Study of menstrual tracking app usage highlights potential role in improving access to reproductive health services

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A new study by researchers in the UK and Denmark, published in Digital Health, provides the first publicly accessible analysis of global downloads for menstrual tracking apps.

While the market for menstrual tracking apps is rapidly growing, there have been no large-scale analyses about why users download these apps, and particularly few studies on their use in the Global South.

Using data from the Google Play Store and Apple App Store between April and December 2021, the study explores why users download these apps in the Global South and North.

Three apps - Clue, Flo and Period Tracker - dominated the market, with over 250 million downloads combined. Most downloads of menstrual tracking apps were concentrated in the Global North, but there were also downloads throughout the Global South, with a particularly high prevalence in South America.
Of the 112 countries included, the study found that low-income countries with a higher unmet need for family planning and higher total fertility rate are associated with more downloads.

Lead author Dr Francesco Rampazzo, Lecturer in Demography at Oxford's Leverhulme Centre for Demographic Science and Department of Sociology, said, 'Our findings reinforce emerging evidence that menstrual tracking apps are more popular in areas with limited access to reproductive health services and contraception. This highlights the important role these apps may potentially play in improving access to reproductive health information and services, especially in low-income countries.'

The study employed various analytical methods and a Bayesian model to estimate downloads for 25 menstrual tracking apps that had at least 3,000 installations, 10 reviews, and 60 ratings. The authors also analysed reviews left by the users of these apps between 2009 and 2021. Using a language processing model, the researchers identified 19 topics for app usage, 12 of which were related to reviews. Menstrual cycle tracking was the most common reason reported for using these apps (61%), followed by achieving a pregnancy (22%), a sense of community (9%), and avoiding getting pregnant (8%).

Co-author Dr Alyce Raybould, Research Fellow and Survey Manager at the University College London's (UCL) Centre for Longitudinal Studies said, 'Our study suggests that while many use these apps to understand more about their reproductive health and menstrual cycles, others are using them to help avoid pregnancies. This warrants further investigation to see how these apps could be affecting outcomes like unplanned pregnancies, given that a very limited number of these apps market themselves as a contraceptive tool.'

The study shows that menstrual tracking apps are used worldwide, even in low-income countries, though usage is lower in areas like Sub-Saharan Africa and Central Asia, likely due to internet access and economic barriers. The authors note that most apps are designed with Western assumptions, which may limit their cultural relevance and effectiveness. This highlights the need for research into their impact on reproductive health, particularly in areas with limited health services.

Dr Francesco Rampazzo adds, 'Our study highlights the potential of menstrual tracking apps to empower users in managing their reproductive health. By understanding the global trends and motivations behind app usage, we can better address the needs of diverse populations.'

These research questions also connect to broader policy areas, such as the United Nations Sustainable Development Goals (SDGs) on women's reproductive health and well-being, as well as their access to technology, resources, and information.

As the study's findings are limited by potential disparities in data availability and quality between regions, the researchers call for further research to track changes in app usage and its impact on reproductive health over time.

Given the global popularity of these apps, the authors urge policymakers to take timely action, as existing research raises concerns about the information disseminated by private corporations and the monetisation of individual-level data collected from users worldwide.

Co-author Dr Douglas Leasure, Senior Researcher and Data Scientist at the Leverhulme Centre for Demographic Science and Oxford Population Health's Demographic Science Unit said, 'While it is encouraging that these menstrual tracking apps could empower women in locations with unmet family planning needs, we also hope these results will spark a conversation about potential risks when private-sector app developers fill in for reproductive health professionals.'

The full paper, '"UPDATE: I'm pregnant!": Inferring global downloads and reasons for using Menstrual Tracking Apps', is published in Digital Health.