Emily Neiman, lead author and clinical instructor of practice in the College of Nursing at The Ohio State University. Credit: Courtesy of Emily Neiman
Ohio State researchers discovered the use of fertility-tracking apps and websites increased in certain states following the U.S. Supreme Court’s 2022 decision to grant abortion regulation authority to individual states, according to a Jan. 10 study.
The research — led by Emily Neiman, a clinical instructor of practice in the university’s College of Nursing — found nearly half of surveyed women in Ohio, Arizona, Iowa, New Jersey and Wisconsin reported using digital tools to monitor their menstrual cycles and fertility in the year following the 2022 Dobbs v. Jackson Women’s Health Organization ruling.
This marked an increase from just over one-third of surveyed women before the decision, except for Wisconsin, where usage remained steady at nearly 50% both before and after Dobbs, according to Ohio State News.
On June 24, 2022, the Supreme Court ruled the U.S. Constitution does not guarantee a right to abortion, thereby leaving regulation to individual states. The decision overturned the previous court precedent of Roe v. Wade, which federally legalized abortion in 1973, according to the Associated Press.
Abortion laws in the five surveyed states vary significantly, according to the Guttmacher Institute. Of the five, Iowa has the most restrictive laws, banning abortions after six weeks.
Arizona and Wisconsin are also identified as “restrictive” by the institute, with Ohio being labeled as having “some restrictions/protections” and allowing abortion up to fetal viability — which is roughly 22-24 weeks. In contrast, New Jersey is “very protective” of reproductive rights, recognizing abortion as a fundamental right under its state constitution.
In the wake of Dobbs, privacy advocacy groups like the Center for Democracy and Technology and digital rights advocacy group Fight for the Future warned reproductive health data collected by apps could be accessed by third parties, including law enforcement in states with strict abortion laws, according to NPR.
Neiman said social media users and activists have urged people to delete their period-tracking apps to avoid this potential misuse of personal data.
“There have been instances where prosecution of abortion cases involved subpoenaing Facebook Messenger chats and similar records,” Neiman said. “The fear was that if there was data suggesting someone had gotten an abortion, that data could potentially be used to charge them in states where abortion was illegal.”
Amy Schmitz, a professor at the Moritz College of Law who specializes in data ethics and cybersecurity, emphasized the importance of reviewing an app’s terms of service to understand its privacy protections. However, she cautioned this alone may not be enough, as some apps have previously violated their own privacy policies.
For example, Flo Health marketed its Flo Period & Ovulation Tracker app as a tool for women to “take full control of [their] health,” according to the Federal Trade Commission. Despite promising privacy protections, in January 2021, the company shared users’ private fertility data with third parties — leaving consumers feeling “outraged,” “victimized” and “violated2
“Privacy laws in the U.S. are not clear, and there is variation among the states,” Schmitz said. “Moreover, one never knows if there will be a hack on the system.”
Despite these concerns, the Ohio State study found overall use of fertility trackers increased post-Dobbs.
Researchers analyzed survey data from the research organization Surveys of Women, which polled women aged 18-44 about their reproductive health habits. Sample sizes were in the low-to-mid 2,000s both before and after Dobbs, according to Ohio State News.
Neiman said the five selected states were those with both pre- and post-Dobbs survey data available. The survey itself was an online questionnaire that volunteers filled out in waves, including questions about whether they used an app or online program to track their fertility, their reasons for using such tools as well as general inquiries regarding birth control use, medical mistrust and their beliefs about the legality of abortion.
“While the subject pools differed from pre- to post-Dobbs, we were still able to compare trends,” Neiman said.
Neiman said the study’s findings highlight the growing role technology plays in reproductive health. Still, she cautioned that most free fertility-tracking apps provide only rough estimates and may not be reliable for pregnancy prevention.
“There is an FDA-approved app called Natural Cycles that uses biomarkers and is much more individualized, but many of the free apps people use are based on a standard 28-day cycle,” Neiman said. “In reality, many people do not have 28-day cycles, and cycle lengths can vary. Relying on an app’s ovulation prediction could result in miscalculating fertile windows.”
Neiman said she has observed a growing social media movement discouraging hormonal birth control, which may have contributed to the increased use of fertility-tracking apps.
“There’s this narrative online that hormones are bad or that hormonal birth control causes future health problems, but there are many health reasons to use it beyond contraception,” Neiman said. “Speaking with a healthcare provider about risks and benefits is important.”
Ultimately, Neiman emphasized the need for better public education concerning the limitations of fertility-tracking apps.
“I don’t think we’re doing a great job in medical visits asking people if they use these tools and explaining how factors like the type of data inputted or whether they’re using a free versus paid version can impact accuracy,” Neiman said. “If someone really doesn’t want to be pregnant, an app shouldn’t be their only method of contraception.”
As these technologies may continue to gain popularity, Neiman said she encourages healthcare providers to engage in conversations about fertility-tracking apps with patients to ensure they have accurate information when making reproductive health decisions.
“It’s important for us to meet patients where they are and understand why they’re making certain decisions,” Neiman said. “That allows us to frame things in a way that makes sense to them.”
