales. We also asked participants if they had ever applied any
changes to their period-tracking habits and practices due to the
overturn of Roe v. Wade. We ended the survey with demographic
questions. See the full survey questions in Appendix A.
3.3 Pilot Survey
Before launching the formal survey, we conducted a pilot study
with 20 Prolic participants. Based on the timing ndings of the
pilot survey, we reduced the number of presented vignettes from six
scenarios (average completion time of 31 minutes) to four scenarios
for our main survey (average completion time of 14 minutes).
3.4 Participant Recruitment
We initially recruited 200 participants on Prolic. The participants
were required to be 1) at least 18 years old, 2) living in the United
States, 3) self-identied as a female, including transgender and
cisgender females, and 4) having an approval rate of over 95%
on Prolic. To investigate dierences between participants from
abortion-banned states and abortion-allowed states (according to
the latest data from [
3
] as of Aug 2023), we recruited half of our
participants from 15 abortion-banned states (e.g., Texas), while the
other half were recruited from 8 abortion-allowed states, with no
gestational limit (e.g., Minnesota). On average, it took 14 minutes
for the participants to complete the survey. Upon completion, each
participant received a 4 USD compensation.
3.5 Data Analysis
3.5.1 Qantitative Analysis. For the quantitative analysis, we sta-
tistically modeled participants’ self-reported privacy concerns to-
ward period-tracking apps’ data practices presented in vignettes.
Since the possible responses to the concern question were ordinal
categorical (e.g., slightly concerned, somewhat concerned), we con-
ducted an ordinal regression analysis by constructing a cumulative
link mixed model (CLMM). We selected a mixed model as our sur-
vey had a repeated-measure design, where each participant was
asked the same question about their level of concern regarding four
vignettes. To count for potential within-participants’ data depen-
dencies, we constructed a mixed regression model with random
intercept (CLMM).
Using the Akaike Information Criterion (AIC) as the metric for
the model’s goodness of t, we performed model selection with
forward addition. For the model selection, we considered the four
scenario factors (see Table 1), the order in which we presented
the scenarios (Scenario Order), the demographic factors, and the
rst-order interaction terms.
For each factor, we selected one level as the baseline. For example,
for User Control, we selected None as the baseline. It is important
to note that any level of each factor can be selected as the factor’s
baseline, and the selection of baseline does not have any impact
on the relative importance of the levels of factors. Table 3 shows
the explanatory variables that we included in the nal regression
model after the AIC model selection process.
In the following, we provide details regarding the CLMM we
employ for inference. Consider the
participant in our survey,
. Concern levels for the
app
sees can be represented as
,
∈ {
1
,
2
,
3
,
4
,
5
}
. For
∈ {
1
,
2
,
3
,
4
}
, the probability that the
concern level of
is at most is modeled as
Pr
,
≤ =
|+1
+
,
−
ˆ
,
where
(·)
is the sigmoid function,
|+1
is the threshold parame-
ter between the class
and
+
1 determined by the model, and
is the random eect modeled as a Gaussian with zero mean and con-
stant variance
2
ˆ
is the model’s estimates for
(
1
, . . . ,
)
, and
.
is the observed demographic and app attribute data for participant
.
3.5.2 Qalitative Analysis. For open-ended survey questions, we
conducted content analysis [
104
]. One of the authors rst annotated
and coded 20 responses (10% of our total responses). According to
the annotations, the author constructed a codebook to analyze the
remaining responses. Two researchers independently applied the
codebook to the responses and iteratively revised the codebook
through several meetings. After resolving the coding discrepan-
cies and disagreements, we reached a Cohen’s Kappa inter-coder
agreement of 87.5%, which is considered “almost perfect.” [
20
]. The
resulting codebook contains 10 main codes, 55 sub-codes, 101 sub-
sub-codes, and 9 sub-sub-sub-codes. The nal codebook is available
in Appendix B.
3.6 Ethics and Positionality
3.6.1 Ethical Statement. The study has been approved by the uni-
versity’s Institutional Review Board (IRB). In addition, prior to the
start of the survey, each participant was informed of the study
procedure, risks, compensation, condentiality, voluntariness, and
rights to contact. All the participants read and agreed to our terms
before participation.
3.6.2 Positionality Statement. In qualitative research with respect
to marginalized groups such as women, it is crucial to clarify re-
searchers’ positions in society and their identities [
105
]. Researchers’
positionalities such as class, gender, and race could invariably im-
pact the research process and outcomes [
41
,
92
]. In this work, four
out of ve authors are cisgender females, and three of us were
located in the US when conducting the research, making most of
us part of the same marginalized group described in this study,
i.e., women in the post-Roe v. Wade US. Therefore, our own iden-
tities and personal experiences informed the design of the survey
questions that our participants could relate to. Additionally, when
conducting the qualitative analysis, our identities also helped us
resonate with participants’ privacy concerns.
Women’s Privacy Concerns Toward Period-Tracking Apps in the Post Roe v. Wade Era CHI ’24, May 11–16, 2024, Honolulu, HI, USA
Age State Race Political Aliation Degree
Range 19-75 Legal abortion state 51.37% White 73.8% (75.5%) Democrat 52.5% (39%) Bachelor’s degree 33.3% (22.8%)
Mean 39.05 Full abortion ban state 47.54% Black or African American 4.9% (13.6%) Independent 21.8% (30%) Some college credit, no degree 26.8% (16.6%)
STD 12.34 Prefer not to say 1.09% Asian 3.3% (6.3%) Republican 17.5% (28%) High school diploma, GED, or alternative 13.1% (28%)
Median 36.0 Hispanic or Latino, or Spanish Origin of any race 2.7% (19.1%) None 3.8% Associate’s degree 12.0% (10.7%)
US Median 38.9 American Indian or Alaskan Native 1.6% (1.3%) Other* 2.2% Master’s degree 9.3% (10.6%)
Prefer not to say 1.1% Prefer not say 2.2% Doctorate degree 2.7% (1.7%)
Multiracial 12.6% Professional degree beyond bachelor’s degree 1.1% (1.2%)
12th grade—no diploma 0.6%
Prefer not to say 1.1%
Table 2: Demographic breakdown of survey participants. Note that for race, participants were able to select multiple answers.
The political aliations of the people who selected ‘other’ are either ‘anarchist’, ‘green’, ‘leftist’, or ‘Marxist-Leninist.’ In the
Race and Degree columns, the numbers in parentheses show the US average for women, according to census data from 2022
and 2023 [
22
,
23
]. In the Political Aliation column, the numbers in parentheses show the US average for women, according to
Pew Research Center data from 2020 [26].
3.7 Limitations
Our study employed a vignette-based approach to understand how
dierent privacy practices of period-tracking apps may impact
individuals’ privacy concerns, attitudes, and practices. To limit the
survey length for response quality, we only tested a limited range
of data practices that have been identied by prior work to impact
users’ privacy attitudes and concerns. Future work could expand the
factors and their levels to evaluate more period-tracking scenarios,
such as sharing period-tracking data for analytics and academic
purposes [107].
In addition, while vignettes help isolate specic factors and their
levels, it should be noted that they may not fully illustrate the com-
plexity of real-life behaviors. Thus, participants’ reactions to these
scenarios might dier from their actions in real life. To make the
scenarios as realistic as possible, we included privacy factors and
levels that are similar to data practices of period-tracking apps. In
addition, we included participants’ free texts in our in-depth quali-
tative analysis to better reect participants’ lived experiences [
75
].
While the majority of period-tracking app users are female, we
acknowledge that there are other populations using period-tracking
apps, e.g., male partners [
88
,
119
]. Partners’ use of period-tracking
apps, such as for intimate surveillance [
119
], supporting their fe-
male partners [
4
,
55
], and increasing chances of conceiving [
83
],
may violate women’s privacy by disclosing their reproductive in-
formation without women’s knowledge or permission, i.e., interde-
pendent privacy (IDP) violations [
88
]. In this study, we focused on
how period-tracking apps are approached by users who use such
apps for their own reproductive health [
79
]. Therefore, we only
recruited female participants. However, considering the potential
existence of IDP violations in period-tracking apps, we encourage
future work to investigate other users’ (e.g., partners) perspectives,
especially if their app activity would put women at risk.
Participants were recruited through the Prolic platform, which
may introduce biases related to the characteristics of its users. In
addition, our participants are not completely representative of the
U.S. population. For instance, only 4.9% of our participants identied
as Black or African American alone, compared to the U.S. Census
estimate of 13.6%. Those identifying as Hispanic or Latino only
constituted 2.7% of our sample (U.S. Census reports 19.1%).
4 RESULTS
We initially recruited 200 participants from the Prolic platform,
who identied themselves as women. In our survey, we presented
four randomly selected vignettes to each participant. For each sce-
nario, we asked one attention-check question to assess participants’
understanding of the data practices described in the scenario (see
Section 3.2.3). In data analysis, we excluded participants who (1)
got at least 3 attention-check questions wrong, (2) did not give full
consent, or (3) were not in completely abortion-allowed or banned
states (e.g., Virginia). As a result, we removed 17 responses. We
report our ndings from 183 participants. The average age of our
participants was 39 years old. We recruited a balanced sample of
participants who live in states where abortion is banned (87/183,
48%) and states where abortion is legal with no gestational limit
(94/183, 51%). We summarize our participants’ demographic infor-
mation in Table 2. Complete demographic information can be found
in the Appendix C.
4.1 Participants’ Attitudes And Usage Toward
Period Tracking
Figure 1: Distribution of participants by period-tracking tool
used. Note that participants were able to select multiple an-
swers; thus the sum of participants in the gure may not sum
up to 183. Among the 3 participants who indicated using an
alternative period-tracking method, one reported relying on
an IUD, the others reported keeping mental notes of period
dates or using the notepad app on a computer.
Period-tracking apps are the most common tools to track
upcoming periods. 67% of our survey participants (123/183) re-
ported that they are currently tracking their periods or have pre-
viously tracked their periods. The predominant choice for about
-
-
-
-
-
-
~
~~~~~=::::::::::::~~~~~~~
~~
:
=
CHI ’24, May 11–16, 2024, Honolulu, HI, USA Jiaxun Cao, Hiba Laabadli, Chase Mathis, Rebecca Stern, and Pardis Emami-Naeini
51% of our participants (94/183) to track their periods was using
period-tracking apps, mainly Flo, Period Tracker Period Calendar,
Apple Cycle Tracking, and Clue. Other frequently mentioned meth-
ods were using a paper diary or calendar (58/183, 32%) and using
birth control pills (49/183, 27%). Preparing for upcoming periods
emerged as the most common purpose for using a period-tracking
app (81/183, 44%). Other commonly mentioned purposes included
becoming aware of how the body is doing (40/183, 22%) and tracking
fertility (35/183, 19%).
Desire to download period-tracking apps varies depending
on who is recommending. We asked participants to rate their
likeliness of downloading a period-tracking app recommended by
dierent stakeholders (see Table 2). 82% of participants (150/183)
reported being not at all likely to trust an app recommended by gov-
ernment and law enforcement ocers. Similarly, most participants
were not likely to download a period-tracking app recommended
by their employers (137/183, 75%) or insurance companies (99/183,
54%).
Figure 2: Distribution of downloading a period-tracking app
based on dierent stakeholders’ recommendations. Ordered
by ‘Extremely likely’ Ratings.
However, 74% of our participants (136/183) were at least some-
what likely to accept the app recommendations from healthcare
professionals. Likewise, 53% of participants (98/183) showed at least
some receptiveness to downloading an app recommended by family
members. Interestingly, participants showed relatively low recep-
tivity to downloading an app recommended by romantic partners,
as 39% (72/183) reported to be not at all likely to do so.
4.2 Factors That Inuence Privacy Concerns
Toward Period Tracking (RQ1)
We asked participants to rate their concerns regarding using various
period-tracking methods. Notably, they were most concerned by
the privacy implications of posting on social media about fertility-
related topics. Using period-tracking apps either on a wearable
device, a personal computer/tablet, or a phone generated similar
levels of concern, indicating that the choice of devices did not
signicantly impact their privacy concerns (�-value > 0.05).
Participants showed relatively lower levels of concern regarding
the privacy implications of searching for period-tracking-related
information online or engaging in discussions through communi-
cation platforms (e.g., WhatsApp). This observation is noteworthy,
especially considering that it is the strategy law enforcement cur-
rently relies on to criminalize abortion seekers [
58
]. Full results are
shown in Figure 3.
Figure 3: Distribution of privacy concern levels towards dif-
ferent period tracking practices. Ordered by ‘Very concerned’
Ratings. PTA here refers to period-tracking apps, while PTT
refers to period-tracking and fertility topics.
To gain deeper insights into the specic data and privacy prac-
tices contributing to participants’ privacy concerns, each partici-
pant was presented with four randomly selected period-tracking
app scenarios. Based on the Akaike Information Criterion (AIC)
of the CLMM regression model, the party with whom the data is
being shared with (Data Sharing) was the most important factor
to explain the participants’ privacy concerns. The second most im-
portant factor was the type of controls users have regarding their
data (User Control). The type of data collected by period-tracking
apps (Collected Data) was the third most impactful factor, and
where the collected data is being stored in (Data Storage) was the
least important factor in explaining participants’ level of privacy
concerns toward period-tracking apps. In the remainder of this
section, we describe the surfaced themes. When providing a quote
from our participants, we include the state the participant resides
in and indicate whether the state legalizes abortion or not using B
(banned) and L (legal), e.g., Minnesota, L.
Data being shared with law enforcement is most concerning.
Compared to data not being shared with any parties, participants
were most concerned about data being shared with government and
law enforcement ocers (row 7: estimate
=
4
.
54,
�
-value
<
0
.
001).
Data being shared with law enforcement ocers signicantly in-
creased participants’ level of privacy concerns even when the de-
scribed period-tracking apps oered the control to the user to delete
their collected data (row 21: estimate = 1. 75, �-value < 0.05).
When being asked to specify the reasons for the level of concern,
37% of participants (67/183) indicated that they perceived their
personal data being shared with government and law enforcement
ocers “unacceptable”, especially when it comes to data as sensitive
as menstrual cycle data. 33% of the respondents (22/67) added that
they were confused about why law enforcement ocers would
need menstrual cycle data. P38 said:
Sharing personal information of this nature with law
enforcement is unnecessary, not to mention incredibly
wrong. (Alabama, B)
According to P38, the confusion caused by unnecessary data
sharing led to their distrust of the app. Importantly, app companies
should earn more users’ trust by restricting their data sharing with
unnecessary third parties that do not directly benet users’ goals
of using period-tracking apps.
Women’s Privacy Concerns Toward Period-Tracking Apps in the Post Roe v. Wade Era CHI ’24, May 11–16, 2024, Honolulu, HI, USA
Level of Concern (AIC = 1864.70)
Row Factor
OR
Std. Error -value
Collected Data (baseline = Menstrual cycle data)
1 Location Data 5.562 1.72 0.298 ***
2 Intimacy Data 5.238 1.66 0.352 ***
3 Mental Health Data 2.314 0.839 0.292 **
4 Physical Health Data 1.498 0.404 0.316 0.2
User Control (baseline = None)
5 Control Delete 0.08 -2.52 0.313 ***
6 Control Share 0.289 -1.24 0.617 *
Data Sharing (baseline = None)
7 Law Enforcement 93.317 4.54 0.714 ***
8 Third Parties 26.762 3.29 0.641 ***
9 Healthcare Providers 7.367 2.00 0.610 **
10 App Companies 4.549 1.52 0.484 **
Data Storage (baseline = Device)
11 Cloud 0.833 -0.183 0.449 0.683
Education Level (baseline = No Degree)
12 Degree: Prefer not to Say 13.45 2.60 1.66 0.118
13 Bachelor’s Degree 3.892 1.36 0.421 **
14 Graduate Degree 2.519 0.924 0.544 0.089
15 Associate’s degree 1.161 0.149 0.562 0.791
Political Party (baseline = Democrat)
16 Republican 3.04 1.11 0.513 *
17 Independent 0.986 -0.014 0.388 0.971
Age (numeric)
18 19,...,75 1.014 0.0144 0.0161 0.373
Data Sharing (baseline = None) : User Control (baseline = None)
19 App Companies : Control Delete 1.956 0.671 0.517 0.194
20 Healthcare Providers : Control Delete 17.082 2.84 0.749 ***
21 Law Enforcement : Control Delete 5.755 1.75 0.816 *
22 Third Parties : Control Delete 2.659 0.978 0.745 0.189
23 Healthcare Providers : Control Share 1.10 0.0956 0.810 0.906
24 Law Enforcement : Control Share 1.23 0.206 0.889 0.817
Scenario Order (baseline = Scenario 1)
25 Scenario 2 1.33 0.287 0.252 0.255
26 Scenario 3 1.55 0.438 0.265 0.0988
27 Scenario 4 1.09 0.0894 0.288 0.756
Threshold Coecients
28
4|5
- 0.851 0.740 -
29
4|5
- 2.59 0.741 -
30
4|5
- 4.08 0.745 -
31
4|5
- 5.43 0.756 -
Random Eects
32
2
- 4.170 - -
�
Note: * < 0.05 ** < 0.01 *** < 0.001
Table 3: CLMM regression model to describe how various scenario factors impact participants’ level of privacy concerns toward
period-tracking data collection and use. Each row corresponds to a single factor and shows the resulting model estimate, i.e.,
the coecient, for that factor. The odds ratios are ranked in descending order according to their eect size, represented by the
magnitude of the model coecients (
�
). A positive estimate for a factor-level (e.g., Collected Data: Intimacy Data) implies that
transitioning from the baseline of the corresponding factor (e.g., Menstrual Cycle Data) to that level of the factor (e.g., Intimacy
Data) would increase the perceived level of concern. A negative estimate reects the opposite of this trend. In addition, we
included the AIC value for the model, which represents the model’s goodness of t.
Besides the lack of necessity, another expressed concern for
sharing data with law enforcement was due to “the current polit-
ical climate in the US.” Notably, only 8% of participants (14/183)
attributed their privacy concerns to the overturn of Roe v. Wade.
P110, who terminated the use of period-tracking apps indenitely,
mentioned:
I decided last year, after the overturn of Roe v. Wade,
to quit tracking my data completely and decided never
to reuse any tracking apps. The safety and reproduc-
tive freedoms in the US are simply too uncertain and
dangerous, and although I trust Planned Parenthood,
I don’t trust the government or some other apps and
I am uneasy about my data ever getting shared with
anyone or anything else. (Minnesota, L)
Since the participants saw period-tracking app-related questions
before we gave them the context of the overturn of Roe v. Wade as
described in 3.2.3, we did not prime participants with the inuence
of Roe v. Wade. As a result, to some extent, the low percentage
of relevant responses speaks to the general unawareness of the
association between period-tracking apps and the overturn of Roe
v. Wade among participants.
Concerns toward potential harms caused by third parties
accessing period-tracking apps’ data. Third parties were the
CHI ’24, May 11–16, 2024, Honolulu, HI, USA Jiaxun Cao, Hiba Laabadli, Chase Mathis, Rebecca Stern, and Pardis Emami-Naeini
second most concerning stakeholder to have access to the period-
tracking data (row 8: estimate
=
3
.
29,
�
-value
<
0
.
001). 31% of
participants (57/183) mentioned that they were concerned about
how third parties including advertisers and insurance companies
could use the period-tracking apps’ data against them. P116, who
reported to be strongly concerned about data being accessed by
insurance companies, said:
I suppose some companies and entities could use
your negative health history in negative ways like
insurance companies charging more because of pre-
existing conditions. (Oregon, L)
With that said, concerns toward third parties can be more persis-
tent than other concerns due to commercial prots. As participants
like P116 strongly suspected third parties would benet hugely
from users’ period-tracking data, it would be harder for app com-
panies to dispel users’ doubts, even with opt-out guaranteed. P105
mentioned:
This app does say they will not share my data with
anyone, but I wonder if any of my information may
be shared without my knowledge. (New Mexico, L)
Similar to P105, 11% of the participants (21/183) explicitly said
that app companies might still share their data despite opt-out.
Consequently, app companies must put in more eort to convince
users of the eectiveness of their data protection practices instead
of simply giving users an opt-out option without further and valid
illustrations.
Privacy calculus in data sharing with health professionals.
The second least concerning type of data sharing was healthcare
providers (row 9: estimate
=
2
.
0,
�
-value
<
0
.
01). 10% of the partici-
pants (19/183) stated healthcare professionals having access to be
benecial for their health goals. P36 mentioned:
If the only one shared with was my own doctor, then it
would probably be a good app to have, as it helps keep
your doctor included in your health goals. (Wisconsin,
B)
In essence, when participants’ needs for such healthcare goals
outweigh their privacy concerns, they prefer sharing data, indicat-
ing the existence of privacy calculus [
47
,
106
] in period-tracking app
usage. However, compared to data not being shared with anyone,
9% of the participants (17/183) were still signicantly concerned
(row 9: estimate
=
7
.
37,
�
-value
<
0
.
01) about their data being
shared with healthcare providers, even if they were being oered
the option to delete their collected data (row 20: estimate
=
2
.
84,
�
-value
<
0
.
001). Among these participants, ve explicitly men-
tioned their desire to have more control over specic types of data
to be shared with health professionals. Hence, a granular sharing
setting is important in respecting users’ dierent privacy calculus
perceptions.
Participants are least concerned when data is being shared
within the app company only, despite some reservations. In
comparison, participants are the least concerned when the app com-
pany is the only data sharing stakeholder (row 10: estimate
=
1
.
52,
�
-value
<
0
.
01). However, in qualitative responses, participants
still demonstrated concerns about data sharing with app compa-
nies. 19% of participants (34/183) mentioned concerns toward app
companies’ data security practices. P30 mentioned:
My personal health information and intimacy details
are exposed in public or private research app com-
panies. I would be worried if my health personal in-
formation were misused or in the event of hacking
instances, I would become a victim. (Texas, B)
When it comes to highly sensitive and risky data, users expect
more security for app companies’ data storage, preventing events
such as hacking. However, as prior work noted, users’ sensitive
information stored in mHealth apps could be easily leaked through
network trac or log messages without being encrypted [57].
In addition to security practices, some participants (6/183, 3%)
were concerned about app companies updating their data practices
without notifying users. P7 reported:
Their policy to share that data outside of the company
could change and I would at the very least like to be
informed about that and have the option to delete it.
(Indiana, B)
Limited user control decreases trust toward period-tracking
app companies’ claimed practices. Users’ control over their
period-tracking apps’ data (User Control) was the second most
eective factor in explaining participants’ level of privacy concerns
with the apps. The regression results showed that compared to
having no control, participants’ privacy concerns’ signicantly
dropped when being presented with an option to control their
data (see Table 3). Compared to being able to opt out from data
sharing, the ability to delete the collected data was more eective in
decreasing participants’ privacy concerns (row 5: estimate
= −
2
.
52,
�-value < 0.01).
Participants who expressed concerns about not having any type
of control over their period-tracking apps’ data reported that such
lack of control would severely impact their trust toward the apps’
companies and their claimed data practices (e.g., not sharing users’
data with third parties). P36 mentioned:
If you have no user control over your data, how do
you know that it is being used ONLY as it says? (Wis-
consin, B)
Consequently, for users like P36, having more control over their
data means more insights into whether app companies’ claimed
policies match their practices. Therefore, we suggest increasing
users’ control to improve the data transparency of period-tracking
apps, leading to more users’ trust.
Participants generally were less concerned about apps that al-
lowed data to be deleted. However, if apps shared data with Health-
care Providers or Law Enforcement, the ability to delete one’s data
no longer reduced concern about the app, as indicated by the ob-
served interaction eect. (see rows 20, 21: estimates
=
2
.
84
,
1
.
75;
�-values < 0.001, 0.05 respectively.)
Collecting location data is concerning as it is not relevant to
apps’ main functionality. Among the ve tested levels of data
type collected by period-tracking apps (Collected Data), partici-
pants perceived the collection of users’ location to be most concern-
ing (row 1: estimate
=
1
.
72,
�
-value
<
0
.
001). In their open-ended
Women’s Privacy Concerns Toward Period-Tracking Apps in the Post Roe v. Wade Era CHI ’24, May 11–16, 2024, Honolulu, HI, USA
responses, participants most frequently (49/183, 27%) mentioned
that the period-tracking apps’ primary functionality should not
rely on users’ location and, therefore, such data collection is irrele-
vant and should not happen. This nding echoes an earlier nding
regarding users’ concern toward data sharing with unnecessary
and irrelevant stakeholders such as law enforcement.
Intimacy and mental health data are perceived as highly
personal and not required for period tracking. Our participants
were signicantly concerned about the collection of intimacy (row 2:
estimate
=
1
.
66,
�
-value
<
0
.
001) and mental health data (row 3:
estimate
=
0
.
839,
�
-value
<
0
.
01). Most participants (47/183, 26%)
found such information to be highly personal and were concerned
about this data being accessed by others. P107 noted:
Intimacy data is one of the most private parts of a
person. There’s always a potential mishap of leaked
information. (New Jersey, L)
Lack of perceived relevancy to period tracking was again a com-
monly mentioned reason (12/47, 26%) as to why participants were
signicantly concerned about the collection of intimacy and mental
health data. P110 said:
For intimacy data, I don’t feel that it is needed to have
to track that. What about it is applicable to menstrual
health? (Minnesota, L)
Least concerns toward the collection of menstrual data only.
Compared to the tested levels of collected data, our participants
perceived the lowest privacy concerns toward menstrual data to
be collected by period-tracking apps, mainly due to its importance
and relevancy for period tracking. P112 reported:
The app’s limited scope, focusing solely on menstrual
cycle tracking, may lead users to believe that the data
collected is used solely for the intended purpose with-
out extensive proling or analysis. (New Jersey, L)
By now, we have seen participants constantly against irrele-
vant and unnecessary data being collected (location, intimacy, and
mental health data) and shared (with law enforcement). These nd-
ings suggest that users’ concern toward period-tracking apps is
closely tied to the relevance between privacy practices and core
functionality (more discussed in Section 5).
Political party and level of education show a signicant as-
sociation with perceived privacy concerns. Our results showed
that women identifying as Republicans tend to be signicantly more
concerned about period-tracking apps’ data practices compared to
their Democratic counterparts (row 16: estimate
=
1
.
11,
�
-value
<
0
.
05). Half of participants who identied themselves as Repub-
lican were living in states where abortion was banned. Therefore,
such a higher level of concern toward period-tracking apps’ privacy
practices might be attributed to the legal landscape of their states.
In addition to participants’ political party, there was a signi-
cant connection between the level of education and participants’
reported privacy concerns toward period-tracking apps’ data prac-
tices. Notably, compared to those having no degree, our participants
who reported having a Bachelor’s degree were signicantly more
concerned about period-tracking apps’ data practices (row 13: esti-
mate = 1. 36, �-value < 0.01).
4.3 Privacy And Risk Mitigation Practices
Toward Period-Tracking Apps (RQ1)
Usability and privacy concerns were primary reasons to stop
and switch period-tracking apps. We surfaced several reasons
for why some participants (56/183, 31%) switched their period-
tracking apps or stopped using them. The most common reasons
(30/56, 54%) were the lack of perceived convenience and the usability
challenges of period-tracking apps. P110 explained:
I was using the Spot On period-tracking/birth control
pill monitoring app by Planned Parenthood up until
about 2018-2019. I initially stopped using it because
it became high maintenance to remember to log my
data every day. (Minnesota, L)
Following the poor usability, privacy concerns were the second
most mentioned reason (12/59, 20%). Among them, 42% of responses
(5/12) specied the overturn of Roe v. Wade as their main reason to
stop using period-tracking apps or using a more privacy-protective
app. P102 mentioned:
I think there was one called Flo. I decided to stop using
the apps and switched to Apple Health for tracking
when Roe v. Wade was overturned. (Colorado, L)
Notably, looking at the fact that only 8% of all participants attrib-
uted their concern to the overturn of Roe v. Wade (Section 4.2), the
proportion of participants who stopped using period-tracking apps
due to the overturn was even lower (5/183, 3%). This may suggest
that the overturn of Roe v. Wade has played a limited role in female
users’ privacy concerns and practices toward period-tracking apps.
Only a few participants took steps to mitigate their privacy
concerns. Among our participants who expressed concerns toward
period-tracking apps’ data practices, only 9% (16/183) reported tak-
ing steps to manage their privacy concerns. Deleting the period-
tracking apps was the most commonly used strategy to mitigate
privacy concerns (6/16, 38%). Another practice that several partici-
pants (5/16, 31%) mentioned was to inform themselves about the
apps’ data practices. P110 reported:
I have taken the steps of reading an in-depth expla-
nation of the app’s security and sharing practices. In
the example of the Spot On app, I read their privacy
policy cover to cover and ensured that they would
not share data. (Minnesota, L)
91% of our participants (167/183), however, mentioned that they
had never used any mitigation strategies, mainly due to their lack
of privacy knowledge and awareness. P127 mentioned:
I have not yet done this as I was unsure how to pro-
ceed with this, and I did not know if these steps would
be successful. (New Jersey, L)
13% of the participants (2/16) reported that despite their concerns,
they still had to use the app to help them get through the period.
P11 said:
I am not too concerned. I need to keep track of my
cycles because I literally can’t function on day 2 and
3. (Texas, B)
CHI ’24, May 11–16, 2024, Honolulu, HI, USA Jiaxun Cao, Hiba Laabadli, Chase Mathis, Rebecca Stern, and Pardis Emami-Naeini
13% of the participants (2/16), who lived in states where abortion
was legal, reported that they felt safe and, therefore did not feel the
need to take any further steps. P123 mentioned:
I live in a state in which I feel safer about my repro-
ductive health options; I do not feel scared that my
data would impede my ability to get the care I need.
(Minnesota, L)
In summary, echoing prior work [
79
], most participants did not
do anything other than delete their apps. In addition, we found that
for the majority of participants who did not have any mitigation
practices, feeling uninformed, dependent on the functionality of
period-tracking apps, and living in abortion-legal states were the
primary reasons.
4.4 Privacy Attitudes And Awareness Toward
The Overturn Of Roe v. Wade (RQ2)
We asked participants about their familiarity with the overturn
of Roe v. Wade and its impact on their privacy perceptions and
practices of period-tracking apps.
Figure 4: Participants’ (a) knowledge level of the privacy
practices of their PTA, (b) familiarity with the overturn of
Roe v. Wade, and (c) perceived impact on concerns toward
the privacy of their PTA post the overturn of Roe v. Wade.
Concerns toward potential privacy implications of the over-
turn of Roe v. Wade. Almost all participants reported to be at
least slightly familiar with the overturn of Roe v. Wade. For most
participants (110/183, 60%), the overturn impacted their perceived
concerns toward data practices of period-tracking apps (see Fig-
ure 4). These participants expressed concerns about the potential
consequences of period-tracking. They reported that they suspect
the data from period-tracking apps could be used to detect preg-
nancy abortion, and even criminalize users accordingly. 7% of those
(8/110) mentioned in their open-ended responses that they had
never thought about the potential privacy implications of the over-
turn before taking the survey, showing appreciation to our study
for raising their privacy awareness.
Our quantitative results showed that those who reported that the
overturn impacted their privacy concerns indeed perceived signi-
cantly higher concerns (
�
-value
<
0
.
05) toward data practices of the
presented period-tracking app scenarios. 48% of those participants
(53/110) predicted that the overturn would increase the chances for
law enforcement to track individuals. P75 said:
If they are tightening abortion laws and basically mak-
ing it illegal (I live in the South), then they are going
to start looking at our data. (Texas, B)
Among these participants, 17% of them (9/53) expected an in-
crease in using period-tracking apps after the overturn due to the
potential risks of the need to have an abortion, leading to women’s
higher exposure to privacy risks. P9 mentioned:
If access to safe and legal abortions becomes restricted
or limited, individuals might rely more heavily on
period-tracking apps to monitor their reproductive
health. This could increase the amount of sensitive
and personal health data shared with these apps. (Ten-
nessee, B)
For 38% of participants (70/183) who perceived minimum or no
privacy impact of the overturn of Roe v. Wade explained that they
could not envision how the shared data would impact them in
practice. P18 reported:
I never thought that the overturn would cause law
enforcement or healthcare providers to require app
companies to share period-tracking data with them.
But even if so, I’m not sure how it will impact the
users since usually you just mark your starting date,
mood, weight, etc. (Washington, L)
In summary, after participants were explicitly asked about the
inuence post-Roe v. Wade, most participants indicated their per-
ceived huge inuence. This may suggest that users’ privacy con-
cerns toward the overturn exist but have not yet been contextualized
in their period-tracking app usage.
4.5 Privacy Expectations Toward
Period-Tracking Apps (RQ3)
We asked participants what privacy features they would like to
have in period-tracking apps. In addition, we asked them who they
believe is most responsible for protecting their period-tracking
apps’ data privacy and how.
4.5.1 Desired Privacy Features In Period-Tracking Apps: Usable
Controls, Encryption, Granularity, And Anonymization. Collectively,
our participants have expressed interest in features that can em-
power them with more data control, encryption, granularity, and
anonymization. Among these features, more usable controls (e.g., a
control to delete data) were mentioned most (16/62, 26%). Having
end-to-end encryption was the second most frequently requested
feature (12/62, 19%). P24 mentioned:
I wish there was an option to have the data be end-to-
end encrypted so that not even the company knows
the details of what I’m sharing with the app. (Texas,
B)
For participants like P24, end-to-end encryption features would
allow users to have more autonomy over their interaction with
the apps. Having granular permission settings for data access was
another feature our participants requested to have in order to have
more control over their data (9/62, 15%). P9 explained:
Allowing users to customize permissions for dierent
aspects of the app, like sharing data with other users
or health professionals, could provide more control
over their information (Tennessee, B).
From participants’ qualitative responses, we can see dierent
participants showed dierent receptivity to health professionals’
having access to their data. They also had dierent perceptions
of what types of information could be shared with health profes-
sionals. Therefore, a granular permission setting can help people
Women’s Privacy Concerns Toward Period-Tracking Apps in the Post Roe v. Wade Era CHI ’24, May 11–16, 2024, Honolulu, HI, USA
with dierent privacy preferences better customize their choices,
increasing users’ autonomy over their data. In addition, a few par-
ticipants (4/62, 6%) mentioned data anonymization as their desired
privacy feature in period-tracking apps. These participants wanted
their data to be anonymized before being stored and shared.
4.5.2 Stakeholders Who Are Responsible To Protect Period-Tracking
Apps’ Data. In response to the multiple-choice questions regarding
perceived stakeholders, 87% of participants (159/183) considered
app developers to be most responsible for protecting their period-
tracking apps’ data privacy. Notably, participants’ primary con-
cern well aligns with what has been suggested in prior work [
107
],
which is that developers perceive reproductive data as “simply
another piece of data rather than health data that is sensitive in
nature.” [
107
]. In addition, 49% of respondents (90/183) perceived
users themselves as most responsible for protecting their privacy.
48% (87/183) indicated mobile app store companies (e.g., Apple,
Google) to be responsible, and 18% (33/183) attributed the respon-
sibility of protecting the privacy of period-tracking apps’ users to
the government.
Call for app companies to improve the transparency of their
privacy and security practices. In qualitative responses, partici-
pants who perceived the period-tracking app companies to be most
responsible (146/183, 80%) requested the companies to 1) let users
have more control over data deletion and data sharing (80/183, 44%),
2) make privacy policies and user agreements transparent, simple,
and straightforward (49/183, 27%), and 3) make sure the data is safe
from law enforcement (11/183, 6%).
In particular, participants who expected more transparency (36/146,
25%) reported that they would most like to know about 1) the pur-
poses of data usage (12/36, 33%), 2) whenever their data is being
shared and with whom it is shared (12/36, 33%), 3) the benets and
risks of data sharing (7/36, 19%), 4) the types of controls that are
available to users (3/36, 8%), 5) and the possibility of data recovery
after data deletion (2/36, 6%). For instance, P110 was interested in
having easy access to information about data practices of period-
tracking apps:
I like to know if my data is being shared, and if so,
where it is being shared. I’d also like to know how
permanent my data is—as in, if I delete it, will it be
permanently deleted or can it be recovered via some
sort of hard drive of data kept by the app developer?
(Minnesota, L)
P110’s response covered many types of data transparency that
are currently largely unknown to users of period-tracking apps [
5
,
118
]. For participants, data transparency is particularly important
in the current political climate in the US. Hence, it is worth noting
that eleven participants explicitly requested data safety from law
enforcement. In better protecting users’ reproductive privacy from
law enforcement, we propose technology-based recommendations
in Section 5.
Call for enhancing privacy law regulations. Participants (37/183,
20%) consistently requested law sectors to enhance privacy regula-
tions to protect users’ data in period-tracking apps. P110 noted:
I want to see a law passed that protects the privacy of
all users of these apps AND their data. I also want to
see that law upheld and not challenged by the courts.
I think it is an infringement on our freedoms and pri-
vacy and should already be protected by amendments,
but it isn’t always. (Minnesota, L)
P110 emphasized law enforcement’s role in ensuring their repro-
ductive data can be unconditionally protected while acknowledging
the reality, i.e., reproductive data is not always protected by amend-
ments. Participants like P110 were correct, as reproductive data pro-
tections are poorly dened under several major legal frameworks in
the US and beyond, e.g., HIPAA (US) [
103
], GDPR (EU) [
80
], MHRA
(UK) [
81
]. In improving the eectiveness of law regulations for
reproductive data, we propose policy-based recommendations in
Section 5.
In summary, according to participants, there are many respon-
sibilities to be fullled by app companies and law enforcement.
Thus, a multi-stakeholder ecosystem must be established for more
privacy support for female users of period-tracking apps, as their
functionality still remains essential for some users (Section 4.3). In
the next section, we will propose more actionable recommendations
to better match our participants’ needs.
5 DISCUSSION
In brief, our ndings highlight that among the tested data practices,
the set of parties with whom the data is being shared was the
most eective factor in impacting participants’ privacy concerns
toward period-tracking apps. More specically, sharing with law
enforcement was most concerning to participants (RQ1). Despite
expressing signicant concerns about the data practices of period-
tracking apps, very few participants felt suciently empowered to
take action beyond deleting the apps (RQ1). Our results showed that
although most participants were familiar with the overturn of Roe
v. Wade, they lacked sucient awareness of how such an overturn
might impact their reproductive privacy (RQ2). To protect their
privacy, participants called for app companies and law enforcement
to enhance their privacy practices and regulations (RQ3). In this
section, we rst discuss how our work extends the prior work in
this area. With the key takeaways summarized, we then propose
actionable recommendations grounded in our ndings and related
work.
5.1 (Re)contextualizing Women’s Privacy
Concerns Toward Period-Tracking Apps
Post-Roe v. Wade
Extensive prior work has discussed people’s privacy perceptions
and attitudes toward mHealth applications [
46
,
57
,
89
,
124
], sug-
gesting that people generally have concerns toward mHealth appli-
cations, especially when the applications collect sensitive health
data [
1
,
81
]. Building on this strand of work, our work has focused
on women’s privacy perceptions and attitudes toward their period-
tracking data. However, in contrast to prior work, we focused on
whether and how the changing landscape around abortion laws in
the US has changed women’s privacy perceptions, attitudes, and
practices.
Without being explicitly asked about the overturn of Roe v. Wade,
only 8% of our participants reported becoming more concerned
CHI ’24, May 11–16, 2024, Honolulu, HI, USA Jiaxun Cao, Hiba Laabadli, Chase Mathis, Rebecca Stern, and Pardis Emami-Naeini
about the data practices of their period-tracking apps after the over-
turn (Section 4.2). This suggests that the majority of participants
were not aware of the potential privacy implications of the overturn
of Roe v. Wade with regard to their period-tracking data.
Before being reminded about the overturn of Roe v. Wade, our
respondents’ privacy concerns and attitudes were similar to the
prior work focused on non-US users of FemTech (e.g., period- and
fertility-tracking apps) [
1
,
12
,
59
,
81
]. For instance, a 2023 UK-based
study [
81
] found that FemTech users expressed concerns toward
data sharing and users were generally unaware of their legal rights
and technological privacy-enhancing protections.
We observed similar trends in our participants’ privacy attitudes
and practices. However, compared to the UK, where abortion is
generally legal within the rst 24 weeks of pregnancy [
2
], women’s
reproductive rights in the US have constantly been worsening since
the overturn [
3
]. Even when being directly asked about the overturn
of Roe v. Wade, about 40% of participants reported that the overturn
had no impact on their privacy practices toward period-tracking
apps (Section 4.4). 38% of participants mentioned that they could
not imagine period-tracking apps sharing their period-tracking
data with law enforcement (Section 4.4). However, we have already
seen cases where abortion-seeking women had been prosecuted
for their access history to an abortion-related website, evidenced
by US law enforcement [128].
Our ndings suggest that due to a lack of awareness of the po-
tential harms of privacy practices of period-tracking apps, despite
being concerned, women may still compromise their reproductive
privacy to use such technologies. We argue an imperative need to
contextualize women’s privacy concerns toward period-tracking
apps post-Roe v. Wade. To help improve women’s privacy aware-
ness in the context of the overturn, we further provide actionable
recommendations in Section 5.3.
5.2 Dening “Necessary” Data Practices and
Data Safety from Governments
One prominent nding in our study is that participants expressed
great concerns toward data practices whenever they were “unnec-
essary” and “irrelevant” to period tracking. For example, in partici-
pants’ qualitative responses, the collection and/or sharing of non-
menstrual cycle data (location, mental health, and intimacy data)
with other parties, including third parties and law enforcement,
were largely concerning because of the perceived nonnecessity and
irrelevance (Section 4.2). Similarly, in another FemTech privacy
study, participants urged apps not to require irrelevant information
when signing up, such as home addresses [81].
As prior work has pointed out, reproductive health data has not
been explicitly covered or dened in many major legal frameworks
worldwide [
44
,
80
,
81
,
103
], including HIPAA (US) [
103
], GDPR
(EU) [
80
], MHRA (UK) [
81
]. Moreover, Mehrnezhad et al. [
80
] eval-
uated the privacy notices and tracking practices of 30 top fertility-
tracking apps, suggesting that these apps’ indierence to users’
privacy in their policies and data practices has been poorly regu-
lated or dened by GDPR.
In the US, policy-based eorts have been made since the over-
turn, but we argue that these eorts still entail further improvement
in dening “necessary” data practices. Since the overturn of Roe v.
Wade, some policies have been released, particularly in response to
the reproductive privacy crisis, including the My Body, My Data
(MBMD) Act in 2022 [
30
] and My Health, My Data (MHMD) Act
in 2023 [
114
]. Filling the gap in the period-tracking data not cov-
ered by HIPAA, the MBMD Act [
30
] aimed to control the sharing
and sale of reproductive health data to third parties “except as is
strictly necessary to provide a product or service.” However, there
is no denition or any information regarding what exactly could
be considered as “strictly necessary.” Theoretically, an app could
still argue the necessity of providing the data for governments if
requested.
Hence, another imperative problem with this Act lies in its over-
sight of law enforcement as a potential data-sharing party. Consid-
ering the worsening landscape around abortion, participants in our
study expressed concerns about data sharing with law enforcement
(Section 4.4). As requested by our participants, period-tracking app
companies should make sure their data is safe from law enforce-
ment (Section 4.5.2). However, in this Act, we found no information
on how app companies should handle users’ data when law en-
forcement requests it. In response to this alarming gap, we further
provide recommendations in Section 5.3.
5.3 Calling For Privacy-Enhancing
Technologies, Policies, and Education
Having discussed the imperative need to recontextualize women’s
privacy awareness post-Roe v. Wade and dene necessary data
practices, we now provide more concrete directions for privacy-
enhancing technologies, policies, and education.
Technologies: Increasing data transparency, user control, and
data protections from law enforcement. Participants in our
study called for app companies to enhance data transparency, user
control, and data protections from law enforcement (Section 4.5.2).
Prior work has shown concerning facts about the data transparency
of mHealth and period-tracking apps [
4
,
80
,
118
], including hav-
ing no privacy policies [
4
,
118
] and no privacy-related content in
their policies [
80
]. Besides privacy policies, another existing data
transparency mechanism is privacy nutrition labels, which draw
from the physical metaphor of food nutrition labels to enhance
people’s privacy awareness [
35
,
37
–
39
,
69
]. Hence, our rst recom-
mendation is to enhance the data transparency of period-tracking
apps by referencing existing mechanisms, as mentioned above. In
particular, when using existing data transparency mechanisms for
period-tracking apps, it is worth taking relevant legal frameworks
into account, especially the newly-released MBMD and MBMH
Acts as mentioned in Section 5.2. Avoiding ambiguity when demon-
strating the regulations in the policy is critical [
80
], such as dening
what would happen if law enforcement requests data.
Notably, participants in our study mentioned they had trust
problems with period-tracking apps’ policies because selling health
data to third parties such as insurance companies was perceived
as hugely protable (Section 4.2). To enhance the credibility of
data transparency mechanisms, we argue that more user control is
needed.
Having more user control would also be benecial for users
with diverse privacy attitudes toward dierent data types and data-
sharing parties (e.g., health professionals) (Section 4.5.2). Hence,
Women’s Privacy Concerns Toward Period-Tracking Apps in the Post Roe v. Wade Era CHI ’24, May 11–16, 2024, Honolulu, HI, USA
we suggest adding user control settings with wide choices and high
granularity. We also emphasize that app companies must go beyond
simply oering more user control settings. They should prioritize
making these settings accessible and straightforward. For example,
it is recommended to avoid the pitfalls of the privacy communica-
tion game [
21
], a strategy where apps supercially enhance privacy
controls but intentionally design them to be complex or unclear.
Considering the potential data request by law enforcement post-
Roe v. Wade, we also suggest companies make it clear how they
plan to handle data requests by law enforcement. As mentioned by
participants, they would like their data to be anonymized before
data collection (Section 4.5.2). Therefore, in protecting users from
potential prosecution, it is worth considering not requiring users
to input any personally identiable information when signing up
by oering the users an option to use pseudonyms or not requiring
an account for usage.
Policies: More considerations for potential conicts with law
enforcement and anonymization. As we have seen from the
newly-released MBMD Act [
30
], data protection from law enforce-
ment has not been dened yet. In future policies regarding data
privacy of period-tracking apps, we recommend three considera-
tions. First, policies should clearly specify if law enforcement can
request access to reproductive health data from companies. This
is particularly critical since some of our participants expressed
a lack of concern toward the overturn of Roe v. Wade, primarily
since they perceived law enforcement ocers having access to the
period-tracking data as unrealistic (Section 4.4). Additionally, if
law enforcement is likely to have data access, companies should be
required to inform users in advance.
Education: Enhancing public awareness through the press
and K12 curriculum. Since the overturn of Roe v. Wade, the
number of articles about the dangers of women’s mHealth apps
has risen [
33
]. However, as we have seen from our participants’
responses (Section 4.2) and our discussion regarding the recontex-
tualization of women’s privacy concerns post-Roe v. Wade (Sec-
tion 5.1), more education eorts might be needed from the press
and schools. The press has the responsibility of promoting the new
possibilities of unwary use of period-tracking apps, such as prose-
cution [
66
,
128
]. In addition, schools could consider incorporating
period-tracking app usage post-Roe v. Wade into their sex education
or menstrual-related curricula.
6 CONCLUSION
Period-tracking apps track and collect a wide range of highly sensi-
tive data, including women’s menstrual cycle, pregnancy, sex life,
location data, etc. The privacy concerns of period-tracking apps
have been aggravated since the overturn of Roe v. Wade, which
took away the constitutional right to abortion and led to diverse
abortion laws across dierent states in the US. Given the current
context, it is crucial to understand women’s privacy perceptions
and practices toward period-tracking apps. Moreover, how much
knowledge and awareness women have about the impact of the
overturn of Roe v. Wade on their reproductive privacy is also a
critical question to investigate in support of women’s reproductive
justice. In this study, we conducted a vignette survey study with
183 female participants in the US, who were evenly distributed
in abortion-allowed and banned states. Our ndings suggest that
participants generally lacked the awareness and information about
period-tracking apps’ data practices in the post Roe v. Wade era, de-
spite showing signicant privacy concerns. To better raise women’s
reproductive privacy awareness and empower them with more
privacy-enhancing actions, we provide several actionable recom-
mendations for dierent stakeholders such as period-tracking app
companies and law enforcement.
ACKNOWLEDGMENTS
This work was supported by Orau Ralph E Powe Junior Faculty
Award (383001603) and Duke University Trinity College of Arts &
Sciences Award (4517834). We thank the anonymous reviewers for
their constructive feedback.
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Women’s Privacy Concerns Toward Period-Tracking Apps in the Post Roe v. Wade Era
A SURVEY QUESTIONS
A.1 Consent Questions
We started the survey with a consent form and asked participants
questions to obtain their consent to participate in the survey:
(1) I am 18 years or older.
• Yes
• No
(2) I have read and I understand the information above.
• Yes
• No
(3)
I want to participate in this survey and continue with the
task.
• Yes
• No
We presented four randomly selected scenarios to each partic-
ipant. We asked the same follow-up questions at the end of each
scenario. Here, we only include one scenario and its follow-up
questions.
A.2 Scenario Questions (SQ)
Imagine you are looking for a period-tracking app
to install on your phone to keep track of your men-
strual cycle. You see a period-tracking app with the
following data practices: The app only collects your
menstrual cycle data (e.g., days bleeding). This app
will store your data on the device. Your data will
not be shared with anyone. You have the option to
delete your data.
(1)
How concerned are you about the data practices of this
period-tracking app?
• Not concerned
• Slightly concerned
• Somewhat concerned
• Moderately concerned
• Very concerned
If “Not concerned”:
(1)
Please explain why you are not at all concerned about the
data practices of this period-tracking app.
If “Slightly concerned, Somewhat concerned, Moderately
concerned, Very concerned”:
(1)
Please explain what data practices of this period-tracking
app you are concerned about.
A.3 Attention-Check Question Example
(1)
Where is the collected data being stored in the described
period-tracking app?
• Device
• None
A.4 Usage of Period Tracking
(1)
Have you ever used any tool or method to track your period?
• Yes
• No
If “Yes” is selected:
CHI ’24, May 11–16, 2024, Honolulu, HI, USA
•
Please specify what methods you have used. (select all that
apply)
– period-tracking app on my phone
– period-tracking app on my personal computer or tablet
– period-tracking app on my wearable device
– Paper diary/calendar/planner
– Digital diary/calendar/planner
– Using birth control pills
If (period-tracking app on my phone, period-tracking
app on my personal computer or tablet, period-tracking
app on my wearable device) is selected:
–
Please specify what period-tracking app(s) you are cur-
rently using. (select all that apply): We provided a list of
most frequently downloaded period-tracking apps (e.g.,
MyFLO, Drip), where participants can select from. In addi-
tion to the apps, we added two options: I am not currently
using any period-tracking app and Other (please specify).
–
For what purposes do you mainly use or have you used,
your period-tracking app? (select all that apply)
∗ Becoming aware of how my body is doing
∗
Understanding my body’s reactions to dierent phases
of my menstrual cycle
∗ To become prepared for the upcoming periods
∗ To track fertility and plan (not) to get pregnant
∗
To inform conversations with my healthcare providers
∗ Other (please specify)
–
Have you ever had any period-tracking app that you stopped
using after a while?
∗ Yes
∗ No
If ‘Yes’ is selected for the previous question:
∗
Please explain what period-tracking app(s) you stopped
using and the reasons why you decided not to use these
period-tracking app(s).
For all participants
•
Please specify how likely you are to download a period-
tracking app if recommended by the following groups/individuals:
– Groups/individuals are:
∗ My friend(s)
∗ My family member(s)
∗ My employer(s)
∗ My insurance company
∗ The government and law enforcement ocers
∗ Healthcare professionals (e.g., OB-GYN)
∗ Romantic partner(s)
∗ Privacy experts
∗ App reviews
–
Choices are:
∗ Not at all likely
∗ Not so likely
∗ Somewhat likely
∗ Very likely
∗ Extremely likely
CHI ’24, May 11–16, 2024, Honolulu, HI, USA
A.5 Concerns Toward Period Tracking
If (period-tracking app on my phone, period-tracking app
on my personal computer or tablet, period-tracking app on
my wearable device) is selected:
•
How concerned are you about the data practices of your
period-tracking apps?
– Not concerned
– Slightly concerned
– Somewhat concerned
– Moderately concerned
– Very concerned
If (Slightly concerned, Somewhat concerned, Moder-
ately concerned, Very concerned) is selected:
–
Have you ever taken any steps to mitigate your concerns
about your period-tracking apps?
∗ Yes
∗ No
If “Yes” is selected:
∗
Please explain what steps you have taken to mitigate
your concerns about your period-tracking apps.
If “No” is selected:
∗
Please explain why you have not taken any steps to mit-
igate your concerns about your period-tracking apps.
•
Please specify if there are any security or privacy protections
or features you wish were oered by your period-tracking
apps.
For all participants
•
Please rate your level of concern about the privacy implica-
tions of the following period and fertility tracking practices:
– Period and fertility tracking practices:
∗
Using a paper diary/calendar/planner to track my men-
strual cycles
∗
Using a digital diary/calendar/planner (e.g., Google Cal-
endar) to track my menstrual cycles
∗
Using a period-tracking app on my phone to track my
menstrual cycles
∗ Using a period-tracking app on my personal computer
or tablet to track my menstrual cycles
∗
Using a period-tracking app on my wearable device (e.g.,
smartwatch, smart ring) to track my menstrual cycles
∗
Searching online about period and fertility-related top-
ics
∗
Posting online on social media about period and fertility-
related topics
∗
Using communication tools (e.g., WhatsApp, Telegram)
to discuss period and fertility-related topics with others
– Choices for concern level:
∗ Not at all concerned
∗ Not so concerned
∗ Somewhat concerned
∗ Very concerned
∗ Extremely concerned
•
Who do you think is most responsible for protecting the
privacy of period tracking data?
– The developers of the apps
– The government
Jiaxun Cao, Hiba Laabadli, Chase Mathis, Rebecca Stern, and Pardis Emami-Naeini
– The users of period-tracking apps
– Other (please specify)
•
Please specify what specic actions do you want these re-
sponsible individuals/groups to take to protect the privacy
of period tracking data
A.6 Information Toward Data Practices of
Period-Tracking Apps
If (period-tracking app on my phone, period-tracking app
on my personal computer or tablet, period-tracking app on
my wearable device) is selected:
•
How informed are you about the data practices of your
period-tracking apps?
– Not at all informed
– Slightly informed
– Somewhat informed
– Moderately informed
– Very informed
If (Slightly informed, Somewhat informed, Moderately
informed, Very informed) is selected:
–
Please explain what resources you usually use to become
informed about the data practices of your period-tracking
apps.
•
Please explain what information about the privacy and data
practices of your period-tracking apps you would like to
know about, if any.
A.7 Knowledge and Concerns Toward the
Overturn of Roe v Wade Decision
•
How familiar are you with the overturn of the Roe v. Wade
case/decision?
– Not at all informed
– Slightly informed
– Somewhat informed
– Moderately informed
– Very informed
•
In your own words, how would you describe the (overturn
of) Roe v. Wade case/decision?
•
How much impact do you think the overturn of Roe v. Wade
has had on your concerns about the data practices of period-
tracking apps?
– No impact
– Minor impact
– Moderate impact
–
Major impact
If Minor impact, Moderate impact, Major impact is
selected
–
Please explain how the overturn of Roe v. Wade has im-
pacted your concerns about the data practices of period-
tracking apps.
Else
–
Please explain why the overturn of Roe v. Wade had no
impact on your concerns about the data practices of period-
tracking apps.
•
Have you ever applied any changes to your period tracking
habits due to the overturn of Roe v. Wade?
Women’s Privacy Concerns Toward Period-Tracking Apps in the Post Roe v. Wade Era CHI ’24, May 11–16, 2024, Honolulu, HI, USA
– Yes
– No
If "Yes" is selected
–
Please explain what changes you have applied to your
period tracking habits due to the overturn of Roe v. Wade.
If "No" is selected
–
Please explain why you have not applied any changes to
your period tracking habits due to the overturn of Roe v.
Wade.
A.8 Demographics
•
What is your age? Please leave this question blank if you are
not comfortable sharing your age.
• How do you describe your current gender identity?
– Cisgender Female
– Cisgender Male
– Transgender Female
– Transgender Male
– Non-binary
– Prefer to self-describe (please specify)
– Prefer not to say
• Do you identify as a member of the LGBTQ* Community?
– Yes
– Maybe
– No
– Prefer not to say
•
How do you describe your race or ethnic identity? (select all
that apply)
– American Indian or Alaskan Native
– Asian
– Black or African American
– Hispanic or Latino, or Spanish Origin of any race
– Native Hawaiian or Other Pacic Islander
– White
– Prefer not to say
– Other (please specify)
• What is the highest degree you have earned?
– No schooling completed
– Nursery school
– Grades 1 through 11
– 12th grade—no diploma
– Regular high school diploma
– GED or alternative credential
– Some college credit, but less than 1 year of college
– 1 or more years of college credit, no degree
– Associate’s degree (for example: AA, AS)
– Bachelor’s degree (for example: BA. BS)
–
Master’s degree (for example: MA, MS, MEng, MEd, MSW,
MBA)
–
Professional degree beyond bachelor’s degree (for exam-
ple: MD, DDS, DVM, LLB, JD)
– Doctorate degree (for example, PhD, EdD)
– Prefer not to say
• What is your current marital status?
– Single
– Married
– Divorced
– Bereaved
– Other (please specify)
– Prefer not to say
•
Which of these best describes the general area where you
live?
– Urban
– Suburban
– Rural
– Other (please specify)
– Prefer not to say
– I do not know
• In which state do you currently reside? (50 states)
• In general, what is your political aliation?
– Democrat
– Republican
– Independent
– Other (please specify)
– None
– Prefer not to say
B QUALITATIVE CODEBOOK
The codebook is available at:
hps://osf.io/y7aud/?view_only=fc7469d974b54711ae970cdeb68eab92.
CHI ’24, May 11–16, 2024, Honolulu, HI, USA Jiaxun Cao, Hiba Laabadli, Chase Mathis, Rebecca Stern, and Pardis Emami-Naeini
C FULL DEMOGRAPHIC INFORMATION
Age State Race Political Aliation Degree Marital Status Area Sexual Orientation
Mean 39.05 Legal abortion state 51.37% White 73.8% Democrat 52.5% Bachelor’s degree 33.3% Married 39.9% Suburban 52.5% Non-LGBTQ 67.8%
Range 19-75 Full abortion ban state 47.54% Black or African American 4.9% Independent 21.8% 1 or more years of college credit, no degree 15.3% Single 36.1% Urban 25.7% LGBTQ 25.1%
STD 12.34 Prefer not to say 1.09% Asian 3.3% Republican 17.5% Associate’s degree 12.0% Divorced 15.3% Rural 19.7% Maybe-LGBTQ 5.5%
Hispanic or Latino, or Spanish Origin of any race
American Indian or Alaskan Native
2.7%
1.6%
None
Other*
3.8%
2.2%
Some college credit, but less than 1 year of college
Regular high school diploma
11.5%
10.4%
Bereaved
Other
4.3%
3.3%
Prefer not to say
Other
1.6%
0.5%
Prefer not to say 1.6%
Prefer not to say 1.1% Prefer not say 2.2% Master’s degree 9.3% Prefer not to say 1.1%
Multiracial 12.6% GED or alternative credential 2.7%
Doctorate degree 2.7%
Professional degree beyond bachelor’s degree 1.1%
Prefer not to say 1.1%
12th grade—no diploma 0.6%
Table 4: Complete demographic information of our participants.
