Abstract
This dissertation examines the ethical dimensions of fertility tracking applications, focusing on privacy, consent, and commercial incentives that shape the contemporary femtech landscape. Through systematic literature synthesis, this study analyses peer-reviewed research and policy documents to evaluate how fertility apps collect, process, and commercialise intimate reproductive data. Key findings reveal pervasive privacy violations, including extensive third-party data sharing, inadequate de-identification practices, and opaque retention policies that expose users to significant legal, social, and bodily risks. The analysis demonstrates that current consent mechanisms—reliant upon unreadable terms of service and misleading privacy policies—fail to meet ethical standards of informed consent, thereby undermining user autonomy. Furthermore, the study identifies how commercial incentives drive data extraction practices that conflict fundamentally with users’ reproductive interests, particularly following the reversal of Roe v. Wade in the United States. The dissertation concludes that addressing these ethical failures requires regulatory frameworks extending beyond notice-and-consent models, privacy-by-design implementation, restrictions on commercial data use, and governance structures centred on reproductive justice and data feminism principles.
Introduction
The proliferation of mobile health technologies has fundamentally transformed how individuals engage with personal health management, with fertility and menstruation tracking applications representing one of the fastest-growing segments within digital health markets. These applications, marketed under the empowering banner of “femtech,” promise users unprecedented insight into their reproductive cycles, fertility windows, and overall reproductive health. With hundreds of millions of downloads globally and a projected market value exceeding several billion pounds, fertility tracking apps have become ubiquitous tools for individuals seeking to conceive, avoid pregnancy, or simply understand their bodies better (Gilman, 2021; Siapka and Biasin, 2021).
However, beneath the rhetoric of empowerment and bodily literacy lies a complex web of ethical concerns that demand rigorous academic scrutiny. Fertility applications collect extraordinarily intimate data—including menstrual cycle dates, sexual activity logs, pregnancy status, emotional states, and medical treatments—creating comprehensive digital profiles of users’ reproductive lives. This data collection occurs within commercial ecosystems fundamentally driven by profit motives, where “free” applications monetise user information through advertising networks, data brokers, and opaque third-party partnerships (Mehrnezhad and Almeida, 2021; Kemp, 2023).
The ethical stakes of these practices have intensified dramatically following the United States Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade and eliminated federal constitutional protections for abortion access. In this transformed legal landscape, fertility app data has acquired new potential as evidence in criminal investigations and prosecutions related to reproductive healthcare, transforming what users may have perceived as benign health tracking into potential instruments of surveillance and legal jeopardy (Kelly and Habib, 2023; Song et al., 2024).
This dissertation matters academically because it sits at the intersection of multiple critical scholarly domains: digital ethics, health informatics, feminist technology studies, and privacy law. Understanding how intimate health data flows through commercial ecosystems, and what this means for individual autonomy and collective welfare, represents an urgent interdisciplinary challenge. Socially and practically, this research matters because millions of individuals use these applications daily, often without understanding how their most personal information is collected, shared, and potentially weaponised against their interests. Examining the ethics of fertility tracking applications therefore constitutes not merely an academic exercise but a necessary intervention into technologies that shape embodied experience and reproductive possibility.
Aim and objectives
Aim
This dissertation aims to critically examine the ethical dimensions of fertility tracking applications, with particular attention to privacy practices, consent mechanisms, and commercial incentives, in order to evaluate whether current industry practices adequately protect users’ reproductive autonomy and to identify regulatory and design interventions that might address identified shortcomings.
Objectives
To achieve this aim, the dissertation pursues the following specific objectives:
1. To analyse the types of intimate data collected by fertility tracking applications and map how this data flows to third parties for commercial and other purposes.
2. To evaluate the privacy risks associated with fertility app data collection, including risks of commercial profiling, legal harm, discrimination, and intimate partner abuse.
3. To assess whether current consent mechanisms employed by fertility applications meet ethical standards of informed consent and meaningful user autonomy.
4. To examine how commercial incentives shape data practices within the femtech industry and evaluate tensions between profit motives and user welfare.
5. To identify and evaluate potential regulatory, design, and governance interventions that might better protect users’ reproductive autonomy and privacy interests.
Methodology
This dissertation employs a literature synthesis methodology, systematically reviewing and integrating findings from peer-reviewed academic research, policy analyses, and legal scholarship to construct a comprehensive account of fertility tracking app ethics. Literature synthesis represents an appropriate methodological approach when the objective is to consolidate existing knowledge across multiple disciplines, identify patterns and contradictions in the evidence base, and generate insights that transcend individual studies (Grant and Booth, 2009).
The primary source materials comprise peer-reviewed journal articles, conference proceedings, and scholarly working papers published between 2020 and 2025, capturing the most recent developments in this rapidly evolving field. Sources were identified through systematic database searches using terms including “fertility tracking,” “menstruation apps,” “reproductive health technology,” “femtech privacy,” and “digital reproductive surveillance.” Databases searched included PubMed, Web of Science, ACM Digital Library, and SSRN. Additional sources were identified through citation tracking and targeted searches of relevant journals including the Journal of Medical Internet Research, New Media & Society, and specialist publications in law, gender studies, and human-computer interaction.
Inclusion criteria prioritised empirical studies of fertility app data practices, theoretical analyses of consent and privacy in reproductive health technologies, legal scholarship addressing the post-Roe regulatory landscape, and feminist technology studies examining gendered dimensions of health data commercialisation. Sources were excluded if they lacked peer review, focused exclusively on clinical efficacy without addressing ethical dimensions, or originated from non-academic commercial publications.
The synthesis followed a thematic analysis approach, with source materials coded according to three primary thematic domains derived from the research questions: privacy and data practices, consent and autonomy, and commercial incentives and power. Within each domain, sub-themes were identified inductively from the literature and organised to construct a coherent analytical narrative. Throughout the synthesis process, attention was paid to methodological quality, with particular weight given to empirical studies employing rigorous analytical frameworks and theoretical contributions grounded in established ethical principles.
This methodology has inherent limitations. As a literature synthesis rather than primary empirical research, findings are necessarily bounded by the scope and quality of existing scholarship. The rapid evolution of fertility tracking technologies means that some practices may have changed since the studies reviewed were conducted. Additionally, the preponderance of research from North American and European contexts may limit generalisability to other regulatory and cultural environments.
Literature review
The intimate data landscape of fertility tracking
Fertility and menstruation tracking applications collect data of exceptional intimacy, encompassing information that users might not share even with close family members or healthcare providers. Research consistently documents that these applications request and store data including menstrual cycle dates and symptoms, records of sexual activity and contraception use, pregnancy status and intentions, emotional states and mood fluctuations, physical symptoms and medical treatments, and lifestyle factors including diet, exercise, and substance use (Mehrnezhad and Almeida, 2021; Kemp, 2023).
Empirical analyses of popular fertility applications reveal that this intimate data frequently travels well beyond the confines of the original application. Studies examining between 12 and 30 leading fertility apps found pervasive tracking mechanisms, with data transmitted to numerous third parties across multiple jurisdictions, frequently for advertising and analytics purposes (Kemp, 2023; Mehrnezhad and Almeida, 2021; Jantraporn et al., 2023; Zadushlivy, Biviji and Williams, 2023). These third parties include advertising networks, data brokers, analytics platforms, and social media companies whose business models centre on monetising user information.
The technical mechanisms enabling this data flow include software development kits (SDKs) embedded within applications, tracking pixels, and application programming interface (API) connections to external services. Hudig and Singh (2025) documented how fertility apps share data with tracking services that operate across multiple applications and platforms, enabling the construction of comprehensive user profiles that extend far beyond reproductive health information. This data aggregation capacity transforms individual data points—a logged period, a recorded sexual encounter—into rich profiles suitable for commercial exploitation.
Privacy risks and downstream harms
The literature identifies four primary categories of harm arising from fertility app data practices: commercial profiling, legal jeopardy, discrimination, and intimate partner or coercive harms.
Commercial profiling represents the most ubiquitous risk, with fertility data enabling targeted advertising based on inferred pregnancy status or reproductive intentions. Siapka and Biasin (2021) describe this phenomenon as “menstrual surveillance,” wherein the biological rhythms of reproductive bodies become raw material for commercial extraction. Gilman (2021) extends this analysis, demonstrating how fertility data feeds into broader consumer profiling ecosystems that can predict life events—pregnancy, birth, postpartum period—with significant commercial value.
Legal harms have assumed unprecedented significance following the Dobbs decision. Kelly and Habib (2023) analyse how menstrual cycle data could serve as evidence in abortion-related prosecutions, noting that irregular periods, sudden cessation of tracking, or recorded pregnancy followed by non-pregnancy status could all potentially constitute digital evidence of terminated pregnancies. Song et al. (2024) document how these concerns have generated collective privacy anxiety among fertility app users, with many deleting applications or falsifying data in response to perceived legal risks. Kelly et al. (2025) and Katznelson, McNamara and Shachar (2025) further examine the implications of this under-regulated landscape for reproductive autonomy and healthcare access.
Discriminatory harms extend beyond the legal domain to encompass employment, insurance, and financial services. Gilman (2021) documents how fertility data could inform hiring decisions, insurance underwriting, and credit assessments, while Geampana (2024) analyses how workplace wellness programmes that incorporate fertility tracking may expose employees to surveillance and discrimination risks. These concerns are particularly acute given documented practices of inadequate de-identification, wherein supposedly anonymised data can be re-identified through correlation with other data sources.
Finally, the literature identifies significant risks in intimate partner violence (IPV) contexts. Mehrnezhad and Almeida (2021) document how fertility apps designed for shared use between partners can become instruments of coercive control, enabling abusive partners to monitor reproductive cycles and sexual activity. These applications may be installed covertly on victims’ devices or partners may demand access as a condition of the relationship, transforming ostensibly empowering technologies into surveillance tools.
Consent failures and autonomy deficits
A robust body of scholarship demonstrates that consent mechanisms employed by fertility applications fail to meet ethical standards of informed consent. Fowler, Gillard and Morain (2020) analysed the readability and accessibility of terms of service and privacy policies for menstruation-tracking applications, finding that policies were typically written at reading levels inaccessible to most users, hidden within application interfaces, and lengthy to the point of practical unreadability.
Fowler and Morain (2020) extend this analysis to examine the substantive content of these policies, finding systematic under-disclosure regarding data accuracy, sharing practices, and potential uses. Users clicking “I agree” to access fertility services are therefore not meaningfully informed about the conditions to which they purportedly consent. This analysis aligns with broader scholarship on “notice and choice” consent models, which critics argue create only an illusion of user control while legitimising corporate data extraction practices (Solove, 2013).
Zadushlivy, Biviji and Williams (2023) conducted qualitative content analysis of reproductive health app privacy policies, documenting vague language regarding “research” purposes, undefined categories of third-party recipients, and indefinite data retention periods. Users consenting to these policies therefore agree to terms whose practical implications remain fundamentally opaque.
Beyond informational deficits, the literature identifies structural factors that undermine consent autonomy. Hamper (2024) analyses how users often perceive data sharing as an unavoidable “payment” required to access fertility knowledge, particularly when free applications represent the only affordable option. This perception reflects broader power asymmetries wherein individuals must accept terms dictated by corporations or forego access to services that have become culturally normalised elements of reproductive self-management.
Commercial incentives and the political economy of femtech
The femtech industry represents a multibillion-dollar market built substantially upon data extraction and monetisation. Understanding fertility app ethics therefore requires situating specific data practices within the broader political economy that shapes industry incentives and practices.
Siapka and Biasin (2021) analyse how “free” fertility applications constitute business models predicated on converting intimate reproductive data into revenue through advertising networks and data broker relationships. This commercial logic creates structural incentives to maximise data collection, extend data retention, and expand third-party sharing—incentives that directly conflict with privacy-protective practices. Gilman (2021) describes the resulting ecosystem as “periods for profit,” wherein menstruation itself becomes a site of capitalist extraction.
Critically, the literature examines how empowerment rhetoric deployed by femtech marketing obscures these commercial dynamics. Healy (2020) analyses how fertility applications position themselves as tools for bodily knowledge and reproductive autonomy while simultaneously converting users’ bodies into data commodities. This discursive strategy naturalises data extraction by framing it as the inevitable cost of empowerment, rather than a contingent business choice that serves corporate rather than user interests.
Feminist scholars have further analysed how fertility apps reproduce and reinforce normative expectations regarding reproduction and motherhood. Hamper (2024) documents how application design and marketing emphasise conception and pregnancy as the natural telos of fertility tracking, marginalising users who track cycles for other purposes including menstrual health management or contraception. Clay et al. (2025) extend this analysis to clinical care contexts, examining how fertility tracking may shift responsibility for reproductive outcomes onto individual women while generating data that serves commercial rather than health purposes.
Siapka and Biasin (2021) and Gilman (2021) both emphasise how this arrangement constitutes a form of gendered, unpaid “consumer labour,” wherein women perform the work of data production—logging symptoms, recording activities, maintaining tracking routines—that generates value captured by corporate entities. This labour is rendered invisible within empowerment discourse that positions users as beneficiaries rather than producers of value.
Regulatory gaps and emerging frameworks
The literature consistently identifies significant regulatory gaps that enable the practices documented above. Fertility applications typically fall outside medical device regulation unless they make specific clinical claims, leaving most apps subject only to general consumer protection and data protection frameworks that provide inadequate protection for intimate health data (Fowler and Morain, 2020).
In the European Union, the General Data Protection Regulation (GDPR) provides enhanced protections for health data as a special category requiring explicit consent. However, scholars note significant enforcement gaps and interpretive ambiguities regarding what constitutes “health data” and whether inferred health information receives equivalent protection to directly disclosed information (Siapka and Biasin, 2021). In the United States, fertility applications typically fall outside the Health Insurance Portability and Accountability Act (HIPAA), which governs only covered healthcare entities and their business associates, leaving direct-to-consumer health applications in a regulatory grey zone.
The post-Roe landscape has generated calls for enhanced regulatory protection of reproductive health data. Kelly et al. (2025) argue for explicit statutory protections that would prohibit disclosure of fertility app data to law enforcement absent judicial authorisation based on probable cause. Katznelson, McNamara and Shachar (2025) advocate for guidance from health authorities regarding reproductive health tracking technologies that would establish baseline privacy and security standards.
Beyond regulatory reform, scholars have proposed alternative governance models centred on reproductive justice and data feminism principles. D’Ignazio and Klein (2020) articulate data feminism as a framework that examines how data practices reproduce or challenge intersecting systems of oppression, suggesting that fertility app governance should prioritise the interests of the most vulnerable users—those facing criminalisation, discrimination, or intimate partner violence—rather than accepting privacy compromises that disproportionately harm marginalised populations.
Discussion
Synthesising findings across analytical domains
This literature synthesis reveals a consistent pattern across privacy, consent, and commercial dimensions: fertility tracking applications currently operate within an ethical framework that systematically privileges corporate interests over user welfare. The intimate data collected by these applications flows through commercial ecosystems designed to extract value from reproductive bodies, while consent mechanisms provide only illusory user control over these processes.
The first objective of this dissertation—analysing data collection and third-party sharing—is substantially achieved through the reviewed literature. Studies consistently document that fertility apps collect highly intimate data and transmit it to numerous third parties across jurisdictions. This finding carries significant implications because it reveals that users’ reproductive data does not remain contained within a trusted health management tool but rather enters commercial data ecosystems where it may be aggregated with other personal information, sold to unknown parties, and used for purposes users never anticipated or desired.
Regarding the second objective—evaluating privacy risks—the literature identifies a taxonomy of harms that extends far beyond conventional privacy concerns. Commercial profiling represents the most pervasive risk, affecting virtually all users of free fertility applications. Legal risks have intensified dramatically in the post-Roe landscape, transforming fertility data into potential criminal evidence. Discrimination risks operate across employment, insurance, and financial domains, while intimate partner harms represent perhaps the most immediately dangerous consequences for individuals in abusive relationships. This analysis demonstrates that fertility app privacy is not merely an abstract concern but rather a matter with concrete implications for users’ legal status, economic opportunities, and physical safety.
The third objective—assessing consent mechanisms—reveals fundamental ethical failures in how fertility applications obtain permission to process intimate data. The literature consistently demonstrates that consent mechanisms fail on multiple dimensions: policies are unreadable, material information is obscured, and structural power asymmetries prevent meaningful user choice. This finding has significant implications for the legitimacy of fertility app data practices. If consent is ethically meaningful only when it is informed, voluntary, and competent, then the consent obtained by fertility applications through click-through agreements fails to meet these conditions. Data processing that occurs under these circumstances therefore lacks ethical legitimacy, regardless of its technical legal compliance.
The structural tension between commercial incentives and user welfare
Addressing the fourth objective—examining commercial incentives—requires moving beyond analysis of individual practices to examine structural factors that shape industry behaviour. The fundamental business model of free fertility applications creates an inherent tension between profit maximisation and user privacy protection. When revenue depends upon advertising and data monetisation, maximising data collection and third-party sharing directly serves business interests while compromising user welfare.
This structural analysis suggests that ethical failures in fertility tracking are not merely the result of bad actors or inadequate policies but rather reflect rational responses to commercial incentives embedded in the industry’s business model. Individual applications that adopted privacy-protective practices would face competitive disadvantages relative to rivals willing to monetise user data more aggressively. Market dynamics therefore create a race toward privacy-compromising practices that only regulatory intervention can effectively address.
The empowerment rhetoric that pervades femtech marketing performs important ideological work in obscuring these dynamics. By positioning users as empowered agents gaining knowledge about their bodies, this discourse naturalises data extraction as the necessary cost of empowerment rather than a contingent choice that serves corporate interests. Users who question data practices can be positioned as ungrateful recipients unwilling to accept the terms of a beneficial exchange, rather than rational actors resisting exploitation of their intimate information.
Implications for reproductive autonomy and justice
The ethical concerns identified in this analysis carry particular significance when viewed through reproductive autonomy and justice frameworks. Reproductive autonomy—the capacity to make meaningful choices regarding one’s reproductive life—depends upon informational privacy as a precondition. When intimate reproductive data enters commercial ecosystems where it may be accessed by employers, insurers, law enforcement, or abusive partners, the capacity for autonomous reproductive decision-making is fundamentally compromised.
The post-Roe legal landscape has intensified these concerns by creating direct pathways through which fertility app data could be weaponised against users’ reproductive interests. Individuals in restrictive jurisdictions now face choices between abandoning useful health tracking tools, falsifying their data, or accepting meaningful risks of legal jeopardy. This situation represents a failure not merely of individual applications but of regulatory frameworks that have permitted intimate health data to become legally accessible without robust protections.
Reproductive justice frameworks emphasise that reproductive autonomy concerns affect different populations differently depending on their social positioning. The harms documented in this analysis disproportionately affect those with least capacity to protect themselves: individuals lacking resources to access paid applications with better privacy practices, those in jurisdictions with restrictive reproductive laws, people in abusive relationships where data may be weaponised, and marginalised populations already subject to heightened surveillance and discrimination. Ethical analysis of fertility apps must therefore attend not only to average user experiences but to the distribution of risks across differently positioned populations.
Evaluating potential interventions
The fifth objective—identifying potential interventions—requires assessment of various approaches that might address the ethical failures documented above. The literature suggests interventions across regulatory, technical, and governance domains.
Regulatory interventions extending beyond notice-and-consent models represent the most direct response to consent failures. Substantive data protection requirements—specifying what data may be collected, limiting retention periods, restricting third-party sharing, and prohibiting specific uses—would constrain harmful practices regardless of what users technically “consent” to through unread agreements. Such regulations could be modelled on existing sectoral privacy frameworks or developed specifically for reproductive health data.
Privacy-by-design represents a technical intervention that embeds privacy protections into application architecture from the initial design phase. Hudig and Singh (2025) document approaches to enhancing transparency and control in fertility tracking that could serve as models for industry-wide standards. Technical measures including local data processing, end-to-end encryption, and minimised data collection could significantly reduce privacy risks, though their adoption depends upon either regulatory mandates or market pressures that currently remain insufficient.
Governance interventions centred on reproductive justice and data feminism would restructure decision-making processes regarding fertility data to centre the interests of users, particularly those most vulnerable to harm. Such approaches might include meaningful user representation in application governance, independent oversight mechanisms, and accountability structures that impose consequences for privacy violations. These interventions address the fundamental power asymmetries that enable current practices rather than merely ameliorating their symptoms.
Limitations and areas requiring further research
This analysis necessarily inherits limitations from the underlying literature. Empirical studies of fertility app practices examine specific applications at particular moments, meaning that findings may not generalise to all applications or persist as applications update their practices. The predominance of research from high-income country contexts limits understanding of fertility app ethics in diverse regulatory and cultural environments. Additionally, rapid technological change means that new practices—integration with wearable devices, artificial intelligence-driven predictions, and expanded data partnerships—may generate novel ethical concerns not yet addressed in scholarly literature.
Further research should examine user perspectives and experiences more comprehensively, particularly regarding how different populations understand and respond to privacy risks. Research should also examine the effectiveness of various interventions, including how regulatory changes in particular jurisdictions affect industry practices and user outcomes. Finally, research should address the globalised nature of data flows, examining how fertility data crosses jurisdictional boundaries and whether international coordination might address regulatory gaps that national approaches cannot remedy.
Conclusions
This dissertation has examined the ethics of fertility tracking applications through systematic analysis of privacy practices, consent mechanisms, and commercial incentives. The analysis demonstrates that current fertility tracking ecosystems over-collect and commercialise intimate data under opaque, often non-consensual conditions, creating legal, social, and bodily risks that fundamentally compromise users’ reproductive autonomy.
Regarding the first objective, the analysis established that fertility applications collect highly intimate data encompassing menstrual cycles, sexual activity, pregnancy status, emotions, and treatments, and that this data frequently flows to numerous third parties across jurisdictions for advertising, analytics, and other commercial purposes.
The second objective was achieved through identification and analysis of four primary categories of privacy risk: commercial profiling through targeted advertising and inference of reproductive intentions; legal harms including the potential use of cycle data as evidence in reproductive healthcare prosecutions; discrimination affecting employment, insurance, and financial services; and intimate partner harms wherein fertility data becomes an instrument of coercive control.
The third objective was met through demonstration that current consent mechanisms—reliant upon click-through terms of service and privacy policies that are unreadable, materially incomplete, and structurally coercive—fail ethical standards of informed consent and meaningful user autonomy.
The fourth objective was addressed through analysis of how commercial incentives embedded in femtech business models drive data extraction practices that conflict with user welfare, while empowerment rhetoric obscures these dynamics by positioning data extraction as the natural cost of reproductive knowledge.
The fifth objective was fulfilled through evaluation of regulatory, technical, and governance interventions that might address documented failures, including substantive data protection regulation extending beyond notice-and-consent, privacy-by-design approaches, restrictions on commercial data use, and governance structures centred on reproductive justice principles.
The significance of these findings extends beyond academic contribution to matters of direct practical importance. Millions of individuals use fertility tracking applications daily, often unaware of how their intimate data is collected, shared, and potentially weaponised against their interests. The post-Roe legal landscape has transformed fertility data from a privacy concern into a potential legal liability, making these issues matters of urgency for users, regulators, and technology developers alike.
Future research should examine user experiences and responses to privacy risks more comprehensively, evaluate the effectiveness of regulatory interventions across different jurisdictions, and address the globalised nature of data flows that enables regulatory arbitrage. Scholars should also attend to emerging technologies—wearable integration, artificial intelligence prediction, and expanded data partnerships—that may generate novel ethical concerns requiring analysis and response.
Ultimately, this dissertation argues that ethical fertility tracking requires fundamental restructuring of the relationship between users, applications, and data. Such restructuring demands regulatory frameworks that impose substantive protections rather than relying on fictional consent, technical architectures that embed privacy by design, and governance models that centre reproductive justice rather than data extraction. Only through such comprehensive reform can fertility tracking technologies fulfil their promise of reproductive empowerment without compromising the autonomy they purport to enhance.
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