Cycles of Control: Reproductive rights and digital risks

00:07.16
Gus
Welcome to The Technology Pill, a podcast that looks at how technology is reshaping our lives every day and exploring the different ways that governments and companies use tech to increase their power. My name is Gus Hossein and I'm the Executive Director of Privacy International.

00:21.45
Caitlin
And I'm Caitlin and I'm PI's Campaigns Officer. Hi.

00:22.44
Gus
And Caitlin is hosting this edition of our podcast with our wonderful guests.

00:28.00
Caitlin
So today we're talking about reproductive healthcare. In particular, we're looking at barriers to access to reproductive healthcare, care including abortion and how big tech are collaborating with or supporting tactics to make access to healthcare care harder.

00:41.00
Caitlin
We're also looking at how healthcare data is being collected and whether intentionally or unintentionally contributing to criminalisation and prosecution of people seeking abortions. And we've got some really great guests. We've got Sarah, who's a senior policy officer at PI. And we've got Martha, who is the founder of an organization called Repro Uncensored, who support people seeking information on reproductive health care and on abortion.

01:03.71
Gus
So listening to your fantastic interviews, what I find just bewildering is how in the modern world, getting access to reproductive health care is is just on such extraordinarily thin ice. Like what everybody's about to hear is that you have to consider where you live. You have to consider where to seek information. You have to wonder whether you can even access that information. You have to query whether you trust that information.

01:29.99
Gus
You have to wonder whether you can trust the institutions who are there saying that they're there to help you, including as one of our guests discusses the idea of fake clinics. And if you even know what health care you're seeking, you have to find out whether you can actually get that care.

01:48.41
Gus
And at the end of all of that, and this is where it just gets even more bewildering, you're left to wonder what happens to you and the people and institutions that supported you after the fact.

01:58.81
Gus
And throughout all of that, data is generated every single step and used by companies and governments and anti-abortion actors also using this data.

01:57.81
Yeah. And I think the thing for me, when you look at that really overwhelming list of the things you have to think about is putting it in the context of the personal, right?

02:20.05
Caitlin
Like the time at which you're thinking about those is a very stressful time. It's a very emotional time potentially. And it's a personal medical situation, right?

02:31.85
Caitlin
like And it's this big long list of things, which is actually a small list in the larger context of the bigger questions that you may be thinking about, like your health, your life, your safety, the way that your body is changing and feeling and all of the specifics of every individual person's experience.

02:50.55
Caitlin
Put that on top of all this data that's being gathered in this very kind of complex landscape, the possibility of police intervention and criminalisation and prison and all sorts of other things, it massively heightens the stress, worry, life-altering levels of concern.

03:10.82
Gus
And this is all happening in a very complex global landscape where there's just so many dramatic changes in people's rights reproductive health care. And of course, everybody can so easily focus on the American landscape and like what's been going on in the U.S. s over the last few years, particularly the loss of the constitutional right to an abortion.

03:31.75
Gus
that was established in the Roe v. Wade decision in the 1970s and overturned recently in the Dobbs case, thereby removing a right. I haven't seen a right removed in that way like forever. And now we're seeing prosecutions taking place using the data that we're talking about.

03:51.45
Gus
And so you know we'll cover in this podcast some fascinating and dark instances of police access to data that we find so alarming. But let's not let the American example cast a shadow over the whole discussion because it's actually a very rich picture when you look more globally and else but two years ago now ireland had their change where you can now have access to an abortion same with argentina these were seismic changes and just recently in the uk there was a parliamentary vote in favor of decriminalization. Now, it's very specific, as things are always very specific in the UK when it comes to laws, but it's decriminalization when someone terminates their pregnancy outside of the rules, which is, let's just say the rules can be around 24

04:37.94
Gus
that they'll no longer be at risk of being investigated by the police. But the parties who and institutions that that assisted in the health care may still be investigated. So as one of our guests notes that even after positive legal changes, problems can persevere.

04:50.94
Caitlin
So like before we move on to our guests and before we get into any details and before we get into any kind of specific stories, we're very aware that this topic can be really sensitive and it goes to some quite incredibly dark places.

05:08.34
Caitlin
If you personally experience some of these issues or experience pregnancy loss, please take care of yourself. We're going to share some resources. in the description that we at PI found really useful including the UK charity SANS that you might want to take a look at but please take care of yourself and if this is not the podcast for you please it's not the podcast for you

05:00.34
Gus
So without further ado, we're going to head into Caitlin's interviews with our colleagues, Sarah Sims and Martha.

05:34.95
Gus
We'll first start with Sarah, who'll be taking us through this changing landscape and the role that data and tech play in it. And of course, the risks. So without further ado, over to you and Sarah.

05:59.00
Sarah
Hi, I'm Sarah Sims. I'm a senior policy officer at Privacy International. I currently manage our health project within which we have a stream of work which looks at reproductive rights the use of technology within that sector and the privacy implications.

06:15.09
Sarah
I'd say in general, we are seeing increasingly a rollback of reproductive rights globally, in particular and post-Roe v. Wade. Yeah, an increasingly hostile environment for those seeking reproductive health care, including access to abortion.

06:31.01
Sarah
And in particular, what we've been observing is the increasing use of new technologies within within that sector and actually being used to aid law enforcement in their criminalisation of people seeking abortion care.

06:47.30
Sarah
as well as also by the organised opposition. So, for example, anti-abortion groups, even they are increasingly using and modern technologies and data to basically restrict people's access to reproductive healthcare care and abortion.

06:45.30
Caitlin
And when you say restrict, like what are the things in particular that have freaked us out, I guess?

07:10.02
Sarah
So I guess in general, within the sector, we're seeing an increase in you know, use of femtech, in particular peer checking apps. And we've seen, so in terms of restricting access or criminalising those seeking abortion care, we are seeing, well, fears around data from peer checking apps being used by law enforcement.

07:31.66
Sarah
We've not exactly seen specific cases of that being used. yeah But the narrative post Roe v. Wade definitely is fears around that. And as well in the UK, we've specifically seen that actually UK police have been advised in cases where they're investigating people seeking, you know, procuring an abortion outside the legal limit, that they're actually being advised to seize people's devices, look at their search histories,

08:02.46
Sarah
get data from their period tracking apps to build a case against them. So I guess globally, obviously in particular, Roe v Wade was reversed with the Dobbs decision, which meant that you know individual states within the US could bring in their own bans on abortion.

08:20.99
Sarah
Then I would say that in general, with the rise of far-right narratives, that there is increasingly a kind of rollback of reproductive rights And we've seen different approaches. So for example, France has recently, you know, made a constitutional right to have ah access to abortion.

08:38.63
Sarah
I would also add that in general, especially post-COVID, people are more turning online for access to reproductive health care. And that can be seeking, you know, just general information about how, you know, to manage your reproductive health care, as well as seeking information about how to access an abortion.

09:01.07
Sarah
And then if we think of people that seeking reproductive health care, particularly in a context where abortion is criminalized, people are having to turn to self-manage their abortions at home through accessing abortion pills through providers such as Plan C and Women on Web, who provide pills by post to people in countries where abortion is criminalised or in situations where people don't want to go down the traditional routes of accessing abortion care through, say, their healthcare provider due to a plethora of reasons, stigmatisation, their personal

09:39.79
Sarah
circumstances, they may want to self-manage their abortion at home through pills. The likes of Plan C and women on web who provide pills by post have been instrumental in countries, you know, like I'm from like the north of Ireland, before abortion was decriminalised, people would have sought pills from the likes of women on web because they can't access abortion through means within their own country, within their own state.

10:07.11
Caitlin
So these are like two pills, you take it home and kind of are very safe. They've been regulated and approved by lots of countries and the NHS, for example, in the UK used them kind of before a certain time anyway, because they're very safe, they work really well, and they allow you to go through what is quite, you know, where possible, which isn't everywhere, so depends.

10:28.31
Caitlin
They allow you to go through something that is quite traumatic in a safe setting that is comfortable for you if you can, so at home.

10:35.31
Sarah
Yeah, these abortion pill providers have doctors working for them. You will, you know, have your consultation with a doctor before that they will provide people with abortion pills to take at home.

10:47.36
Caitlin
So to talk a bit more about the barriers to abortion and to access to reproductive health, we're going to talk next to Martha from ReproAnsensitive, who is going to introduce herself.

11:05.63
Martha
My name is Martha Dimitratou. I am originally from Greece. I'm now mostly based in the US in Los Angeles, and I yeah founded Repro Uncensored, which is now a nonprofit, which came together by you know bringing a lot of you know creatives, nonprofits, activists, techs, to really fight and bring awareness on the issue of censorship online and on the ground when it comes to sexual and productive health information and abortion access. And so yeah, you know, we've been around now for for a bit, almost a year officially. And I think the work that we did is is pretty impactful and and, you know, extensive in many ways.

11:50.44
Martha
I would say that one of the main functions that, you know, Repro and Sensor really has been pioneering is this report and incident form. which you know allows individuals, activists, organizations to report if they believe they are facing censorship of their content.

12:09.01
Martha
We then help them get their accounts reinstated. Electronic Frontier Foundation is now part of the project. We document it and we shame big tech through awareness.

12:20.17
Martha
But you' know also doing this proactively, I think, before before it happens for people to know. what censorship looks like. but But I wanted to say that since the Trump inauguration in January, we have been able to report more than I think at this point, 75, 80 cases of censorship.

12:39.74
Martha
And that's just coming to our report and incident form alone. So you know Obviously, we've been raising awareness around this too much more, but also, yeah, we have been seeing an increase.

12:51.15
Caitlin
So when you say censorship, like what kind of thing do you mean?

13:00.77
Martha
Yes, censorship of abortion or productive health information. so information suppression happens in many shapes or forms.

13:03.77
Martha
Some are more you know apparent than others. And I can talk about this all day, but I'll try to be brief for you. And there is a lot of information on this also on reparentcensored.org if you want to have a look.

13:14.69
Martha
I would say there's two, let's say, main ways that people use you know the internet, which obviously is more and more used now for abortion seekers and abortion information. So there's two, I think, main ways that we see people searching for this information. One is the abortion seekers, right? These are people who are actually in the moment need of abortion care. So they need an immediate, you know, answer and they need to take action right away.

13:42.16
Martha
So to our experiences are mostly people who who will be using you know search, for example, right like Google or whatever, Bing, or now actually you know AI, like chat GPT more and more, to try to find care. right And then it's people who you know need to know the information, it's people who would share this information on how they can find abortion care with their communities in case they need it in the future, right?

14:08.70
Martha
And that would be more like social media or whatever, just like general awareness, whether it's digital, but also on the ground, like stickers and brochures and so on. So in both these realms, there is censorship happening.

14:21.76
Martha
As I'm sure you know, Google is... you know, de-ranking, re-ranking accurate abortion information providers. You know, we've seen, for example, i don't know, with Plan C or Women on Web's accounts being totally de-ranked multiple times throughout the world.

14:40.35
Martha
The same happened with 8Xs and a lot of organizations, while us, at the same time, we see that they're fake clinics, so clinics that, as you know, don't actually provide abortion care, but actually can have extremely harmful content and you know even lead to doxxing, intimidation of the abortion seekers.

14:56.67
Martha
And these websites often show up first. ah Google gets a lot of money from them for their ads, and their content can be, yeah, not only around us, but also very harmful.

15:07.80
Martha
We, as, you know, better healthcare organizations are often very vulnerable to this Google core updates as they're called. You know, Google uses their own internal models to decide what content will be shown first, whether they consider more accurate and trustworthy, but obviously that's you know their own internal criteria that are not very transparent and shared with us.

15:30.24
Martha
And that's extremely harmful. And I would just say in terms of search as research was conducted by Women on a Web Appliance C recently that showed that Bing, which as you know, Bing is Microsoft, so it's quite important used very much throughout the world, ah was filtering out accurate results when people were typing key terms for abortion accurately. So say you're typing abortion Poland.

15:53.11
Martha
If you were typing this correctly on your browser, the results that you would expect to see were not showing up. Whereas if you were mistyping this, then you would see the results and then, yeah, was spoke with Microsoft and it turns out that apparently they had no idea this was happening and they had an engineer who had set it up.

16:10.68
Martha
and We put a lot of pressure. It's still ongoing. Shareholders of Microsoft were a good strategy in that case. But the point of this is, you know, the so-called whatever algorithm and and all these things are actually very much human-made and human applied.

16:24.83
Martha
It's not just this you know mysterious, a divine thing that nobody exactly knows what it is. So anyway, that's in terms of search. And then really quickly in terms of you know social, ah we are also seeing a bunch of different forms of censorship, ad accounts being taken down, regular accounts being taken down from individuals as much as big organizations, as well as you know shadow banning, which is much harder to detect. That's when your account doesn't show when, say, for example, you want to put it in your Instagram search or when you get much less rich, you get if you perhaps weren't using specific words or we're talking about a specific theme.

17:03.56
Martha
And um yeah, these are extremely frustrating cases that take a lot of time from all this you know reproductive health organizations that are often small organizations that need to put their dedicated resources to helping people get you know the care they need, yet they are having to appeal this you know ongoing ah censorship cases with Meta and TikTok and all the big tech. So that's that also, you know, the processes are extremely lengthy and there is often hundreds of thousands of people that are deprived from, you know, extremely important information.

17:41.65
Martha
because these things happen. ah you know When plan C's ad account is taken down, we lose you know hundreds of thousands of reach, for example. um And often, I'll just say that, we are noticing even you know through the report on incident form and when this form is filled out that there is a pattern of content and accounts being suppressed and silent around major policy changes, especially in the US, or you know the announcement of possibility of policy changes, whether it's government or big tech. So yeah, so this year alone, we've seen this domino effect of account being taken down one after another.

18:20.37
Martha
And finally, and we just had an article published on this with MSI, we also know how often US policies are impacting organizations worldwide and how US-centered often big tech policies are and they don't often take in consideration a more global landscape. I mean for example, I've worked with a few organizations that couldn't run ads now, right now in you places like Argentina, Mexico on Google. you know They should be able to because it's not illegal anymore.

18:48.86
Martha
But you know this big techs would often set up these very blanket policies that are not very Very reflective of of the legal, cultural and and you know just general landscape of the country. so That's a bit what's going on in terms of censorship.

19:03.75
Martha
It's constant. It's frustrating. There is not a lot of transparency. Abortion is not treated as healthcare. It's often treated as politics, which is very difficult to you know enter enter a conversation with big tech one day when they approach it that way. And um and ultimately, it's also reinforcing stigmatization you know for a lot of people who just want to share the information or don't think they do anything wrong and you know put time to put up a post to talk about what abortion is and how abortion is healthcare care and then they see their entire accounts getting taken down.

19:31.78
Caitlin
Like, do you think it's been getting worse? Or do you think that it has been kind of like this for a long time?

19:33.78
Martha
That's a good question. You know, i'm I'm not a very pessimistic person in general.

19:44.24
Martha
But I believe it is because of the way new governments are getting set up, let's say even in the US, you know, with the current government, there hasn't been, you know, a commitment to protection, whether it's, you know, healthcare, as you know, you know, there's a bunch of things happening on that front or in terms of our data protection or you know abortion, and let alone. So big tech seems to be roaming just free and and taking a lot of decisions on their own, including, for example, getting rid of the fact check function that they had. So that's that. And and and practically, I do see that there is an increase in cases being reported.

20:16.85
Martha
yeah either Even with Plan C, I think it was about a month or so ago, and not only did we get the ad account taken down, but also there was a a bunch of posts that were taken down one after another and within 24 hours, I think about 10 posts. And the same happened to shout your abortion.

20:32.08
Martha
Shout your abortion just had another post taken down. So practically I ah see that there's an increase of cases being reported and there seem to be less and less protection from big tech and an institutional understanding that this is happening in in the healthcare care space.

20:51.08
Martha
to protect us. And I find it harder and harder to appeal with big tech, not only in terms of the way that I communicate with them, but also practically in terms of how the UX and UI is designed, you know, like the buttons don't work, it's harder to find a way to get in touch, you know, so it's the the the whole design is actually set up in a way that it's harder to contest their authority.

21:14.99
Caitlin
So if you were someone like seeking reproductive healthcare, what does that pathway now like for you?

21:20.99
Martha
I would say that abortion pills are becoming the mainstream and that's, you know, it comes from unfortunate circumstances and reasons, which is how much more hostile, at least in the US and I mean in other countries, abortion access has become and how fragmented.

21:38.39
Martha
As you know, with the Dobbs decision, the federal protection against abortion was removed. So, you know, that's resulted in this patchwork of state laws, right? and many of these states reinforcing near abortion bans.

21:53.71
Martha
So, you know, obviously the abortion landscape in the US is a whole thesis on its own, but but you now have, as you know, in in entire massive regions and state by states where there are no clinics, right? Abortion desert. So people have to, you know, get out of their country, fly out ah to be able to find care, which obviously is expensive and affects the most marginalized communities the most.

22:16.59
Martha
And technology has become, you know, and the internet has become one of the main ways, I would say if not the main one, for people to seek care. So, hence why censorship is is such an important issue when people cannot find information they want. So the path right now will be to, if you are lucky enough to live in a state that you know has favorable laws to abortion, you could get abortion pills, go to a clinic.

22:44.82
Martha
But if you live in a state with massive near-ban restrictions, It's extremely difficult and unfortunate and hostile, and you can get you know penalized very severely. So knowing your options, knowing that abortion pills are available still in all 50 states, ah knowing your rights is important.

23:04.15
Catilin
So if I'm living in one of those like particularly bad states and I kind of Google, I don't know, how to get abortion, I guess the first issue would be that what comes up first could potentially be like a crisis pregnancy center or something else, right?

23:38.15
Martha
That's right. And I will tell you that there is um states like in Texas where bills have been introduced that are now threatening to take down information, like, you know, and information, websites that share information on how people can find alternatives to in-clinic care. For example, Plan C, right, has been threatened with a bunch of these bills that threaten to take all these websites down. So yes, so if you're in the States and you don't have in clinic care and you know you're also extremely afraid because you've heard all these things in the news and then you go online and you search for, you know how can I get an abortion?

24:00.09
Martha
and you run into fake clinics. ah We know that about 80% of people don't come back from the first result they click on. So say that's the first thing that you click is a fake clinic, chances are you're going to stick to this website. You're not going to go back to the search. So that's extremely problematic. And then, you know, we did a bunch of searches with ChatGPT and Gemini, and we would search things like, can I have an abortion in Florida? You know, and you would say, no, you cannot.

24:26.86
Martha
So And then you can, let's say, dialogue a bit with Chat and say, okay, but what about abortion pills? And then he would say, oh yeah, actually you can. And then he would give you a few results. But yeah, it's very important for big tech and just the internet in general to understand the responsibility they have to make sure that people ah know their options because that's the main way that a lot of people who are in isolated states ah get the information they need and it's urgent information as you know.

24:57.13
Caitlin
What is a fake clinic? Like what is that kind of thing? if you click on one of those links and you go to a fake clinic what happens?

25:00.13
Martha
Yeah, I mean, a fake clinic is ah an entity that impersonates an entity that really provides abortion care. So yeah, whether it's an actual physical building, you know, where you're going to and you think you're going to get care, but then you don't and try to tell you the opposite or or maybe you realize it as you enter your name and then, you know, they might be calling you and intimidating you. and Or it it doesn't have a physical location, but it exists online and they're doing an excellent job. Their designs are great. They're doing an excellent job at copying accurate healthcare websites. And then, yeah, they capture their your information. And that's it, unfortunately, in a good case, but they can also provide extremely harmful information to you that can lead you into making very harmful decisions for your body. So, there are many of them. and um Again, I'm not an expert, but my understanding is that states like Florida actually fund these.

25:56.73
Martha
Like, people through their taxes actually fund these. There are some nice reports that were done. One actually being, I think, from feminists, that looked into this and how we are all actually, and only many people in many states, funding this fake clinics.

26:11.00
Caitlin
Well, that's crazy.

Martha
It's very disturbing. Yeah.

Caitlin
Are they just an American thing? Is that a stupid question? They're not just an American thing.

Martha
No, it's not a stupid question at They're they're there in the US because the US allows things like this to flourish very much, but they're everywhere in the world. there's um An incredible project that I would link to, because I don't remember exactly right now top of my head, but I think it's a, do you know Shake the Dust? They have a very good map with fake clinics in Europe.

26:40.17
Martha
From my work and experience, I've seen many fake clinics everywhere in Poland, in Italy. And I know people who unfortunately got caught in these and then, you know, had fake clinics calling them and harassing them and their families.

26:55.43
Martha
And that's in Europe. And i think they're everywhere in the world.

Caitlin
That's terrifying.

Martha
It's pretty terrifying.

**music break**

27:08.24
Caitlin
So there's the information barriers to abortion. So, you know, you can't find out if you're allowed to get one, how you can get one. You can't find accurate information on what kind you can get. Are there other kind of significant barriers?

27:18.83
Martha
There's, yeah, information suppression barriers. There is technological barriers per se, because there's a lot of people that still live actually in areas where there's actually not good internet or internet at all. Other people don't have phones. I mean, it's true, right?

27:35.46
Martha
That's that. And then there are policies and bills being introduced, right, in state levels or are and depending on the country that threaten information. you know, for example, Women on Web's website is banned in South Korea, in Spain.

27:51.18
Martha
I think was in Turkey. That's something that happens very much in a country level. It can also happen in a region level. And then there is, yeah of course, the threat of prosecution that is also very much there. and And of course, not having the correct information, which can lead to harmful medical decisions and so on.

Caitlin
When it comes to prosecution, like, have you seen big tech companies that are censoring the information on the and one hand, kind of handing information over to prosecutors on the other?

28:19.17
Martha
I know that our friends at Digital Defense Fund do a really good job at explaining this. But yes, my understanding is that it's not like Facebook would scan every day all the content of abortion online and report it to you know, ah the police, but they are known to have collaborated with ah authorities, at least in the US very much. I think there's a case in Nebraska in 2022 that was a good example.

28:48.54
Martha
So they will use metadata, you know, like IPs and so on, like extract messages to help building ah cases. So that's very much a fact.

29:00.72
Martha
So nothing that you say online is 100% secure and safe. We have on Reprint and Censored a good resource guide on how to stay safe when you're online. And our friends at DDF are doing a great job with this too.

29:13.91
Martha
But yeah, it's something that has been happening.

29:28.28
Caitlin
I mean, yeah, we've seen some really horrendous prosecution cases in the UK. Particularly, there was one woman recently who got arrested at the hospital having had a medical procedure to like, she'd had an abortion that had led to some medical complications. And so she'd headed to the hospital, been arrested. It's just awful. And I can't imagine the experience of either needing to seek an abortion for your own reproductive health, or having a miscarriage, or, you know, losing a pregnancy, and then police show up and you have to justify yourself. That's horrendous and easy to imagine a situation in which you find out you're pregnant, have a decision to make, Google you know reproductive healthcare, how does an abortion work, decide to keep the baby, lose the baby, and then have to justify that entire sequence of events to police forces who aren't that interested in your own personal experience.

30:16.73
Martha
Yeah, that's exactly it. And I think when we discuss abortion, that's something that I don't think we maybe highlight enough. I mean, we know it, but the emotional shock of having to go through this process, I mean, we know it, but you know, you're very right. And I also want to say that within our space, I mean, I'm sure you guys are amazing, but often in this space, we forget how emotional this work is, you know, whether it's help desks or anyone, you know, like I see messages, you know, when I'm do whatever, like ads or something that are people really being in agony or like in extreme need of you this information. So the whole mental care and and needs in this space, I think really needs to be highlighted.

31:01.54
Martha
I think we just are so now just like robotically used to, I don't know, I am responding to like risk and changes. Like, you know, there is the JFK Jr. now, you know, possibility of him trying to question the accuracy of FDA, of how FDA compliant and safe abortion pills are, right? So that's something we had to deal with. And there's Comstock, right? I don't know you know what Comstock is, but it's this act that says that now, you know, if it if it does come back, people's mail, if they have abortion pills, will be opened and can be seized, right? For example, these things are not into effect, but it's just, we're so used, I think, to talking to, you know, responding to press and and threats. And I mean, you know that, but I think

31:40.77
Martha
We often forget how stressful and emotional our work is. And I mean, you know about the women in Atlanta, Adriana Smith, who is having,I think, to carry her pregnancy, even though she's brain dead, right? Because of the law and in the States.

Caitlin
That one is particularly crazy because right that one is full on dystopian sci-fi movie because this poor woman has functionally died.

32:04.55
Caitlin
she's being kept on life support solely so she can incubate a pregnancy. The family don't want that to happen. The family said, this is unbearable. The baby is also not very well.

32:15.57
Caitlin
The baby may not survive. And upon finishing this process, my understanding is they still have to pay for the medical bills. So it's just trauma all the way down.

32:27.63
Caitlin
Like this poor woman who is functionally dead but can't die. This poor family who are being tortured by the fact that she's still kind of there but not there.

32:38.17
Caitlin
The looming threat of medical debt that's hanging over their head. yeah the this This poor kind of foetus that may not kind of have a hugely high quality of life anyway once it emerges, I guess.

32:51.31
Caitlin
It's just ah genuinely obscene. Like that's the example that everyone kind of said, oh, that's slippery slope argument, that's never going to happen. And then it's happened so quickly is crazy.

33:04.47
Caitlin
It's genuinely obscene.

Martha
Yeah. And I think, It's very also disheartening to, you know, obviously I'm sure her community, but also this reproductive health space in general, because it makes you understand or makes you feel, I think in the moment, at least how easily these things can come and happen.

33:25.26
Martha
And, yeah know, some protests work, but often, you know, like we keep talking about these things and, but yeah, it's ah it's a reality that right now it's happening and it came so fast. It was, it was really shocking.

33:37.05
Caitlin
I saw that I think it was West Virginia, women were told to tell the police if they miscarry in order to like protect themselves from criminal charges, prosecution, investigation.

33:49.00
Caitlin
And people were getting kind of charged, they're not necessarily prosecuted for functionally for their miscarriages. So someone I think got charged for like hiding or mishandling i mean not to get graphic but the fetal remains of their miscarriage as if that's something that people know what to do or how to do it and as if some the miscarriage isn't already incredibly traumatic like it's hard i think to understand if it if it's not something you've experienced which it isn't something i've experienced but if it isn't i think it's hard to properly understand or properly empathize

34:27.71
Caitlin
with the trauma involved in all levels of this process, like regardless of what your pregnancy looks like, regardless if it's wanted, regardless if it's not, regardless if it's kind of, you know, wanted but affected by some serious issue that means it will never kind of make it to term or whatever that process looks like. It's hard, I think, to really, really understand how painful and traumatic it is in and of itself.

34:55.16
Caitlin
And then to add on top of that, fear of prosecution, potential actual you know police knocking on your door, potentially your mail arriving opened when you're waiting for abortion pills, even just the fear of like Googling stuff as if that's not a very normal and standard thing to do, just even to get the options.

35:14.96
Caitlin
It's hard to imagine how scary what is already a very scary process is now in a lot of places.

Martha
Yeah, and that's why we need to be careful in how we also communicate these things to the public. And I don't know the answer to it, but I think walking that fine line between making sure that people have the accurate information they need, you know, making sure that they know that there are risks because we don't want to downplay them, especially for, you know, marginalized communities and so on. It's very important, but also without sounding too alarmist because, you know, you don't want to be Googling, I need abortion pills. The first thing you see is a you know massive red thing that says: careful.

35:59.07
Martha
But yeah, so i don't I don't know exactly the answer. It's something that I've i've found extremely difficult in my space to do when I speak you know to community members or journalists or whatever. And um yeah, if if you have an answer, let me know. I think we need to talk more about this.

36:16.15
Caitlin
Yeah. And I think the guidance that you have like on Repro Uncensored, but I think also Plan C has some digital safety tips, are well worth of people going and having a read. Even if you don't need them now, like understanding your options and your rights and and and how digital online privacy works is the same. We've got guides on our website, not on this specifically, but broadly, how you can protect yourself, I think is quite an empowering tool to have. So if you do need to, then at least you kind of feel a little bit more empowered, secure, kind of at least just understanding the environment.

36:50.51
Martha
You're very right. And also, as you know, it's community members sharing this information to other community members that are probably going to be the ones that get the highest and furthest reach. And I'll just add to what you so nicely said that, as you know, that most people get reported by people that they know, whether that's a partner or, you know, another family member. So be careful.

37:15.76
Caitlin
Martha, is there anything you wanted to say that you didn't get a chance to say?

Martha
I would encourage listeners to get in touch, whether it's, you know, just like DM us, blueprint sensor on Instagram or just get on the website and connect because ah think this is a cool project because it's kind of, I think of it as a blueprint for other organizations to use, whether it's, you know, in the reproductive health nonprofit space, but also in a more general way, you know, we just partner with TOR to get into the onion server space. And I think of the, you know, the format itself are something that can evolve. So all this to say that if you all have any ideas and are things that you are interested in, curious to test out, I would think that this is a cool space to do this.

37:58.42
Martha
So yeah, I'll invite you all to get in touch and share any thoughts and I promise I'll get back to you. and Yeah, and and of course, if you can or if you suspect that you have been censored or you know anyone who has or want to let know your communities, let them know and report an incident. the It's very helpful when we speak to big tech and also to just pressure big tech by bringing awareness to this. you know It's always this sweet spot between bringing awareness to the case, getting it out in press, and also if possible speaking to whichever contacts you have internally. I think that's what's been the most ah successful in getting accounts reinstated.

38:38.00
Caitlin
Awesome. We will put the link to the incident report form in the description wherever you're listening to this, along with Reaper Uncensored's website, so you can take a look, along with links to like all the things that we've talked about.

38:51.58
Caitlin
Thank you so much for your time.

38:59.57
Caitlin
At PI, we've had the chance to explore this in the context of like some more specific apps, so let's get right back talking to Sarah about what PI's been doing and what we now know.

39:11.97
Sarah
So Privacy International first began looking at period tracking apps back in 2019. And I would say we were the first kind of organization to really look at the technical and functionality of these apps and the implications for people's privacy.

39:26.74
Sarah
So in 2019, we looked at a handful of apps using our data inception of tool, which actually looks at the app's web traffic. We were able to see actually what data these apps were collecting on users and who they were actually sharing this data with. And in particular, at the time we found one app was sharing users' personal information directly with Facebook.

39:55.84
Sarah
Then in 2020, we looked at peer tracking apps again from a slightly different angle. We did a data subject access request where but under the EU Data Protection Act, you can ask apps what information they hold on you.

40:12.48
Sarah
So, I think this time we looked at five apps and we posed as a user using these apps. We then went to the app company themselves and said, what data do you have on us? Those that actually responded, yeah, were able to hand us pages upon pages of personal information they had on our fake user, basically, such as inputs to do with our medication, our sex life, very, very personal, sensitive information that they held on us.

40:42.21
Sarah
Then after we initially looked at, yeah, period tracking apps in 2019 and 2020, lot, you know, was unfolding in the reproductive rights landscape, in particular post Roe v Wade.

40:56.10
Sarah
And there was a lot of narrative and fear around people using period tracking apps in this post Roe v Wade rollback environment. And yeah, a lot was being said about encouraging people to delete these apps.

41:11.58
Sarah
And we then felt it was important for us to revisit our 2019 research to do the actual tech based research on these apps within this new environment.

41:25.50
Sarah
So in 2025, or 2024 - 2025, PI revisited peer tracking apps. We looked at eight of the most popular apps downloaded on the Play Store, some of which we looked at the first time around and some of which are newly popular apps. And we used our data interception environment tool, which is an in-house technical tool that PI has developed to look at the web traffic of these apps.

41:55.72
Sarah
And we used this tool on these eight period tracking apps to actually assess their web traffic and who they how they function, their data processing capabilities and who they're actually sharing users' data with.

42:11.75
Sarah
The full investigation, the full technical investigation is available on our website where we have a breakdown on what we found on each of the apps and we looked at. And overall, the findings were really interesting. I would say that we did find a lot of actual improvements from the first time around, but there was still some issues of concern that we particularly would be cautious about in this hostile environment for people managing their reproductive health care in situations where abortion is criminalised.

42:45.71
Sarah
In particular, what we found was that it wasn't necessary for users to provide a lot of personal information about them, which was good. We also found that they weren't necessarily sharing personal information, sensitive information that would be classified as that way under data protection laws with advertisers but what we did find was that users device data which your phone make whether it's an iphone 13, the screen size, this kind of device information was being shared with advertisers and although it's not classified as sensitive or personal information there is a technical way through device fingerprinting that could technically identify a user still.

43:33.91
Sarah
And that's concerning within this environment where if period tracking apps are seized, could that data be linked to an individual under investigation?

43:45.06
Sarah
What I'll also say is that we found a recommendation from our research the first time around was to encourage apps to enable users to store the app data directly on the user's device.

43:58.36
Sarah
This means that if an app allows individual to store all the app information, including your period data inputs on your phone rather than the app, which would most likely be stored on the app server.

44:15.36
Sarah
If an app allows a user to store it directly on their device, it means that they have complete control over that data so they can delete the app and actually delete the data.

44:28.08
Sarah
Whereas if you use an app that stores the information on the app server, it means that the app could potentially pass the information on to someone else or it could be seized by law enforcement if they are subpoenaed.

44:45.03
Caitlin
So local storage is, I have a couple of apps that use local storage and it's fantastic in terms of all of the data is mine. It sits on my phone. There's a file right there on my phone, which is where the information is. Like what apps argue and what is kind of to an extent true is like that means it's not functionally backed up on the app service rate like the app can't fiddle around with it but also if i break my phone if i just destroy my phone which I do not infrequently because I'm terribly clumsy then the data goes with the phone so for example i have a little habit tracking app which i find very cute and adorable but i don't necessarily want third parties to know like that i need a little tick button to remind me that i have in fact cleaned my teeth the morning and so i took like a travel phone, like a separate phone when we was going with PI to Brazil. And I had to like manually transfer the data onto that phone along with the app so that I could update it and keep getting the updates and then move it back to my phone when I got back, which is a totally, again, totally possible to do and makes it easier if you want to change apps because you've got that historic data as well.

45:47.66
Caitlin
But it also, yeah, fundamentally deep down, it just means It's your data. It exists on your phone. It exists with you. You have the power over it. And yeah, local storage, I think in general, it's not like the perfect solution, but it also means as well, if the police want that data, they have to come and get it from you.

46:06.80
Caitlin
They can't subpoena the app and get a load of user data. They can't subpoena the app and get your user data specifically without you knowing about it. Like everything has to come through you, which is nice as well.

46:17.44
Speaker
Yeah, exactly. Basically, yeah. Having local storage means that you yourself have complete control over it. you can You can delete it. Yeah. And no one else, no other third parties to have access to that data that you have ah about your period.

46:33.15
Caitlin
Are there any other of the recommendations that you want to talk about now?

46:47.40
Sarah
Yes. So in particular, one thing that we've seen and compared to 2019 2020 and as a response to new the global rollback of reproductive rights and the threats, we have seen some period tracking apps change how they provide their service. So for example, some apps now i provide an anonymous user mode, which is a positive way in which apps are responding to these threats.

47:07.90
Sarah
They do provide the user more privacy. So we did see a lot of improvements. And overall, as far as we could see, we didn't see anything that would say that these apps were breaking data protection laws. But overall, what we would say is that apps can take a privacy by design approach in how they're made, how they function, and data protection law is, you know, a baseline, a minimum, but that they could go further to protect the reproductive rights of their users within this hostile context that we're operating in.

47:45.38
Sarah
And whenever we look at the apps in 2019, we found one app in particular was sharing direct information about the user with Facebook. We didn't actually see that this time, which is great.

47:58.05
Sarah
We actually seen that if any calls on the web traffic were sent to Facebook, that actually Facebook were rejecting these calls.

48:00.58
Caitlin
Which I think is so funny. I really enjoy that. Like, I really enjoy that because the initial research said that basically, lots of people have been developing their app. One of the things you can do and when you develop an app is you get these, they're called software development kits, SDKs from other tech companies like Facebook that lets you log in with Facebook. It's like a cute feature that lots and lots of websites and apps have and People are shoving it into their apps. They weren't paying attention to the defaults. The default was send a lot of information to Facebook, which was a common problem, not for apps with lots of apps. And now, Facebook are like, yeah, we didn't want that.

48:42.56
Caitlin
We don't want that. Don't send us that. We don't want that. Stop trying to send us that. You're weird. That's weird. Stop doing that. And I think that was so funny. I just enjoyed the kind of like, I know they're not real. Like it's, it's, they're all technologies. They're not talking to each other. But in my head, it's like, do you want to know this? And Facebook, famous for wanting know everything, is like, no, you're weird. That's weird. Stop telling us that.

Sarah
Well, that's a good way, actually, to describe what's happening in the web traffic.

49:10.81
Caitlin
It just makes me happy. I don't know why it makes me happy, but it does. But yeah, and if you want to read more about the eight specific apps that we investigated, that Sarah and her team investigated, then you can find them all broken down by the app on the website. Again, there'll be a link in the description. So you can go straight there and have a look, have a play around with all the but most technical kind of information. And yeah, if you're developing one of these apps, you really need to think about the context that you're developing it in.

49:35.90
Caitlin
And if you're choosing one of these apps, again, like have a look, have a little investigate, come read our research. Actually, we've done it for you and have a think about what's important to you in the apps that you use and the way that they treat your data and the way that they treat you as a person that has to exist in the world menstruating, which is hard enough as it is.

49:54.75
Caitlin
Yeah. Sarah, is there anything that you wanted to mention that you haven't had a chance to mention?

Sarah
Yeah. Overall, i would just like to say that depend on your circumstances and, you know, whether you're managing your reproductive healthcare within a state where abortion is criminalized or restricted, or, you know, you're there's a mean you want to ensure the privacy of a reproductive data that there are ways in which apps are trying to protect users' period track data more.

50:25.88
Sarah
You know, you can choose an app with a non-risk mode or you can choose a not-for-profit app. So basically not to completely say that all apps are bad. There are some apps that are taking measures to protect people's privacy more than others, and that you should look into that and choose one that suits you, in particular the environment which you're mapping your reproductive healthcare.

Caitlin
I mean, that makes sense. like yeah A lot of the where we saw the information being passed on to third parties was in order to support ads, right? like who It was to pass information on to advertisers so they can see who's looking at ads, like whether they're successful, or that kind of normal advertiser stuff, which given the context and the data is more concerning than maybe it would be if it was like, lawnmowers And so non-for-profit apps that don't include adverts are maybe something you want to consider, you know not necessarily because they're the world's best privacy policies, not we don't know, it depends on the app, but because that information trading doesn't happen because there aren't ads in the apps if they're not-for-profit. That's the point of them, they're not-for-profit.

51:29.72
Sarah
Yeah, we we would recommend that considering this threatening environment for people now managing the reproductive healthcare, that there's ways that apps can go above and beyond to protect people's privacy and their reproductive health data within this environment.

51:46.11
Sarah
There are certain app functionalities and the development of the app that they can choose to go beyond standard data protection law to ensure the privacy of users' reproductive health data within this hostile environment that we're seeing.

52:00.96
Sarah
Yeah, and one other thing that PI, we have been doing is that we wanted to gather information about the privacy concerns that reproductive justice activists and have when conducting their work.

52:14.07
Sarah
So considering this hostile environment that we're talking about and, you know, people law enforcement and those in opposition to abortion are increasingly using data exploitive tactics.

52:26.30
Sarah
We wanted to reach out to reproductive justice advocates to gather concerns around their privacy when conducting their work and how they can best protect people that they're assisting with reproductive health care.

52:41.46
Sarah
So we did a survey with them to gather information about the concerns that they were having. And the idea is that PI is going to produce a guide for a reproductive justice activists on how best to protect their privacy online and mitigate some of these potential issues for people's data that are seeking protection. You know, abortion healthcare, reproductive healthcare care generally within this environment.

53:01.51
Caitlin
Keep your eyes out, peeled on our website and you can sign up to our mailing list to be the first to hear about the guides when they come out at action.privacyinternational.org and I'll update the description when we have the link. So when it comes out, if you're listening to this, you know, a bit after we release it, then you may be able to already find it in the description.

53:23.67
Caitlin
I promise nothing. Yeah. Thank you very much, Sarah. Thank you.

53:40.59
Gus
Those were some extraordinary interviews and thanks for doing that, Caitlin. Like it's just, it's bewildering to me. The hurdles people to navigate as they seek access to the healthcare, for crying out loud. They have to think about where they live. They have to think about where to seek information from. They have to wonder whether they can even access that information.

54:02.40
Gus
They have to query whether they can trust the information that they're getting. They have to wonder whether they can trust the institutions, such as, for example, the crisis pregnancy centers that Martha referred to, even if they know what they're seeking.

54:17.84
Gus
They have to find out whether they can actually get that care that they're actually asking for. it And then at the end of all of that, they're left to worry whether or not what they've done will come back to haunt them and the people and institutions that helped them along the way.

54:33.81
Gus
That's just kind of, I can't believe this is where we're at. But equally, I completely understand this is where we're at in 2025.

Caitlin
Yeah, and I think it's worth thinking about, you know, we can imagine individual people and individual hypothetical situations from, you know, someone who is seeking to save their own life, someone who's seeking to kind of safeguard their future and the future of their family and all sorts of hypothetical situations.

54:58.83
Caitlin
But every single person facing those questions and their decisions is an individual in individual circumstances. And it's in the context of a much bigger set of questions that are emotional, that are physical, that are influenced by, you know, their financial position, by their health, by their due date, all sorts of other things. And it sucks to add to that workload and that like mental burden.

55:24.26
Caitlin
And then to step on top of that, Oh, and, you know, now you need to become an expert in digital security because the data trail you may have left, you know, may lead to a police investigation in a context in which, you know, you may or may not have sought an abortion, you may or may not have done anything more than Google.

55:43.25
Speaker
That's... really scary and I wanted to mention it the woman in the US in Georgia who was left on life support after functionally she had died to incubate her foetus has now been taken off life support and the baby has been delivered by emergency c-section prematurely. She's kind of now been allowed to die her name's Adriana Smith and i just really wanted to make sure to include her name and ah bit more kind of an update. It is yeah one of the worst examples that i've ever seen and in that case it's not her making those decisions or choices it's her family who are being informed of the choices being made about their loved one and yeah it's just hard to understand or contemplate that that is possible.

Gus
I don't even know how to respond to that like that that case is just sorrow after sorrow after sorrow but add state control to that and it's just bewildering I mean it in all the senses but okay we can't end on such a horrific note.

Caitlin
Yeah I know I know.

Gus
So let me just, from the outside and the distant outside, let me just say one of the things I thought was interesting as I was reviewing all this, listening to the interviews and also reviewing the work that PI had done.

57:11.80
Gus
I got the just faint smell in the air that we're all just a little bit smarter now. that the people building services and building apps and trying to help people, I think that we're just a little bit more careful, potentially, than we were just a few years ago.

57:32.95
Gus
And I think I always had this i this this belief that we were not building a secure society. We were building a highly vulnerable society when we' we're embedding surveillance everywhere, where we weren't securing our devices.

57:46.81
Gus
And I feel that we're getting on just a little bit better. that Maybe that's the only positive note to take from this, that there are some apps out there that recognize that you might not want your data going centrally.

57:59.28
Gus
And whether it is Caitlin's habit recording app or it is the period trackers, they're recognizing that people want to be in control. And it's not just that they want to be control, but they need to be in control. And it's it's for their safety, they need to be in control.

58:15.40
Gus
And so maybe there is something positive to take from all of this.

Caitlin
I think if you look at the broader trend, there definitely is. like The research PI did this time looked very different from the research that we did last time.

58:28.30
Caitlin
And that's because the research that we did last time showed a level of, I would say, carelessness rather than maliciousness, but a lack of thought in the way that the apps had been designed to send such a huge volume of data sensitive data to Facebook and such a just bleeding information. I mean, it was just ridiculous. And that is just not the case anymore.

58:54.74
Gus
Again, Caitlin, thank you so much for this edition. It was an eye-opener and refreshing. And I want to say those words rather than say the negative words again, because i I do want to end on a on a positive note.

59:06.85
Gus
So thank you for listening. You can sign up to be the first to learn more about our work at pvcy.org/podsignup. And we'll include some links to relevant articles and information in the description wherever you're listening or on our website at pvcy.org/techpill.

59:25.31
Speaker
And again, we can't recommend strongly enough the content that's available to support people at the UK charity called Sand. It's just so helpful to navigate, to support others who have gone through difficult times, who have gone through difficult times, and to support yourself.

59:43.23
Speaker
Don't forget to rate and subscribe to the podcast on whichever platform you use. Music is courtesy of Sepia. This podcast was produced by Max Burnell for Privacy International.