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