FemTech is offering new and potentially helpful options when it comes to tracking your fertility and your period, but what are you missing out on when you automate body literacy with apps and wearable devices?
This episode talks about the pros and cons of digital contraceptives and period predictors, and also touches on how the latest dietary recommendations encourage us to ignore our intuition and continue outsourcing body literacy.
Referenced in this episode:
- Clue Birth Control
- Oura Launches Period Prediction Beta
- Nature: Food Compass is a nutrient-profiling system using expanded characteristics for assessing healthfulness of foods
- Tufts Food Compass press release
- The Tufts Food Compass
- Tufts Receives $10 Million Grant to Help Develop Cultivated Meat
- The Funktional Nutrition Podcast – Episode 178
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What is body literacy?
This is a term used in the Fertility Awareness Method, a natural method of family planning and birth control. It means knowledge about your observable fertile signs. I also use it as a more general term, meaning:
- knowledge and intuition about your own body
- knowledge about your personal cycle and the natural fluctuations in emotional and physical feelings throughout your cycle
- knowledge about food that makes you feel good and what doesn’t.
It’s a cultivated awareness of your body and its needs that helps you to be a strong advocate for your health.
This takes work, time, and intention. We live in a culture that really likes the opposite — convenience, speed, and instant gratification — so already we’re resisting something that used to come more naturally because there’s more distraction.
FemTech helps us outsource our body knowledge
What I’m interested in (and slightly concerned about) is what this all means for the health space as tech companies aim to digitize every measurable aspect of our lives.
I’m talking about FemTech — software, apps, and other technology that focuses on women’s health. Things like your period-tracking app, fertility monitors, birth-control telemedicine, wearable devices, and any other tech related to our reproductive and sexual wellness.
I dislike the term FemTech for the same reason I dislike that women’s health is considered a specialty. Something that serves half of the earth’s population shouldn’t be considered a niche market. This makes it easy to dismiss or overlook.
While this area is growing, it’s still not funded nearly as much as general digital-health services and products, nor as highly as tech that’s focused on men’s health.
But I do want to talk about some recent technology that caught my eye and got me thinking.
Clue’s new digital contraceptive
The period-tracking app Clue recently announced that it received FDA approval to launch a digital contraceptive. Digital birth control! Intriguing, right? How could that possibly work?
I dove into all the literature that they had available for it, and the way it works is that it predicts your risk of pregnancy based on your period start date. You need to abstain or use protection on high-risk days, meaning when your risk is high for pregnancy (your fertile window).
When you first start tracking with Clue Birth Control, you’ll have 16 high-risk days. This may be confusing, because we only have a six-day fertile window. When you ovulate, the egg survives up to 24 hours, and sperm can survive in the body for up to five days, so that’s how we get the six-day fertile window. So 16 days is a lot, but it’s really to cover your ass if you don’t have that body literacy.
The more cycles that you track, the more data the app will have to work with to give you a more accurate picture of your fertile window. Clue says that the number of high-risk days will shorten to about 12 after it has more information from your tracking. Again, still longer than your actual fertile window, but, better safe than sorry.
To be eligible for Clue Birth Control, you need to have a predictable cycle, one that’s about the same length of time every month. If you have an irregular cycle, if you have PCOS or difficulty with ovulation, you’re not going to be able to use this type of digital contraceptive.
Personally, I don’t think a period-start date alone is enough to track your fertility, but knowing that this is how the app predicts your fertile window, it does make sense that there is such a high amount of high-risk days.
This method feels like a bare-bones Fertility Awareness Method (FAM), without any actual personal awareness, you’re outsourcing the ability to tell you when you’re at risk for pregnancy.
Outsourcing fertility tracking to an algorithm
I worry about two things with this:
1. Incorrect predictions
The first, obviously, is incorrect predictions leading to unplanned pregnancies. That’s a big worry.
I always recommend that people using period-tracking apps turn off the prediction feature if they can. Especially when getting started, they are almost never correct and end up confusing users. Of course, this is why Clue requires you to have a regular cycle to be eligible to use it; they’re trying to limit any error on their end. There could also be user error if you forget to track or if you input the wrong date.
Many people rely on an app to tell them about their bodies, but what if something changes? What if your cycle is typically regular, but longer one month due to stress or illness, or another factor that can impact ovulation and menstruation? Would users know what to look for?
Predictions rely on users to properly log period-start dates and to keep up with tracking religiously. A lot of people have told me they don’t know what to do with the information they’ve logged in their app, and I feel like this just keeps that autopilot tracking going.
I do think Clue Birth Control will be accurate for those who use it properly and have a working knowledge of their cycles, but I wonder what percentage of users that really is. They do have really great educational resources, they have a great blog, they have a podcast, so I think it could work, but again, I worry about potential errors with the predictions.
2. Staying in the dark about how fertility works
Body literacy is about being in tune with your personal rhythms, observing its signals, and understanding what to do with that information.
The Fertility Awareness Method that I mentioned helps you develop body literacy. It doesn’t rely only on a period-start date. It also relies on observable fertile signs like cervical fluid or discharge, which tells you that your body is working up to ovulation, and your basal body temperature, which is your temperature first thing in the morning that can confirm for you when ovulation has occurred. These two things help you know your fertile window regardless of how long your cycle is each month.
It does require more effort than Clue Birth Control, but you learn so much that you can take with you for life. You can begin to make your own predictions based on the info you’ve tracked — even when things go awry and delay ovulation — and your high-risk days drop to six. An app isn’t going to know if your ovulation is delayed based on a period-start date alone.
Oura’s new period-prediction feature
Shortly after I heard about Clue Birth Control, I heard about the Oura Ring, which is a wearable device. It’s a smart ring, fitness tracker, and sleep tracker that came out with a period-prediction feature in beta.
This is another way to automate tracking, but this option uses your basal body temperature, which is one of the observable signs that we use in the Fertility Awareness Method.
Because it’s a ring that stays on you and constantly monitors you, you don’t have to remember to check your temperature in the morning and then log it in your app, it’s already being done for you, which is convenient. They do note that this will only be useful for people with normal temperature patterns, so if you have any issues in that area, perhaps a thyroid issue that impacts your body temperature, the ring may not work for you for period prediction.
That’s a key thing to note — this is for period prediction only, not for birth control. Basal body temperature can only tell you when ovulation has occurred, so after it’s already happened, your temperature has a clear shift because progesterone begins to rise and naturally warms your body slightly. From there, a normal luteal phase is 12-16 days long, so the app can predict your period that way after the temperature shift.
Oura also says that if you are using hormonal contraceptives (the birth control pill or an IUD), the algorithm will not be able to accurately predict your period.
Automation offers incomplete solutions
Both of these things feel like half of what we want. Clue Birth Control offers the birth control without the body literacy, and Oura offers automated body literacy without the birth control.
I want both. I want birth control and body literacy.
Oura says its “temperature sensor generates 1,440 data points each day and is validated to measure changes as precisely as (0.234°F),” which allows the algorithm to predict your period up to 45 days out. This is awesome if you’re planning a vacation or are mapping out your cycle phases on your calendar and syncing your activities, because that’s what cycle syncing is all about, but again, that requires some knowledge of your body and your personal rhythms. So there are pros and cons to all of this.
I do think the idea of a digital contraceptive is really cool and I’m interested to see how this goes for Clue and Oura and other companies that are trying to get in this space, and I think it’s so important for people to learn about their bodies because it’s knowledge you can take with you for life and apply it to so many areas of your life. So I’m not 100% sold, but I’m glad that there are other options out there.
Outsourcing your food choices
Another aspect of outsourcing body literacy is the new nutrient-profiling system from Tufts University.
If you don’t already know, I take an intuitive approach to health. I’m a believer in the intuitive eating framework, I think there is a time and place for all foods, and I think that we are smarter than diet culture convinces us we are when it comes to making food choices. We are conditioned to separate from our intuition over time and learn not to trust ourselves and that we have to follow the advice of people who claim to be experts when it comes to our own bodies.
So my spidey senses tingled real hard when I saw the new food-scoring system, Food Compass, that ranks the “healthfulness of foods from first to worst.”
Shortcomings of Tufts’ new dietary recommendations
The Food Compass covers individual foods, and meals combining multiple foods. Scores are calculated by a system that accounts for macronutrient ratios (the amount of protein, fat, and carbohydrates), vitamin and mineral content, ingredients, additives, processing, and “other characteristics of public health concern.”
Before I go further, let’s talk about why this is already an issue.
A reductive view of nutrition
Think about supplementation. Sometimes supplementation can be an issue because it can be reductive, or improperly used. The thought process is that a food is helpful because of the individual nutrients we know it has, so we isolate those nutrients, separate them, and put them in capsule form, hoping it’ll have the same effect as eating the whole food.
That’s not always how it works. It’s a simplistic understanding of nutrition that ignores other factors that contribute to overall health.
With that in mind, this scoring system strikes me as the same idea, and some of the scoring is completely illogical — for example, the cereal Lucky Charms scored higher on this healthfulness scale than red meat.
Tufts says that its Food Compass can provide a “nuanced” approach to promoting healthy eating, but I have several questions.
- If a person eats something on the low-scoring end of the scale, should they be afraid it will collapse their health?
- The score implies a certain moral status — higher on the scale = good, lower on the scale = bad. What is the purpose of assigning moral value to these foods?
- What about food access? How do you know if that’s their only access to food and what if, instead of policing what people have access to, we look at why that food insecurity exists in the first place?
- Is it helpful to a person’s health to scare them this way?
- How do you know if they’re eating it all the time or if it’s an occasional thing, and why doesn’t that contribute to the score?
- Why are we still vilifying fat and cholesterol, which contribute to lower scores? Fat helps us absorb certain nutrients, and cholesterol is required for good hormone health.
“Nuanced” to me would be accounting for a more holistic picture of health determinants. Science, although very important, doesn’t always provide a complete solution. Numbers are not nuanced.
Education is why I got into this industry. I learned first-hand how food could enhance my health, and I believe it’s everyone’s right to know about nutrition and how food works in the body, and whether a certain food will contribute to their health or not. I also believe it’s everyone’s right to develop their own awareness around how foods feel in their body, and also to do what they want with that information.
Continuing the long history of flawed advice influencing food policy
Another big problem here is that Tufts is recommending that this system influence food policy.
Food policy impacts government health programs, school cafeterias, and what’s allowed to be taxed, among other things.
When someone or some group is lobbying for policy change, you gotta look at who benefits. So I have more questions.
- Why are branded items like Cheerios and Frosted Mini-Wheats at the top of the list? Higher than actual whole grains that don’t have additives?
- Why are branded items on the list at all?
- Why are vegetable oils, which are known to be pro-inflammatory, ranking higher for healthfulness on this list than other known anti-inflammatory oils? Is it because the vegetable oils are made with government-subsidized ingredients? Just curious, asking for a friend.
- Why are whole, nutrient-dense foods like beef and eggs ranked lower than processed cereals, and lower than meat and egg substitutes?
Ahh, I’m glad you asked. If you look at the competing interests section of the Nature article, where the Food Compass was published, you’ll find that the lead author accepts money from Barilla, a pasta company, and the vegan meat company Motif FoodWorks. He also previously served on the scientific advisory board of Unilever, which is one of the world’s largest manufacturers of vegetable oils.
On top of this, something not listed in the competing interests section, is that Tufts recently received a $10 million grant from the US Department of Agriculture to help develop cultivated meat (a meat alternative grown from cells).
Erin Holt from The Funktional Nutritionist Podcast did a much deeper dive in her episode on the Food Compass and its shortcomings, and one thing she pointed out was that in the press release, it states that the team at Tufts working on this project is also going to be working on “consumer acceptance of cultivated meat,” and what better way to “improve acceptance of lab-grown meat than to tell people that real meat is unhealthy.”
So I’ll take off my tinfoil hat, but it’s information worth considering. A lot of dietary guidelines are and have been in the past, influenced by money over science, unfortunately.
Becoming the ultimate expert in your own body
And the reason I bring this up in a conversation about body literacy is that it’s so important to gain awareness around your body, and what feels good to you. That can be so hard to do with the onslaught of information and recommendations that are constantly being thrown your way.
Everything is conflicting and everything is healthy or unhealthy and you never know what to do with your shopping list. It can be overwhelming and confusing, especially when there’s bias involved that you don’t even realize is there.
But you already kinda know what to do. It’s very simple — whole foods have all the nutrients you need, already in there.
For your sanity and your health, remember that you are the expert in you. Practicing intuitive eating helps you ignore these conflicting messages and focus on what’s true for you and your body, and what makes you feel best.
This information is for educational purposes only, it is NOT medical advice and it is your responsibility to speak to a qualified health care provider about your unique needs. The final decision when considering any diet or lifestyle changes, whether it’s discussed on the internet, in a podcast, or prescribed by your doctor, is always your own.
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