Health Information Sharing as Feminist Rhetorical Work: Rethinking Power, Individuality, and Simplicity in Women and Their Bodies1

“In the previous sections to this course, we have discussed the problems women face in their encounter with our medical system. We have been given inadequate and often incorrect information on how our bodies function. We can’t get birth control, so thousands of us die each year from illegal abortions. Childbirth is often a tarrying and inhumane experience. These problems are not mistakes, they are results of a system which is designed to make profits, maintain a professional elite, and treat certain sick people, rather than deal with the problems of human beings and their illnesses.”
Women and Their Bodies (179, emphasis added)

The authors of Women and Their Bodies (WATB), the earliest version of Our Bodies, Ourselves (OBOS), cautioned readers about the growing power of the “healthcare economy” long before such a term was in circulation. Although the authors encourage users to further their health education, they warn them to be wary of particular organizations, insurance companies, and, ironically, doctors. The authors characterize Ortho and Tampax as “capitalist organizationsp” [sic] that “[push] their own products for profit” (5), and they contend that Planned Parenthood “pushes population control and birth control pills” (5). The authors alert users to insurance companies’ goals and practices, noting that healthcare “will be the nation’s largest industry” by 1975 (182). They explain that doctors earn additional profits from Medicare’s “usual and customary” billing system (186), and they examine evidence from a range of sources to reveal how the privatization of hospitals prevents low- and middle-income patients from seeking care (186).

But the authors could not have anticipated that health information is the primary capital of the twenty-first century healthcare economy. Today, in an age of chronic, ambiguous, and contested health problems, sharing health data—which includes culling anecdotes, doctor’s names, medical tests, and validated and experimental treatments—is a necessary strategy for gathering information. Patients with these challenging conditions rely on data sharing for multiple reasons. Primarily, traditional doctors and data from clinical studies have not cured their health problems. After years of living with ambiguous symptoms and paying for expensive, ineffective treatments, these patients remain ill. They do not want to pursue additional treatments without clear justification. They worry that consulting with too many medical providers may be seen as suspect and thus wish to pursue healthcare selectively. Accordingly, these patients seek out others’ health data via social media, patient advocacy groups, nonprofit organizations, “fringe” healthcare providers, and data sharing apps and repositories, all of which offer more capacious discussions of chronic, ambiguous, and contested health conditions and user-generated data (Singer).2

However, processing user-generated patient data can be confusing, especially for patients who face dire health circumstances. Women, in particular, are vulnerable yet empowered in their search for adequate healthcare and health information. In Tasha Dubriwny’s words, they are forced to “grapple with and make active decisions” based on a range sources with ambiguous credentials, including websites, magazines, and advertisements (6). These sources are made more confusing by “[n]eoliberal marketing strategies,” which “have effectively blurred the line between medical research and marking of pharmaceutical drugs and illnesses” (147). As part of this dynamic, when patients review other patients’ data, they often feel compelled to share their own. Lori Beth De Hertogh notes that new “interactive features” in online health spaces, such as discussion boards, prompt users to “collectively produce and share health-related content” (“Feminist Digital” 486). Clearly, patients stand to benefit from reviewing other patients’ health data, but what do they gain from sharing their own health data? And, perhaps most importantly, how are patients persuaded to share their health data—and at what personal cost?

As patients shift away from a manual-centered health information sharing system, in which texts such as OBOS were central, they will be forced to seek out other validated sources and make choices about sharing their own health data. Because OBOS and other trusted print sources are no longer being updated, patients must learn to navigate a confusing digital terrain replete with persuasive appeals. As they decide which apps, websites, and platforms are worthy of their attention (and data), Robert Johnson’s framework for classifying user-centered versus user-friendly technology remains a helpful guide. Building on Johnson’s framework and Jordynn Jack’s embodied feminist rhetorical approach to examining mobile technologies, I argue that a feminist rhetorical approach to user-centered technologies involves three key principles: power, simplicity, and individuality. To demonstrate, I first show how the principles work by rhetorically analyzing WATB, which I assert is a truly user-centered text. Next, I show how a current health information sharing platform, MyLymeData (MLD), employs similar rhetorics of user-centeredness but does not yet achieve the same goals for transformative access as WATB. Even when MLD and other technologies appear to be system-disrupting and claim to “help a user to manipulate parts of the system, negotiate the system, or change the system even in a small, local way,” they still require users to agree to their restrictive terms and conditions and submit their data in exchange for access (Seigel 74). I examine WATB and MLD as a user-rhetorician, drawing on my experiences as a patient and a scholar to reveal the complexities of health information sharing. I conclude by imagining what truly user-centered versions of health information sharing platforms might look like and considering directions for future research.

From Manual to Digital: User-Centered Technology and Women and Their Bodies

As Marika Seigel (2013) and Sarah Hallenbeck (2015) have shown, there have long been manuals about women and their bodies, most of which circumscribed their agency and opportunities for engagement. Although it is celebrated for many innovations, Susan Wells argues that WATB (published in 1970) was the first manual that prompted women to “investigate their own bodies directly” (185). Wells and Seigel clarify that WATB was unusual for this reason and others. Seigel argues that manuals often “assume uncritical acceptance of the technologies and processes about which they instruct the reader” and take for granted “an expert-notice relationship between the rhetor and reader” (32). However, like many contemporary social media platforms, blogs, and digital health information repositories, WATB framed users as experts—or at least equals—and engaged them by invoking their knowledge and experiences. Similarly, the authors created the manual by combining scientific and medical research with their own experiences with healthcare. They “decided on the topics collectively” and “were doing research and writing that were about us and for us” (3). The authors’ horizontal workflow, which included undertaking a “dynamic” process of writing, “g[iving] support and helpful criticisms to each other,” and rewriting, meant that the users were integral and the knowledge was crowdsourced (3).

In turn, WATB and newer digital health sharing platforms have three key things in common: the centrality of the user, the focus on user expertise, and the collection of crowdsourced information. In Robert Johnson’s book, User-Centered Technology: A Rhetorical Theory for Computers and Other Mundane Artifacts, he theorizes the role of the user and considers how users “unwittingly surrender knowledge and power due to our lack of reflection on our mundane interactions with technology” (10). Johnson defines users quite simply: as “the audiences of technology” (xv). User-centered technologies, he argues, offer users an opportunity to be “active participants” in the “negotiated process of technology design, development, and use” (32, emphasis original). Seigel contends that WATB, the first version of OBOS, is truly user-centered and, accordingly, provides a model of a system-disrupting technology. These technologies allow users transformative access, or the ability to change the technology in ways that benefit them personally as well as others in the system. In other words, the authors of WATB  hoped that users would not simply learn to identify their body parts, but also to have orgasms, discover their sexual proclivities, advocate for themselves in clinical environments, create additional content, teach the content to other women, and reform the healthcare system to make it less sexist, racist, and classist. Seigel focuses on the chapter on pregnancy, which aims to “[disrupt] the user’s functional engagement with the components (or subsystems) of the healthcare system” (74) and, as such, “overwhelmingly focuses on questions of definition and evaluation” (76). In the remainder of this section, I extend Seigel’s work by reading across the text to consider how the authors invoke power, simplicity, and individuality, aiming to empower users to help themselves and radically reform the healthcare system. From there, I compare WATB with MLD, a contemporary health information sharing website, to pose questions about the challenges of creating transformative user access in the current age of health information sharing.

From its instantiation, the structure, organization, and content of WATB aimed to enable transformative user access. WATB is merely 193 pages long and divided into twelve sections. The authors envision the manual to be a “course” in women’s health. Using this frame, the authors encourage users to draw on their own expertise and offer “more deliberative than prescriptive” instructions for examining women’s bodies (Seigel 81). In an effort to provide transformative user access, many sections of WATB focus on patients’ power (and lack thereof in most cases).3 In the introduction, the authors discuss how the users were “an integral, participatory force in the process of writing” (Johnson 31). There is a long section about the iterative writing, drafting, and revision process, which involved groups of women from across the Boston area. The authors note that the text is “not final” (3) and “not static” (3), recognizing that it “should grow and include other topics” based on users’ needs (4).

To further empower users, the authors urge them to use the manual “as a tool” for prompting “discussion and action, which allows for new ideas and change” in an effort to ensure that users’ needs are met (4). Similarly, the content of the manual centers users’ ambitious needs and goals: to “act together on our collective knowledge to change the health care system for women and for all people” (4). Whether the authors are discussing the “capitalist medical care system,” which they emphasize is “no more dedicated to improving the people’s health than can General Motors become dedicated to improving people’s public transportation,” or the doctor-patient relationship, they aim to empower users to understand their personal power in relation to the institutions that govern U.S. healthcare (8).

Moreover, the authors offer simple, straightforward information using a simple, straightforward approach. They streamline complex medical terminology and information so that it is easy to understand, but they do not undermine users in the process. The authors critique the “pseudoscientific jargon” that allows doctors to “set themselves off from other people” (8) by offering relevant medical terminology alongside relatable analogies. In the “Women, Medicine, and Capitalism” section, for instance, the authors discuss female sex organs and suggest methods and reasons for self-investigating them. Specifically, they offer a short, friendly description of how a reader can palpate her cervix:

“You can touch your own cervix; it feels like a large nipple with a small dimple in its center, extending from the top part of the vagina way towards the back. The uterus changes position during the menstrual cycle, so where you feel the cervix one day may be slightly different from where it will be next! The entrance into the uterus through the cervix is very small, about the diameter of a very thin straw. This is the little dimple that you feel in the middle of the ‘nipple.'” (12)

The description is conversational rather than technical, clearly oriented towards the user population: women who were self-aware but unfamiliar with their reproductive anatomy. Readers are addressed in second person. They “can” touch their vaginas—they are able to and empowered to if they wish. The description of the cervix as a “large nipple with a small dimple in the center” and the entrance to the uterus as “a very thin straw” are colloquial and would have been easily understood by users at the time. The addition of an exclamation point signals the surprising joy that can be found in learning about one’s body, which is an affordance of self-investigation that benefits users personally. Later in that section, the authors note, “We emphasize that you take a mirror and examine yourself. Touch yourself, smell yourself, even taste your own secretions. After all, you are your body and you are not obscene” (14). Here, the language is more directive, but the authors know that most users have internalized overwhelming shame about their bodies, particularly their vaginas, and they must prompt users to work through this shame to become more educated and, thus, be more empowered as they make decisions about their healthcare (Adams). By offering accessible yet explicit instructions for investigating their sex organs, the authors show how a plain language approach to healthcare instruction can be simple without being reductive.

Despite their effort to simplify information and provide general knowledge, the authors still manage to emphasize users’ individuality. Throughout the “course,” the authors highlight the importance of individuality by providing a range of personal stories from contributors and encouraging users to figure out what works for them specifically. The authors explain that the paper on sexuality, in particular, includes many personal stories “because we felt that our own voices, our own histories rang the clearest and truest and helped us reclaim the mysterious topic of sexuality as familiar and ours” (16). These personal stories, or vignettes, are a few sentences long and present a wide variety of experiences, including instances of sexual pleasure, confusion, and violence. Even fraught topics such as masturbation (23) and sexual fantasies (30) are covered comprehensively. Moreover, with each vignette, the authors honor the individual’s story and reemphasize their focus on the individuality of the user. After the vignettes about masturbation, to take one example, the authors note, “If you have never masturbated, don’t feel like you are confined to these techniques. Finding what you like to do is what it’s all about” (23, emphasis original). This multifaceted understanding of individuality remains a central focus throughout the “course.” As the authors emphasize, “By talking to each other, taking support from each other, we can set our own standards which will bear the mark of sanity and individuality” (18). Such notes make it clear that the authors do not simply want users to replicate other users’ techniques or experiences, but instead to pay attention to their own individual needs to improve their wellbeing.

Later on, the authors emphasize repeatedly that the manual is not merely a how-to guide for pleasing women; instead, it is a course designed for personal and collective empowerment. They address “any men who happen to read” the course directly, noting that it is not a “marriage manual” (37). Instead of experimenting with the advice offered by the course, the authors implore men to “change [their] behavior” and “start doing half the housework” (37). This is yet another instance in which the authors reinforce the importance of individuality and using the manual to discover themselves and their needs, not to please others nor find a universal approach to doing so.

In all, WATB functions as both a manifesto and a manual, offering critiques of the capitalist, “pay-as-you-die” (7) healthcare system alongside accessible instructions for how users might explore their own bodies and personally benefit from reading the text. Unlike WATB, which aimed to convince users to self-investigate as a way to counter the “corporate capitalist entities” (7) that make up our healthcare system, contemporary data-sharing technologies are created and sustained by the “new medical-industrial complex” (Relman 963). These apps, websites, and health data sharing platforms often deploy a rhetoric of user-centeredness that is eerily similar to that of WATB, emphasizing qualities such as power, simplicity, and individuality. However, while these platforms claim to help patients, they may also profit in various ways from collecting their health data. Whether or not they are selling the data to interested companies, health data collection platforms may seek to gain political power or influence, advocate for certain treatments over others, and more. Additionally, as Marissa J. Doshi and other scholars show, data sharing may have unanticipated consequences (197). In a study of over 100 of the most popular Google Play apps, researchers found that more than 70% shared users’ data with outside sources, such as Amazon and Google (Grundy et al.). The study found that data sharing in health apps is “routine,” and that some forms of unauthorized data collection are considered “legitimate business practice[s]” despite issues with consent, privacy, and ethics (n.p.).

In what follows, I offer a case study of MLD, a nonprofit health data collection platform for Lyme disease patients. By charting the struggles of Chronic Lyme disease patients and others who struggle with chronic, contested, and ambiguous illnesses, I consider why these patients are motivated to share their health data and the questions and concerns they may have as they make data-sharing decisions.

Lyme Disease and MyLymeData

Lyme disease is just one example of the many chronic, ambiguous, and contested conditions from which Americans increasingly suffer. Lyme disease is a common condition that comes bacterium transmitted to humans when they are bitten by infected deer ticks. Theoretically, Lyme disease is simple to diagnose and treat, and recovery should begin as soon as it is treated. According to the most recent clinical guidelines, patients who are diagnosed quickly after their initial infection and treated with antibiotics for fourteen to twenty-one days are expected to recover completely (Wormser et al.). However, there is no consensus in the medical community about how to diagnose or treat persistent, ambiguous Lyme disease symptoms, which impact 10-20% of patients (Rebman et al.). Many people refer to these persistent symptoms as Chronic Lyme Disease, but term is hotly contested in the medical community. Thus, patients may suffer for years from so-called “subjective symptoms,” such as joint pain, fatigue, and brain fog, waiting in vain for a diagnosis, which, as medical anthropologist Mara Buchbinder notes, may be “the fundamental explanatory act in medicine” (9). Since Chronic Lyme patients face challenges with receiving a correct diagnosis (Hirsch et al.) and may “undergo multiple diagnostic tests while being seen by many health care professionals from numerous subspecialties, thus extending the time to diagnosis” (Drew and Hewitt 23), they seek out information in the interim.

With delays in diagnosis and few long-term solutions, Chronic Lyme disease patients are forced to consult shared health data on blogs, “Lyme literate” doctor’s websites, patient advocacy websites, nonprofit organizations, and social media platforms in an effort to get well (Singer 161). Patients and their allies face a difficult crossroads. Since there are no simple cures for Lyme disease, patients are left with one option: they can take comfort in sharing their pain, their stories, and their data to prevent others from experiencing the same suffering. For many patients, these sharing platforms are critical. For instance, users may compile their health data in apps to help them track symptoms, identify trends, chart a history of treatments. Most importantly, patients’ participation in data sharing does not (ostensibly) adversely affect their ability to obtain healthcare, render them “noncompliant,” nor interfere with their current treatment plans. In turn, ill individuals may see sharing their health information as less risky than not sharing their information. So, with few other choices, they share their data and examine other patients’ shared data.

When I first came across MLD, the primary health information sharing platform for Lyme disease, I felt energized for the first time in months. It seemed like website authors knew me and my Lyme disease story and were speaking directly to me. I was immediately drawn to the text in the center of the homepage, which reads, “IMAGINE A WORLD where people with Lyme disease are diagnosed and treated correctly and go back to living their lives” (“Home”; see Fig. 1; emphasis original). I have imagined this world for eleven years, since I was diagnosed with Lyme disease in November 2009. I am one of the 300,000 or more people who are diagnosed with Lyme disease each year (“Data and Surveillance”), and I am one of the 10-20% of patients who are affected by long-term “subjective symptoms” (Rebman et al.).  

Image shows a screenshot from the MyLymeData homepage. There is a woman standing to the left of text that reads "Imagine a world" in bold typeface.

Fig. 1. MLD homepage, 19 February 2019, Screenshot by author.

Reading on, MLD tells me, “YOU CAN BE PART OF MAKING THIS HAPPEN” (emphasis original) and implores me to “Add your Lyme data to MyLymeData to help find a cure for Lyme disease” (“Home”). Throughout the years, I have suffered significantly. I would do almost anything to prevent others from the same pain: negotiating with well-intentioned but disbelieving doctors, taking drugs that cause intolerable side effects, spending thousands of dollars on medical tests, and sleeping away their youth. I have worried about my treatments, which sometimes caused more harm than good. I have taken conventional medications, such as antibiotics, anti-inflammatories, and biologics, and paired them with elimination diets, exercise, and other complementary therapies. I have dreamed about “living” my life and recovering from Lyme disease. I have felt so powerless over my own body—which doctors tell me is my responsibility to control—and it is exhilarating to think that I can use my experience to help others. And, perhaps more importantly, to help myself. The next paragraphs explain the goals of the website, but I have already clicked the bright orange “Count Me In!” button to sign up. This is the moment I have been waiting for: I can be “counted on” to share my experiences of suffering, which, more importantly, will finally “count” for something, towards something better.

MLD’s immediate goal is quickly producing research that improves Lyme disease diagnosis and treatment processes. In a recent letter to Peitho, the Principal Investigator elaborated on MLD’s history and mission:

MyLymeData is one of the very few patient-driven research projects in the nation. The registry is a project of, which was founded in 1989 as a grass-roots organization. Over 80% of the members of the board of directors of are patients or have family with Lyme disease and the Principal Investigator is a patient who suffered from chronic Lyme disease. Hence, MyLymeData is run by patients, and holds patient interests at the center. The funding for MyLymeData is exclusively from individual donors or individual foundations. We do not sell data to pharma, commercial industry interests, or any other entity. We are a trusted community based data steward for vetting researchers, data use and re-use, and ensuring that data is used to benefit Lyme disease patients.” (Johnson, “Letter”; emphasis original)

To achieve this goal, MLD implores users to share their health data, which the MLD leadership team studies and shares with others at their discretion. “User [s]ubmitted [c]ontent,” as noted in the Terms & Conditions, “may be available for viewing by other registered users or toLDo-approved4 affiliates, service providers or other business partners of as de-identifiable data only, for research, statistical, study, and evaluation purposes” (Terms & Conditions). Because MLD is a project of, a nonprofit that has been advocating for Lyme disease patients since 1989, users likely believe that the organization’s key “principles”—patient empowerment, participation, and self-determination”—inform its selection process for data sharing (“Who We Are”). However, as a user-rhetorician, it seems as though users are an “integral, participatory force” in MLD’s data collection process (Johnson 30) but also “inevitably ancillary” when it comes to circulating and publishing the data (27). MLD cannot conduct research without users’ health data, but users do not appear to be leaders in the research development nor publication processes.

In the next section, I consider how MLD employs similar rhetorics of power, simplicity, and individuality as WATB. While the platform aims to support Lyme disease patients, my interpretation of the website’s content suggests that it does not yet offer transformative user access. As I will suggest, a truly patient-powered data sharing tool would ensure users transformative access to information as well as tangible benefits from sharing their data.


MLD’s use of the term “patient-powered” is its most significant rhetoric of user-centeredness. The term appears on nearly every page of the website. On a page titled “Patient Powered,” the term is defined more specifically: “MyLymeData expects to gather more data about Lyme disease than any research study has done before and build a patient-centered research community. That’s what patient-powered research is about!” Further down the page, the authors note that “New technology allows patients to take the lead” and “MyLymeData lets patients lead the way to help find a cure” (“Patient Powered”). As a user-rhetorician, the idea of “patient-powered” research is very exciting to me because it seems like a bottom-up, rather than a top-down, approach to gathering data. To me, “patient-power” suggests that patients are leaders in the data collection, use, and sharing processes. Traditional clinical trials are “patient-powered” in the sense that researchers gather and process patients’ data, from which they discern results and make recommendations for future research, treatments, and protocols. Patients like me do not have power beyond choosing to participate. However, the idea that MLD is “patient-powered” makes me think that typical users like me are at the helm of making important research and publication decisions.

After reading more closely, though, it becomes clear that MLD users cannot share any of the data they find on MLD without explicit permission. The Terms & Conditions page outlines the “[a]llowable [a]ctivities” for users: “users shall not disclose, post, publish, display, or transmit any of the Website content, without the written consent of” In order to do anything publicly with the “user-submitted content,” including “downloading,” “modifying,” or “distributing” the data, users must “secure all necessary rights and permissions” (Terms & Conditions). As a user-rhetorician, it might be helpful for me to look at other users’ data to see, for instance, which medications they are using to treat their Chronic Lyme disease. However, telling my illness story has always been central to my healing process. Whether I am sharing it in private groups on social media sites, blogging about it, or writing about it as part of my academic work, my personal and scholarly mission is bringing attention to the plethora of information available to health seekers and how they make decisions about that information. I draw on my personal experiences with illness to help students, academics, and community members understand why some people rely on “bad” sources, try dangerous treatments, and thwart traditional medical research. Even though the official purpose of MLD is to “allow individuals, families and medical and research providers to register certain information on the Website’s registry database” (Terms & Conditions), the rhetoric of “patient-power” that permeates the website makes me feel like the platform wants to help me directly.

Most of the MLD webpages are directive and friendly, promoting the benefits of “patient-power” in Lyme disease research. Regardless of what any other page says, though, I am bound by MLD’s terms and conditions. While the majority of the website is replete with invitational, bold colors and graphics, the Terms & Conditions page seems typically system-centered. It includes large blocks of text and does not match the same infographic style as the rest of the website. In my work as a patient and as a rhetorician, comparing, analyzing, and amplifying recent research about Lyme disease is crucial. While many health information sharing platforms do not allow even partial access to disaggregated, deidentified data, MLD does not offer me transformative access if I cannot share the information without a review and approval process.

Moreover, as a user-rhetorician, I trust the leaders at MLD to make careful choices about who is allowed to access my data. However, I was not permitted to gain researcher-level access to the MLD data, which made me wonder about the selection process. When I contacted MLD in 2017 about their work and asked for a copy of their survey questions, the Primary Investigator offered to talk with me but wrote that it was “unlikely that [she] would provide [me] with a copy of [the MLD] survey as it is confidential and proprietary” (Johnson, “Dissertation”). Ultimately, we were unable to connect. I was surprised that MLD seemed opposed to allowing a graduate student, especially one who is deeply invested in seeking equitable treatment for Lyme disease patients, to review their survey. While there may be valid reasons why MLD chose not to provide me with researcher-level access to their data, the process made me—a user-rhetorician—question how their policies were different from for-profit health information sharing platforms. To whom do they give access and why? Again, I was reminded that even though I contributed my data, I cannot share it without permission, even in service of conducting additional research to further the cause.

As I continue to review MLD as a user-rhetorician, I am struck by some of the paradoxes of the “patient-powered” research process. It seems like patients power the website by sharing their data, but patients have little power in what happens to their data once they share it. It seems like the idea of health information sharing is powerful enough to harm patients, but MLD employs powerful rhetorics to persuade users to share their data with minimal acknowledgement of the potential consequences. Even though MLD does not sell patients’ data, other organizations and companies do. I am surprised that there is not greater acknowledgement of the problems with data misuse and breaches, especially since MLD is a nonprofit and does not benefit financially from patient’s data. There are also other, more subtle places where I am reminded that I am a regular user—that my “patient-power” is serving MLD rather than me specifically. On the “About MyLymeData” page, the MLD authors note, “After the first one, we will send you additional surveys (about quarterly) asking additional questions and tracking your progress. We will let you know what we discover.” The we-you-we pattern here illuminates a persuasive hierarchy: MLD is the organizing and authoritative power that propels me into action, but they cannot have power without me. Although users can view the data, only high-level authorities make decisions about developing, analyzing, and circulating it for broader audiences. While the advisory board members are primarily Lyme disease patients and healthcare experts, they are also business leaders, authors, and members of other advisory boards (“Board of Directors”). At press time, they hail solely from California and Utah. It is hard to imagine that they fully understand my experiences as Lyme disease patient from the east coast and that I would agree with their choices about collecting and publishing MLD’s data. This hierarchy is very different from WATB, in which users are encouraged to adapt the course to meet their personal and specific community’s needs. Again, I was struck by the differences between MLD’s discussion of “patient-power” the discussion of power in WATB. Instead of empowering users to become part of the health information sharing process to help themselves and help reform the healthcare system, MLD’s rhetoric struck me as a classic example of neoliberalism at work, in which patients are conscripted into sharing their data and are not compensated for their efforts.


In addition to the focus on “patient-power,” the MLD authors deploy ostensibly user-centered rhetoric that acknowledges users’ individuality. MLD’s focus on individuals and individuality is primarily constructed through two key phrases, which appear on multiple pages of the website: “Count me in!” and “Can one make a difference?” (see Fig. 1). These phrases appear to be user-centered, but they ultimately work to persuade patients to contribute their data to MLD, which may not necessary help them directly. This is vastly different from the authors’ inclusion of personal stories and perspectives in WATB. The phrases, “Count me in!” and “Can one make a difference?,” emphasize that individual voices are not merely important but integral to finding a cure for Lyme disease.

Image is a screenshot of the MyLymeData website showing a page where users can sign up to be part of the study by clicking on an orange button that says "Count Me In!"

Fig. 2. “Count Me In!” button on the “About MyLymeData” page, 19 February 2019, Screenshot by author.

The phrase “count me in!” has multiple meanings, particularly for Lyme disease patients like me (see Fig. 2). Although researchers in fields such as entomology, public health, rheumatology, and infectious diseases are studying Lyme disease, there have been only a few clinical trials for patients with Chronic Lyme (Turk et al.). Clinical trials for Lyme disease often have strict inclusion criteria, requiring multiple positive tests and the presence of a bull’s eye rash. I, personally, have not qualified to participate in any clinical trials despite all of the documentation verifying that I tested positive for Lyme disease. Since interested patients like me are unable to participate in these clinical trials, we are excited about other opportunities to advance research. More than that, I want to be counted. After years of doctors questioning my pain and evading answers about my prognosis, I want to move forward knowing that others will not have to suffer in the same ways that I did. The language of “counting” honors individuals’ identities, stories, and experiences, especially Lyme disease patients who do not “count” in other settings. This user-centered rhetoric invites users to contribute their data and authorizes them to share diverse experiences. It’s important to note, however, that once I am “counted,” I am still not authorized to share any information I learned from MLD without permission.

Image is a screenshot from the MyLymeData website showing a still image to a video with "Can 1 Have Power?" written in orange text. Underneath in a bright blue banner is the text "Add your Lyme data to MyLymeData to help find a cure".

Fig. 3. “Can 1 Have Power?” video slide, 19 February 2019, Screenshot by author.

The second phrase—“one can make a difference”—suggests that that I, personally, can help create new scientific knowledge about Lyme disease. This phrase is primarily presented in the 1:28 minute video, “Can 1 Have Power?,” which is featured at the top of the MLD “Home” page as well as on the “Videos” page (see Fig. 3).This video begins by asking “Can one person have power?” and tells me, “If you have Lyme Disease, YOU’RE NOT ALONE” (“MyLymeData Videos,” emphasis original). This statement resonates with me. For the first five years especially, I felt isolated because of my illness. Each time a friend complained that I cancelled plans due to illness, asked why my fatigue could not be cured with a nap, or wondered how I could be so young and so sick, it reaffirmed that chronic illness was destroying my social life. The video goes on to introduce “big data,” which is framed as a “new kind of research” that combines individual experiences to learn more about Lyme disease. As a user-rhetorician, I’m surprised by the simplistic definition that is offered: big data “is a big deal” and “allows you to fight Lyme disease with your own health information.” Starting in 2013, so-called “big data” has been critiqued in highly respected publications such as The New York Times, Scientific American, Time Magazine, Newsweek, and The Atlantic. The video goes on to explain, “When researchers study lots and lots of health data from you and thousands of others living with Lyme disease, they can see patterns. And those patterns could lead to better understanding, treatments, or even a cure for Lyme disease.” I can appreciate this idea, but it also makes me wonder: What will be missed by looking at Lyme disease experiences through a big data lens? I am worried about what “big data” means at MLD and how they take care to preserve the texture and individuality of people’s stories. It seems like users do not need to understand anything about science or “big data” to feel agented (or perhaps more significantly, obligated) to contribute to Lyme disease research. The video concludes, “It’s within your power to change the future, starting right now. Add your Lyme data to my Lyme data, and help find a cure for Lyme Disease.” At this point, it almost seems unethical for me not to contribute my data and increase the seemingly exponential power of MLD’s big data project.

After watching the video, I can understand how big data might be a useful tool for researchers, but I am not yet sure how it will help me individually. To me, it makes sense that gathering and analyzing large quantities of data and searching for patterns can provide new insight about Lyme disease. Perhaps when this research is published it will make a difference for me, but in the interim, I am not sure what this research method offers. It seems like another example of how the MLD appears to center users but has designed the platform to serve their own interests. On the “About MyLymeData” page, MLD suggests that “big data” is what makes their study so simple and easy. They cite three easily comprehensible benefits of big data research: it “provide[s] lots of information,” “uses very broad entry criteria,” and “examines treatments used in the real world.” And yet there is no acknowledgement that big data requires patient labor and creates an exclusive sharing economy, which economist Chris J. Martin defines as the exchange of knowledge, tools, skills, or other information that is primarily “driven by digital technologies” (152). As it plays out on MLD, users must become members and share their data in order to gain access to the platform’s data repository. Although sharing economies may lead to “a more sustainable form of consumption,” they may also be rhetorically “reframed by regime actors as purely an economic opportunity” (Martin 149). In other words, sharing economies may reinforce system-centered practices and technologies. Estee Beck notes that sharing can allow for “reciprocity, trust, and…altruism,” but her work suggests that it can also have a “dark side” that involves “capitalistic exploits of unpaid labor of its users” (38). I am left wondering about how the sharing economy shapes MLD’s big data project. It is difficult to compare it to WATB, which does not require users to share their data to gain access to the information and has clear benefits for individual users.


As I think more about MLD and how its rhetoric agents me—as an individual—to share my story and my data, I cannot help but think about how easy the website makes it to do so. MLD employs a rhetoric of simplicity and goes to great lengths to make it possible for users to contribute, but it prompts me to ask: How could contributing my personal health data be so simple? What am I missing? The language of simplicity, ease, and speed contradicts the rhetoric of complexity that typically undergirds scientific work.

These concepts appear on most pages of the MLD website, beginning on the “Home” page. The authors contend, “Our patient surveys draw over 9,000 responses! We’ll use the information provided by patients to help figure out how to prevent and treat all stages of Lyme disease. It’s that simple” (emphasis added). Similarly, the “About the Study” page urges users to “Sign up to become part of the study. It’s easy” (emphasis added). It is strange to think about the MLD surveys as “simple,” since there are multiple surveys that ask hundreds of questions about users’ experiences with Lyme disease. For me, answering all of the questions might require me to look back at my medical records, speak with my range of medical specialists, and “fact check” key symptoms and dates with my partner. Furthermore, “simply” taking the survey may require a relatively high level of medical literacy that goes beyond the scope of some users’ comprehension. In turn, the repetition of this language seems to detract from the complicated issues at stake, such as data security. 

Image is a screenshot from the MyLymeData FAQ webpage. It shows two questions "How do I sign up for the study" and "What's the purpose of MyLymeData" on the lefthand side of the page, and the questions' corresponding answers on the righthand side.

Fig. 4. MLD FAQ page, 19 February 2019, Screenshot by author.

With these issues in mind, I turn to the FAQ page in search of answers. As a user-rhetorician, I see FAQ pages as essential to my understanding of how a platform works and what I can expect if I choose to engage with it. By nature, FAQ pages appear to be user-centered because they seem to anticipate users’ questions and concerns. In this case, however, the MLD FAQ page appears to prioritize its organizational needs over me, the user. Users are immediately confronted with this concept of simplicity, starting with the first question: “How do I sign up for the study?” (see Fig. 4). Rhetorically, the content managers have chosen to put this information first because they want users to pay the most attention to it. The answer to this question, accordingly, is “Signing up is easy. Just fill in the required information. Then, simply take your first survey” (“FAQ,” emphasis added). Two FAQ questions in particular focus on the language of simplicity. In the answer to Question 7, the content creators report that “If you are of legal age (18 years old in most states), simply sign up” (emphasis original). Similarly, in question 9, which is about privacy, the answer notes that if I get uncomfortable, “[w]ith few exceptions, [I] can simply skip questions [I] prefer not to answer” and that if I decide to withdraw from the registry, I can “[s]imply contact the registry and all of [my] data will be removed from the database” (“FAQ,” emphasis added). The repetition of the word “simply” here is notable because without signing up and taking a survey, it is unclear, exactly, how easy it is for participants to skip questions and revoke their data.

Some of the questions that I need answered, such as “How will my data be used?” and “What about privacy?” are buried in the middle of the FAQ list, which does not have numbers or bullet points. For me to read the list, I am forced to either control+F search for this information or skim through large blocks of small text. The second-to-last questions—“Is there IRB approval for the study?” and “Who can I contact if I have questions about the study?”—may be the most important of all, but again, they are buried in the FAQ list and are not organized in a user-centered way. The questions themselves are easy to read, but they generally focus on how I can contribute to MLD rather than how MLD will protect me, my story, and my data. For example, Question 5 reads, “What is expected of me?” and Question 7 reads, “How can I participate?” These questions prioritize me, the user, by employing first-person language, but the answers repeat information that is available throughout the website rather than sharing additional details.

After I review the FAQs, I find that I still have other questions, so I look for the MLD contact information. The MLD website “Contact” page (which is accessible only via a small link at the bottom of the home page that says “CONTACT,” emphasis original) has two buttons: one for “MyLymeData Support” and one for “Researchers.” If users click on the “MyLymeData Support” option, they must select one of five ambiguous subcategories, none of which directly address potential issues with data breaches or other negative consequences of data sharing. Overall, I am left concerned about a number of issues: Is revoking my data a truly simple process? If the “Contact” page does not offer an option that matches my concerns, where will I go to find additional information?


Unfortunately, nearly fifty years later, many of the problems articulated by the WATB authors remain unsolved. Many patients still do not receive necessary preventative care (183). Black women are three- to four-times more likely than white women to die in childbirth—unchanged from 1970 (183).5 As the authors lamented, children still lack sufficient vaccines and major cities are experiencing outbreaks of previously eradicated diseases (179). We have been unable to ameliorate the root causes of so many health problems: “bad housing, poor nutrition, poor sanitation, pollution, and dangerous working conditions” (179). It is still true that many of these issues are “suffered mainly by poor people who have no control over them” (179). And, perhaps worst of all, the U.S. still spends more money per person on healthcare than any other country (182).

Accordingly, feminist rhetoricians and healthcare activists are tasked with identifying “new forms of feminist knowledge that meet the challenges of corporatized, neoliberal health care” (Dubriwny 154). One of these challenges is figuring out who, specifically, health information sharing platforms aim to support. It is easy to imagine how health information sharing platforms would be different if average patient users had transformative user access to their research, data collection, and publication processes. In Kristin Arola’s book chapter, “Indigenous Interfaces,” she considers how Facebook would be different if it had been created “by and for” American Indian users (209). Drawing on interviews with twelve American Indian people, mostly from the Keweenaw Bay Indian Community Lake Superior Band of Chippewa Indians, Arola argues that a Facebook for American Indians would look different, perhaps using Native colors and “iconic image[s] like a feather or medicine wheel” (212). She also suggests that it would be used differently, in a way that “allows and encourages certain actions important to a group of people” (215).

What are the actions that are important to people with chronic, contested, and ambiguous illnesses? Building on Arola’s findings, health information sharing platforms could allow for transformative user access by taking the following steps:

  1. Allowing patients to publicly use and discuss their data.
  2. Discussing the benefits and limitations of using “big data” as a research method and explaining how the platform is truly doing “big data” differently than other companies and organizations, which may sell or misuse data.
  3. Making the FAQ and terms of service pages more user-centered. Ultimately, terms of service documents are legal documents that govern data use and misuse. Adding bolding, highlighting, and other forms of emphasis; eliminating legalese whenever possible; and providing context about why users have certain rights and not others would invite transformative access.

Most importantly, it is integral that average patient users can be intimately involved with managing the site, making changes based on evolutions in patients’ needs, and analyzing and publishing the results of data collection projects. Instead of emphasizing the simplicity of big data and avoiding discussions of the potential for data misuse, which are typically only addressed in terms of service documents to which users must agree before signing up, health information sharing platforms should be community-oriented. They should provide tools to help users mine through other users’ data and anecdotes. They should include supporting information that contextualizes conventional and radical treatments, thus integrating scientific and medical research alongside patients’ stories. They should provide talking points for discussing the data with different types of healthcare providers (such as primary care providers versus specialists) and have charts outlining potential responses, noting how a patient might proceed if their efforts to share data are rebuffed.

In a world without dependable texts like OBOS to ground patients’ research, feminist rhetoricians must continue investigating Dubriwny’s core questions, especially: How can we “recognize” the important work of apps, website, and health data sharing platforms in a way that presents a “critical stance” yet does not “unquestioningly embrace” them entirely (161)? There is much work to be done, and by considering issues of power, individuality, and simplicity in language and information design, feminist rhetoricians are equipped to lead the way.


  1. This article was updated in March 2020 in response to letters from and Invitae. The author wishes to thank representatives of these organizations for their interest in her article. The author has updated this article in an effort to correct any potential misunderstandings about the work of and Invitae Corporation. To most effectively define the goals and work of these organizations, the author has chosen to quote directly (rather than paraphrase) from their websites and recent correspondence, sometimes at greater length than is typical in peer-reviewed journal articles in rhetorical studies. [return to text]
  2. As I’ve written elsewhere, patients are forced to find, contextualize, and evaluate what I call “wildcard sources” in their quest for good health information. Wildcard sources typically include a range of scholarly and non-scholarly features, such as “personal testimonies, interpretations of scholarly research, plain language descriptions of complex diseases, reference lists, frequently asked questions sections, and descriptions of provider qualifications” (164). [return to text]
  3. WATB and OBOS have been critiqued for its focus on white, middle and upper-middle class women’s experiences. While they may not have transformed the healthcare system for women of color nor people with other multiply marginalized identifies, the manuals clearly “[call] attention to” gender, race, and class power dynamics (De Hertogh, Lane, and Ouellette 12). [return to text]
  4. The author is unsure if this is a spelling error or an acronym. [return to text]
  5. This statistic has been reported by multiple publication venues. For more information, see the CDC’s Pregnancy Mortality Surveillance System webpage. [return to text]

Works Cited

About MyLymeData.” MyLymeData. Accessed 19 Feb. 2019.

Adams, Heather Brook. “The Feminist Work of Unsticking Shame: Affective Realignment in the 1973 Edition of Our Bodies, Ourselves.” Peitho 21.3 (2019): 580-598.

Arola, Kristin L. “Indigenous Interfaces.” Social Writing/Social Media: Publics, Presentations, and Pedagogies, edited by Douglas M. Walls and Stephanie Vie, The WAC Clearinghouse and University Press of Colorado, 2017, pp. 211-226.

Beck, Estee. “Sustaining Critical Literacies in the Digital Information Age: The Rhetoric of Sharing, Prosumerism, and Digital Algorithmic Surveillance.” Social Writing/Social Media: Publics, Presentations, and Pedagogies, edited by Douglas M. Walls and Stephanie Vie, The WAC Clearinghouse and University Press of Colorado, 2017, pp. 37-52.

Board of Directors.” Accessed 20 Feb. 2020.

Boston Women’s Health Collective. Women and Their Bodies. 1970.

Buchbinder, Mara. All in Your Head: Making Sense of Pediatric Pain. U of California Press, 2015.

Data and Surveillance.” Centers for Disease Control and Prevention. Accessed 2 March 2020.

De Hertogh, Lori Beth. “Feminist Digital Research Methodology for Rhetoricians of Health and Medicine.” Journal of Business and Technical Communication 32.4 (2018): 480-503.

De Hertogh, Lori Beth, Liz Lane, and Jessica Ouellette. “‘Feminist Leanings:’ Tracing Technofeminist and Intersectional Practices and Values in Three Decades of Computers and Composition.” Computers and Composition 51 (2019): 4-13.

Doshi, Marissa J. “Barbies, Goddesses, and Entrepreneurs: Discourses of Gendered Digital Embodiment in Women’s Health Apps.” Women’s Studies in Communication 41.2 (2018): 183-203.

Drew, Debra, and Hilary Hewitt. “A Qualitative Approach to Understanding Patients’ Diagnosis of Lyme Disease.” Public Health Nursing 23.1 (2006): 20-26.

Grundy, Quinn, et al. “Data Sharing Practices of Medicines Related Apps and the Mobile Ecosystem: Traffic, Content, and Network Analysis.” BMJ 364 (2019): 1920. doi 10.1136/bmj.l920.

Hallenbeck, Sarah. Claiming the Bicycle: Women, Rhetoric, and Technology in Nineteenth-Century America. SIU Press, 2015.

Home.” MyLymeData. Accessed 19 Feb. 2019.

Jack, Jordynn. “Leviathan and the Breast Pump: Toward an Embodied Rhetoric of Wearable Technology.” Rhetoric Society Quarterly 46.3 (2016): 207-221.

Johnson, Lorraine. Letter to Jen Wingard and Wendy Sharer. 23 January 2020.

—. “Re: Dissertation.” Received by Sarah Singer, 11 April 2017.

Johnson, Robert R. User-Centered Technology: A Rhetorical Theory for Computers and Other Mundane Artifacts. SUNY Press, 1998.

Hirsch, Annemarie G., et al. “Obstacles to Diagnosis and Treatment of Lyme Disease in the USA: A Qualitative Study.” BMJ Open 8.6 (2018): e021367. doi:10.1136/ bmjopen-2017-021367.

Martin, Chris J. “The Sharing Economy: A Pathway to Sustainability or a Nightmarish Form of Neoliberal Capitalism?.” Ecological Economics 121 (2016): 149-159.

Patient Powered.” MyLymeData. Accessed 20 March 2020.

Rebman, Alison W., Soloski, Mark J., and John N. Aucott. “Sex and Gender Impact Lyme Disease Immunopathology, Diagnosis and Treatment.” Sex and Gender Differences in Infection and Treatments for Infectious Diseases, edited by Sabra L. Klein and Craig W. Roberts, Springer, 2015, pp. 337-360.

Relman, Arnold S. “The New Medical-Industrial Complex.” New England Journal of  Medicine 303.17 (1980): 963-970.

Seigel, Marika. The Rhetoric of Pregnancy. University of Chicago Press, 2013.

Singer, Sarah Ann. “Embracing Wildcard Sources: Information Literacy in the Age of Internet Health.” College English 82.2 (2019): 152-172.

Turk, Siu P., et al. “Post-treatment Lyme Disease Symptoms Score: Developing a New Tool for Research.” PloS One 14.11 (2019): e0225012. doi:10.1371/journal.pone.0225012.

Wells, Susan. Our Bodies, Ourselves and the Work of Writing. Stanford University Press, 2010.

“Who We Are.”, Accessed 20 March 2020.

Wormser, Gary P., et al. “The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America.” Clinical Infectious Diseases, vol. 43, no. 9, 2006, pp. 1089-1134.

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Tracing the Future Lineage for OBOS: Reproductive Health Applications as a Text for Feminist Rhetorical Inquiry

As women, knowledge of our reproductive organs is vital to overcome objectification…The purpose of this paper is then to help us learn more about our own anatomy and physiology, to begin to conquer the ignorance that crippled us in the past when we have felt we don’t know what’s happening to us. The information is a weapon without which we cannot begin the collective struggle for control over our own bodies and lives.

(Boston Women’s Health Course Collective, p. 9-10)


This abbreviated essay discusses the future of feminist health rhetorics research given the announcement that the Boston Women’s Health Collective will no longer publish updated versions of Our Bodies, Ourselves. Specifically, we situate the Collective’s decision to end production of this important text by considering the rise of (and simultaneous reliance on) female reproductive health technologies, commonly referred under the scope of the “FemTech” industry.1 This industry is largely technology-driven, promising women’s empowerment in health-related decisions through the collection of personal health data. Examples of such products and services include mobile reproductive health applications such as Clue (a period and health tracker), Glow (an ovulation and period tracker used often for predicting fertility), and Maven (a digital clinic for women). Recent projections predict FemTech to become a $50 billion industry by 2025 (“FemTech Digital”). Frost and Sullivan’s reporting indicates that this boom in female-centered health technology can be traced to new statistics citing women as primary users of digital health tools. In fact, these statistics reveal that women are 75 percent more likely to use digital tools for healthcare than men (Magistretti). Additionally, 66 percent of female internet users look online for healthcare information (“FemTech—Time”). Frost and Sullivan’s findings underscore women’s turn towards technology as a platform to increase empowerment in the making of health decisions and marks a palpable shift in the types of texts women consult and trust when seeking new methods for assessing health information. Nonetheless, we find that without the publishing of Our Bodies, Ourselves (OBOS), the FemTech industry would not be the dominant industry it is becoming today. OBOS laid the foundation for valuing new methods that enhanced women’s health literacies by fusing both embodied and medical expertise into one text with the goal to increase female agency and sense of empowerment in making health decisions.

In what follows, we trace the parallels between OBOS and reproductive health technologies with a focus on period and fertility tracking applications; both can be seen as resources that seek to empower female users with an increased self-knowledge about their reproductive health. Establishing commonality between the two resources, we turn our attention to their differences and how reproductive health applications and FemTech at-large. A critical look at these reproductive health applications unearths how data collection that occurs within the apps precariously positions female users and impacts their assertion of agency over their health. We examine the feminist ethics of collecting personal health data in exchange for providing female users with an increased self-knowledge about their reproductive health and suggest how OBOS’ history can inform more ethical, feminist approaches to the collection of personal data in these applications. Pivoting outwards, we reflect on what FemTech technologies, like reproductive applications, can learn from OBOS’ past by pointing to a series of questions to guide future feminist health rhetorics research. These questions may be viewed as an invitation for further scholarship that evokes critical care, an idea that posits rhetorical scholarship can influence how care is extended to scenes of health and its stakeholders. We end by articulating that perhaps the most important contribution OBOS made to women’s health, including the rise of the FemTech industry, was the ability to collectively use one’s voice to advocate for better care.

From the Textual to the Digital: A Commitment to Empowering Women

For over 40 years, OBOS operated as a “living document” representing a collective of female voices, which “provided the tools for women readers to challenge medical decision making and to seek alternative structures of care based on the notion of experiential knowledge” (Kline 11). Strategically, the text was always in a state of revision so as to be “viewed as a tool which stimulates discussion and action, which allows for new ideas and for change” (OBOS 5). Additionally, the Collective’s decision to write the text as a fusion between medical terminology and embodied experience allowed for crowd-sourcing of expertise, thereby providing women access to medical discourse so as to advocate for their own personal experiences.

Because of OBOS, expertise was no longer in the hands of medical professionals, but women had access to the complex medical language that discussed their bodies as well. Susan Wells explains, “this language destabilized the relationship between expert knowledge and experience to suggest a different way of knowing the body” (707). Further, the coupling of medical discourse with embodied experience provided new moments for increased patient agency, inviting female patients to share with each other and, later, with their doctors how they felt (emotionally and physically) during a procedure and/or illness. For example, Wells explains how this fusion enhanced female agency in the clinic, writing: “women who shared their stories of menstruation or childbirth empowered one another to effect or demanded change” (72). Through the collective, women shared stories that enabled them to look at their bodies as a source of inherent knowledge. These stories challenged the top-down expertise on the female body from physician-to-patient, and, instead, empowered women to have access to medical and embodied discourses resulting in more of an equal stake in their care. The Collective’s decision to incorporate personal experience into the narrative notably allowed for a “process of transforming medical knowledge into something subjective, political, and empowering” (Kline 15). As a book, OBOS structurally changed the language of how women talk about their bodies and the ability to challenge notions of medical expertise.

By changing women’s access to medical language/terminology and, thereby, increasing their health literacies, OBOS created strategic linguistic moves to emphasize “embodiment as central to emancipation” (Wells 715). For example, in the 1973 edition of OBOS, the Collective underscored their embodied approach to the book claiming, “For us, body education is core education. Our bodies are the physical bases from which we move out into the world; ignorance, uncertainty—even, at worst, shame—about our physical selves creates in us an alienation from ourselves that keeps us from being the whole people that we could be” (1973, xix). OBOS served to create a counter approach to prior female experiences in the clinic. It radically changed where expertise lived—no longer only from the position of physician but as negotiated expertise between female patient and medical expert. In many ways, OBOS made space for boundary spanning, which works to establish authority “by demonstrating their ability to use the techniques and vocabulary of the dominant profession or community” (Lay 78). By making medical terminology more readily available and accessible to women, OBOS served as a text that allowed individuals to become an authoritative subject over their health. Yet, how OBOS represented women’s embodied experiences was often criticized for a lack of “a commitment to honor difference, particularly racial difference” (Wells 710). As the project developed, a real need emerged “to negotiate two commitments: to the body as universal, as the ‘real’ upon which feminist solidarity could be based, and to the differences in women’s modes of embodiment as they are shaped by class, race, sexual orientation, and age” (Wells 714). Readers of the text identified a need to acknowledge that while bodies may be female, their lived experiences in the world and experiences with health are directly impacted by their varied lived experiences and positionalities. This critique that OBOS sought to speak for all women continued as the book was reprinted. Wendy Kline explains that “readers expected to find themselves described within the book’s pages, and expressed confusion, disappointment, frustration, or anger if they did not” (31-32). As Wells and Kline point out, while OBOS as a text sought to be inclusive and empowering, issues of representation remained.

Reproductive health applications, and the rise of the FemTech industry, mirror OBOS’ commitment to women’s empowerment, offering personalized health information that also asserts that women’s health varies between bodies. As digital texts, reproductive health applications operate as technologies that empower users by

  1. their wide accessibility and affordability, and
  2. their capacity to collect and interpret personal health data to enhance agency in health-related decisions (Novotny and Hutchinson).

These two points, we argue, make FemTech more appealing than less-digital texts such as OBOS. And while, OBOS will no longer update its text, new reproductive health applications are being developed and downloaded for use at a consistent rate. For example, a 2015 IMS Institute for Healthcare Informatics report found that of the 90,088 health apps in the U.S. Apple iTunes store, 7 percent of them are marketed solely as products assisting with women’s health and pregnancy. Another study reported that women who are under the age of 35, trying to become pregnant, and have regular cycles are more likely to use apps to track their periods than other women (Lanham and Christensen). Additional studies cite that use of these applications support more interactive and engaged conversations between women and their physicians concerning their reproductive health (Haelle). The embrace of these apps, the impact they have had on patient-physician interaction, and the ease of accessing these applications for relatively no-to-little-cost suggests how they mirror much of the self-empowerment intentions of OBOS.

Therefore, the intuitive design of these technologies enhances the use and appeal of FemTech compared to a physical text like OBOS, as these apps are generally affordable, easily accessible on a mobile device, and generate personalized health information that recognizes the embodied differences of individual users. The default requirements of their programming ask users to input name, weight, race, gender, age, height, and detailed information about their reproductive cycles. The collection of this information, when collated through the complex algorithms within the application, seek out to provide users with an individualized, tailored user-experience directed personally for them. These apps mirror prior commitments made by OBOS and the women’s health movement which argued that bodily knowledge can support women’s agency over their bodies. In these ways, reproductive health applications embrace the commitments of OBOS and simultaneously respond to the need to recognize difference in women’s embodied experiences.

Though specific facets of both OBOS and FemTech support women’s ability to assert more agency over their bodies through acquisition and access to medical discourse about their body’s functions, certain limitations still present issues. Marissa J. Doshi built off of feminist communication research that showed how reproductive health applications operate based on traditional, heteronormative ideologies of gender to study how these applications also reinforce beliefs on what constitutes a “healthy female subject” (185). Looking at applications within the iTunes app store that specifically targeted women’s health, Doshi found that these applications overwhelming depict white women who fit the Barbie stereotype, are “bikini ready,” and exists in a resting state of fertility (187). Doshi’s research points to how the marketing and design of FemTech further normalizes limited—and even oppressive—views of what constitutes a healthy woman. FemTech offers the potential to increase women’s agency over their reproductive health, but also encapsulate limitations of representation that OBOS has as well.

Troubling the Empowerment of “DIY” Health Technologies: FemTech for Profit

We find reproductive health FemTech operates as “do-it-yourself” (DIY) technologies. Such applications offer a variable of services to monitor user’s bodies that provide them with substantial information about how their reproductive cycles function. Many track women’s menstruation cycles to predict ovulation dates in order to help users either plan for or avoid pregnancy. Applying user generated data, some, such as Glow, provide financial support to guarantee pregnancy; others collect and compile user data to provide substantial reproductive health information such as STI/D prevention (Clue) or promise to work as digital contraception (Natural Cycles). The popularity of these apps shows just how needed they are and how necessary users find having access to both information and the means to monitor their body’s reproductive health on their individual terms.

Technology companies have capitalized on these reasons and promoted their apps accordingly. However, as the Electronic Frontier Foundation (EFF) reports, “Women’s health is big business” (Quintin 3). Not only has news surfaced that these apps tend to fail in their marketing promises, but they also have significant security issues. In 2017, EFF published The Pregnancy Panopticon, a twelve-page research report that analyzed security and privacy issues within the most popular apps claiming to empower women over their reproductive health. EFF found that, while many of these apps like Glow and Clue use certificate pinning (a security measure that protects data from being intercepted in transit between the user to the company’s servers that, apparently, most bank applications do not even use), they tend to allow third parties to track users throughout their use of the app (Quintin). The big business of women’s health through FemTech inevitably means that the data provided within these apps—content users provide through app use—is what drives profit. Michelle Murphy’s work points to how necessary–and feminist-it can be for women to look at their own bodies (117), whereas reproductive applications can mediate how users visibly interface with their bodies in similar ways.2 If the empowering promises of FemTech texts are replacing the use of OBOS, we would like to call on feminist health rhetorics scholars to investigate how the collection of data empowers and creates moments of agency through for users of these reproductive health applications interactive participation.

The Feminist Ethics of Collecting Personal Health Data

Our scholarship has focused on FemTech because we have experienced the value of reproductive health apps first-hand (see “Teaching a Critical Digital Literacy of Wearables: A Feminist Surveillance as Care Pedagogy” and “Data Our Bodies Tell”). For example, Maria has relied on fertility and ovulation prediction applications as an alternative option to expensive out-of-pocket clinical services. Les looked to several pregnancy platforms during her complicated pregnancy to gain insight for navigating health complications. Like other users of these applications and technologies, we, too, value the appeal of these apps to have support while making health decisions across a variety of industries that are often costly, inaccessible, and even invasive or depersonalized.

Incidentally, we also know, as feminist researchers who think critically about how our bodies are implicated through our technologies, that the data collected from our bodies by these applications raise concerns both for their security issues, but also their backend design to profit off of user bodily data. We have previously discussed the implications of third-party tracking, explaining that both collecting and providing access to data to third parties through these apps envelops users in a non-consensual relationship with unknown entities (Hutchinson and Novotny). Because, while many of these apps have extensive security backend design to prevent public leaking of sensitive health data, they still give access to private (and often silent) corporations at the benefit of the technology companies.

Acknowledging these design contractions, we find that FemTech apps are not as empowering as they make themselves out to be, and offer a definition of empowerment situated in rhetoric. Natasha Jones explains that “while rhetorical agency creates a (negotiated) rhetorical space for resistance and potential change, empowerment represents the actual enactment of rhetorical agency in a transformative way” (342). Her emphasis on empowerment needing the capacity to act with rhetorical agency shows how users of FemTech would need the ability to enact agency over their health data. To be more empowered as users of reproductive health apps, women should have a say in what data is collected from their bodies, how it is collected and stored in the company’s servers, and who has access to their personal, private health information. We consider here the ethical problems surrounding data collection when users have no means for input or negotiation when that data is content derived from the body. In her chapter “Terror and the Female Grotesque,” Rachel Hall felt prompted to move conversations around surveillance “away from matters of privacy, security, and efficiency to a consideration of the ethical problem of combating new forms of discrimination that are practiced in relation to categories of privilege, access, and risk” (148). Hall’s prompt returns us to OBOS’ purpose: women feeling empowered over their reproductive health with language and knowledge through the collective uplift of their voices. Though FemTech may do all of these things, the self-knowledge gained does not solely rest with the individual user. At the end of the day, all the bodily data collected is for sale. We wonder, for those of us doing feminist health rhetorics, how can we intervene to support further feminist empowerment via FemTech?

Future Questions to Guide Feminist Health Rhetorical Research

We see the capacity for OBOS to inform ethical approaches in reproductive health application design. For instance, Kline reminds feminist researchers of OBOS’ commitment to honoring the lived experiences of users of the text. She explains, “By its very formation, then Our Bodies, Ourselves encouraged readers to respond” (Kline 90). However, Kline and other scholars have noted the limited capacity to integrate a diversity of representations in the text and also found issue with OBOS’ lack of providing women with the means to address gender discrimination from their physicians (98). This same fundamental commitment to inviting readers critique and response is a feminist ethic we also see missing in the FemTech industry. Technology companies can better design their reproductive health apps to adapt critique and response through user experience surveys regarding data collection and consent, consultation with privacy and surveillance scholars, and by redesigning Terms of Service/Use with options for users to decide what and how their personal, private health data is collected, stored, and used by the technology companies and their third parties.

We also propose that reproductive health technology companies and designers take note of The Design Justice Network’s series of principles that can guide ethical, just design. These Network Principles3 set a standard of practices that promote decolonial, feminist, community-based practices that challenge us all to consider how we can evaluate and intervene with these technologies. By redesigning apps that already work to promote user empowerment in many ways, but still require change to limit commodification and exploitation of users through data collection, these applications can fully fulfill their marketing promises to their users by respecting them as knowledgeable contributors to the application’s community.

We offer the following questions as consideration to guide technology designers, researchers, educators, and users in evaluation and intervention of FemTech and reproductive health applications:


We call upon designers, as well as instructors of design, to consider not only the use of health applications but the ethics of these applications. The questions below, we hope, will guide more just design and ultimately empower users of FemTech applications.

  • What does a more socially just design of a reproductive health application look like?
  • What aspects of data collection could this design adopt to support user empowerment?
  • What is beneficial and supportive about the apps already available to users that helps them feel empowered over their health data, and how can designers continue designing for what works well while making more supportive accommodations?
  • In what ways can designers create applications that invite responsive critique from users during real-time app use?


As feminist health rhetoricians, we seek to not only critique the limitations of FemTech but hope our scholarship may respond and inform user empowerment. We see then these questions as guiding future feminist health rhetoric inquiry:

  • What feminist theories and methodologies would inform the design of reproductive health applications to promote user agency?
  • What sub-fields or related areas of inquiry might feminist scholars draw upon to respond to the collection of personal data in reproductive health applications? How may these fields inform or re-envision an empowering user experience?
  • How may feminist commitments of inclusivity and social justice assist in how researchers gauge and study user experience of reproductive health applications?
  • How might Indigenous research methodologies inform data collection and storage so as to limit the effects of cultural appropriation, racism, and the technology industry’s ecological imprint on the land?


Many feminist health rhetoricians apply their scholarship to writing, rhetoric, and/or technical communication classroom. In these positions, we may instruct and train future designers and users of FemTech. We see the following questions as informing our instruction and curriculum design:

  • What courses would be most beneficial for students to inquire about socially just application design?
  • What readings and assignments would work well pedagogically in support of these courses’ curriculum?
  • How can a service-learning course be designed to critique the collection of personal data and serve local and global communities invested in inclusive responses to reproductive health?
  • How can writing studies educators bridge relationships between community stakeholders and FemTech industry partners to support collaborative design of empowering reproductive health applications?


As feminist health rhetoricians, we and our students are also potential users of FemTech. Given this position, we reflect on the following questions:

  • How can users call for a redesign of an application based on negative experiences such as surveillance, non-consensual data collection, or troubling interactions with other users and/or representatives working on behalf of the tech company (content moderators, designers, etc.)? 
  • Can users act on their own behalf as individuals or is collective user response needed to make these changes? 
  • Where does user agency exist when reproductive health applications have secret relationships with unknown third parties? 
  • What does user-centered, feminist resistance look like in these applications when FemTech fails to listen? Do users quit using the app? Do they protest online in other digital spaces? What forms of resistance are available to users?

These questions offer an entrance for feminist designers, researchers, educators, and users to intervene and reimagine the empowering potential of reproductive health apps and the FemTech industry. As a physical text, OBOS can inform and inspire a critical look at how reproductive health applications handle data collection. As feminist health researchers, we believe in the value and potential of FemTech applications for how they enable users’ access to better understanding their reproductive cycles. OBOS has shown how empowering access and information can be for women. By critically examining and calling attention to moments where female agency could be negatively affected, we believe reproductive health applications and FemTech have opportunities to reimagine how their technologies (physical and digital) may empower, and ultimately provide better care, for users.

Our hope is that this piece can serve as a call for women to continue using their voices by demanding reproductive health apps demonstrate more critical care for their users and be more responsible with private health information. OBOS created a legacy by giving women the language in which to exert agency over their bodies, and reproductive health apps can do the same. With our collective voices, we can challenge FemTech to hear us as our needs evolve and continue to represent our many different—yet all valid and important—lived experiences. The future of OBOS is with us.


  1. FemTech can be defined as “software, diagnostics, products, and services that use technology often to focus on women’s health” (“FemTech—Time”).
  2. We engage in a critical rhetorical analysis of fertility applications in a 2019 issue of Technical Communication Quarterly entitled “Data Our Bodies Tell: Towards Critical Feminist Action in Fertility and Period Tracking Applications.” This article presents a more thorough interrogation of this argument in order to discuss how users interact with the design of fertility application interfaces. Due to the limit of space and time in this article, we do not go into that analysis here.
  3. To view these principles, please consult:

Works Cited

Boston Women’s Health Course Collective. Women and Their Bodies: A Course. New England Free Press, 1970. Print. 

Design Justice Network. “Design Justice Network Principles”.

“FemTech Digital Revolution in Women’s Health: Global Transformation Health Team at Frost & Sullivan”. Frost & Sullivan. 2018,

“FemTech—Time for a Digital Revolution in the Women’s Health Market”. Frost & Sullivan. 31 Jan 2018,

Haelle, Tara. “Pregnancy Apps: Your Patients Use Them — Are Your Up to Speed?” Medscape Ob/Gyn. 28 Feb 2018, 

Hall, Rachel. “Terror and the Female Grotesque: Introducing Full-Body Scanners to U.S. Airports.” Feminist Surveillance Studies edited by Rachel E. Dubrofsky and Shoshana Amielle Magnet. Durham, NC: Duke University Press. 2015. 127-149.

Horwitz, Jeremy. “Qualcomm and Intel have 5G Devices at CES 2019, but Huawei’s are MIA.” VentureBeat,

Hutchinson, Les, and Maria Novotny. “Teaching a Critical Digital Literacy of Wearables: A Feminist Surveillance as Care Pedagogy.” Computers and Composition 50 (2018): 105-120.

IMS Institute for Healthcare Informatics. “Patient Adoption of mHealth”., 2015.

Jones, Natasha N. “Rhetorical Narratives of Black Entrepreneurs: The Business of Race, Agency, and Cultural Empowerment.” Journal of Business and Technical Communication 31.3 (2017): 319-349.

Kline, Wendy. “Please Include This in Your Book”: Readers Respond to” Our Bodies, Ourselves.” Bulletin of the History of Medicine (2005): 81-110.

—. “Transforming Knowledge: The Making of Our Bodies, Ourselves.” Bodies of Knowledge: Sexuality, Reproduction, and Women’s Health in the Second Wave, University of Chicago Press, 2010. 9-40

Lanham, Michael, and M. A. Christensen. “Fertility-related smartphone application use among patients seeking treatment for infertility.” Fertility and Sterility 104.3 (2015): e354.

Lay, Mary M. The Rhetoric of Midwifery: Gender, Knowledge, and Power. Rutgers University Press, 2000.

Magistretti, Berenice. “Frost & Sullivan: Femtech could become a $50 billion market by 2025.” Venture Beat. 08 March 2018. 

Murphy, Michelle. “Immodest Witnessing: The Epistemology of Vaginal Self-Examination in the U.S. Feminist Self -Help Movement.” Feminist Studies 30.1 (2004): 115-147.

Novotny, Maria and Les Hutchinson. “Data Our Bodies Tell: Towards Critical Feminist Action in Fertility and Period Tracking Applications.” Technical Communication Quarterly 28.4 (2019): 332-360.

Our Bodies, Ourselves: A Book by and for Women. New York: Simon and Schuster, 1973. Print.

Quintin, Cooper. “The Pregnancy Panopticon.” Electronic Frontier Foundation, 27 July 2017: 1-14.

Wells, Susan. “Our bodies, ourselves: Reading the written body.” Signs: Journal of Women in Culture and Society 33.3 (2008): 697-723.

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“Like regular underwear, but so much better.”: How Thinx Can Create Feminist Embodied Subjects through the Enduring Legacy of OBOS

Underwear for People Who Menstruate

Across time and cultures, women have used and continue to use a variety of products for catching menstrual flow. The choice often comes down to comfort, availability, convenience, and price. You might find the perfect match right away, or you might try different options, looking for more comfort or a better fit.

(Our Bodies, Ourselves, 2011)

From its conception in 1969 at a Women’s Liberation Conference in Boston, Massachusetts, Our Bodies, Ourselves (OBOS) has been committed to informing its audience about topics of health and the body through feminist perspectives. While OBOS began as a text targeted toward straight middle class white women, each update has been more inclusive of different bodies and identities. Although the production and printing of OBOS has been discontinued, OBOS creates a tangible legacy for future feminist health literacies and technologies. In this way, OBOS provides a means to compare and measure other feminist health texts and objects. In this article, I use that legacy to explore the implications of Thinx panties, which are underwear that can be worn during the menstrual cycle sans other menstrual products, or as a backup to other menstrual products. While Thinx panties were not invented before the last printing of OBOS in 2011, their products represent the kinds of technologies OBOS contributors would showcase in their feminist health text, which is evidenced in the current OBOS blog. In 2015, OBOS contributor Miriam Zoila Pérez published a blog post detailing Thinx as a menstrual product that is both innovative and more sustainable than other menstrual products.

Thinx was founded by Antonia Saint Dunbar and sisters Miki and Radha Agrawal in 2011, and they began selling their menstrual products in 2014. This company provides people who menstruate with underwear that can be worn during the menstruation cycle sans other menstruation products, or as a backup to other menstruation products. In product advertisements, Thinx boasts that their “period panties” have a patented four-layer technology that is supposed to allow the wearer to move through their day without the interruptions that other menstruation products can cause. Wearing these undergarments may limit the interactivity a menstruator might normally have with other menstrual products (i.e. tampons, pads, menstruation cups, etc.), as wearers might have less need to check the fullness of the undergarment and actual menstrual byproducts are potentially more fully concealed through this technology. Because OBOS and Thinx are part of an evolving ecology of lived practical experiences centered around feminist reproductive health and feminine coded bodies, I consider the following questions in this article:

  1. how might a feminist health literacy text like OBOS inform how we think about products like Thinx?
  2. what do both OBOS and Thinx underwear suggest in terms of assumptions made about the size, shape, and movement of menstruating bodies?
  3. how does the case study of Thinx underwear as a feminist wearable technology become important for the future of feminist health literacies?

To answer these questions, this article makes a case for Thinx underwear as a wearable technology by expanding upon feminist rhetorical research that considers technological objects from an embodied perspective. Positioning OBOS as an agentive prior text, this article shows how OBOS has, through its many editions, strived to be inclusive not only of different bodies and identities but also of multiple approaches to reproductive healthcare technologies and activism. Drawing on this foundation, I conduct a materialist rhetorical analysis of Thinx underwear in connection to OBOS using Jordynn Jack’s feminist wearable technology framework. This article explores how Thinx panties can become a structure of feminist meaning-making that is transmitted through bodies, analyzes the assumptions that this technology makes about menstruating bodies, and argues in the spirit of OBOS that powerful agencies are invented in the collaboration among Thinx underwear and menstruating bodies. The concluding discussion focuses on how continued feminist rhetorics of embodiment and wearable technologies are important for the future of feminist health literacies, for complicating Thinx underwear, and for the enduring legacy of OBOS.

Feminist Rhetorics of Embodiment and Wearable Technologies

Feminist Rhetorics of Embodiment

OBOS and Thinx both have the potential to empower bodies through feminist rhetorical action; as a result, turning to feminist rhetorics of embodiment can help us better understand their interrelation. Through our embodied choices, we have the agency to create rhetorical action that can empower or disempower our bodies. For example, Maria Novotny and Katie Manthey position the journey of coming to understand and embrace their bodies as a feminist rhetorical act. More directly, Manthey explains, “How I manage my body and specifically, how I present it to other people through dress practices including clothing that hides or reveals my flesh, is a feminist rhetorical move” (11). A number of feminist scholars have correspondingly illustrated that the intersection between bodies and the everyday is a deeply rhetorical space (Johnson et al.; Molloy et al.). Feminist rhetorics of embodiment can also focus on the agency bodies can have with and through technological objects. In this regard, Lisa Melonçon states, “The instrumental nature of technology means that human bodies exist as tool-beings that use a variety of equipment, or technology, to move through each day” (71). In further drawing from this point, Jack asserts, “…the ways that we live in and through our bodies are inextricable from the technologies we use” (209). Because we are inextricably linked to technologies through our bodies and lived practical experiences an expanded understanding of what counts as a technology is necessary if we want to fully consider the embodied potential of technologies.

Feminist Rhetorics of Technology

Thinx underwear is a wearable technology: a product or material that provides a means to assist the wearer in everyday life. They are, however, an unusual wearable technology in that they challenge the predominant notion of how wearable technologies are currently understood. To better understand Thinx underwear as a wearable technology, we need a broader conception of technology use, particularly within a feminist rhetorical framework. Specifically, we need to consider Thinx and other menstruation technologies from a feminist rhetorical framework that, as Jack contends, considers these objects as “everyday rhetorics” (208). Arguing for a feminist rhetoric of technology, Amy Koerber expands the definition of technology based on feminist observations that address how previous definitions of technology, “…have evolved in a way that excludes the historical contributions of women” (60). Her expanded definitions by contrast “enrich[es] the rhetoric of technology…by revealing the blind spots inherent in narrow definitions” (60). Jessica Enoch similarly explains that we should open more paths in feminist rhetorical research through “scholarly interventions” that invite more scholars to “push the boundaries of feminist research” (438). However, pathways that push the boundaries of feminist perspectives of technologies must not only consider broader definitions of technologies but also reconsider the rhetorical implications that are disseminated through technological artifacts. For example, Sarah Hallenbeck articulates the idea that “everyday practices gain strength and traction as rhetorical actions through their articulations within the networks that support or subvert them” (22). Feminist rhetorical studies of technological objects, then, should consider and reinvent how technologies enact or subvert imbalanced power relations, binary understandings of gender, and divisions in social categories.

Jenny Edbauer’s work offers an important method for analyzing the relationships between technologies and rhetorical effects and affects. In her proposed reconfiguration of the rhetorical situation, Edbauer suggests a strategy for theorizing rhetorics as “a circulating ecology of effects, enactments, and events by shifting the lines of focus from rhetorical situation to rhetorical ecologies” (9). A rhetorical ecology recognizes how texts and objects circulate and transform those who interact with them. An analysis of Thinx’s “period panties” as a technological artifact should position these objects in a developing ecology of lived practical experiences centered around reproductive health and menstruating bodies.

Feminist Wearable Technologies

While popular definitions of wearable technologies tend to be understood through ubiquitous computing and the ability to collect and track quantifiable data, in this article I take the position that wearable technologies can include a wide range of objects and artifacts that people can wear. Clothing and shoes, for example, provide a layer of protection from natural and synthetic elements. I further argue that it is a feminist rhetorical practice to redefine understandings of technologies to be more inclusive of marginalized experiences that are lived through these technologies. Continually, it seems, broad understandings of technologies often only consider innovative technologies in their definitions. For instance, dominant understandings of wearable technologies commonly connect closely to cutting-edge digital technologies. When the term “wearable technology” is used, many might call to mind images of Apple iWatches, FitBits, GoPros, smart glasses, etc. Isabel Pedersen refers to this type of technology as “wearable computers,” and explains them as “…computers that you strap to the body and ‘wear’” (183). However, a wearable technology does not necessarily have to be understood as a digital gadget.

Thinx underwear can provide the function of protection from the messes that menstrual periods have the potential to cause, and they can also allow the wearer to move more freely throughout the day. Before the invention of commercialized menstrual products, menstruators used objects like cloth rags, cotton, sheep’s wool, handed knitted pads, or even animal furs and plants like grass to stifle blood flow. With the evolution of menstrual products, a menstruator’s ability to exist in the world during a menstrual cycle has become easier to manage. Like most menstrual technologies, Thinx stifles a menstruator’s blood flow so they are able to move more easily through their day. While these undergarments do not rely on ubiquitous computing technology and do not collect or track data in the usual sense, they do, I argue, have the potential to assist the wearer in their everyday lives. Following Jack’s emphasis for further research of wearable technologies that takes up a feminist perspectives of rhetorical embodiment more directly, in my analysis I further explore how wearing Thinx underwear can become a rhetorical act that encourages a feminist embodied subject who can participate in knowledge creation. In order to move forward in this analysis, I now turn to OBOS as a forerunner in providing increased agency to menstruators and their bodies.

OBOS and Practices of Inclusion

My understanding of Thinx panties as related to the legacy of OBOS is primarily positioned in the ninth edition published in 2011, and I want to start by considering how this feminist health literacy text is situated in a feminist history of inclusion. Different iterations of OBOS show how contributors have strived to be more inclusive of different bodies, identities, technologies, and activist movements. As Heather Stephenson, Zobeida Bonilla, Elizabeth Sarah Linsey, and Marianne McPhearson trace in a 2005 special issue for the journal for the National Women’s Studies Association Journal themed around the update and revision of the eighth edition of OBOS, inclusivity, attention to current reproductive health issues, and the desire to stay relevant through technological advances have long been at the core of the driving beliefs behind OBOS. Stephenson, who led the revisions project for the eighth edition update published in 2005, describes how her revisions speak to new and different generations of women. Stephenson explains, “Our aim has been to reach the next generation while retaining the essential strengths that make the book beloved by longtime fans” (173). This commitment to generational inclusion that Stephenson describes is part of what makes OBOS a legacy text against which to compare and measure other feminist health texts and technologies.

Inclusion of Language and Identity

The inclusion of marginalized voices and experiences extends to language use within OBOS. Bonilla, for example, focuses on the struggle for OBOS to continue to be inclusive through the use of the “royal we,” how inclusive pronouns are used, and the constructions of the Other in the text. Bonilla explains, “The use of the word ‘we’ in OBOS has been a fundamental feature of the book, which has given OBOS an accessible and caring tone and a more inviting and embracing voice” (176). She further explains how in the early iterations of OBOS the “royal we” did not necessarily include everyone. This point is evidenced in Linsey’s article in the same special issue. Linsey discusses her experience with updating the gender and sexuality chapter for the eighth edition of OBOS. In doing so she describes how as an “anti-authoritarian African American high femme dyke from a working poor family,” she did not feel she fit into the intended audience for OBOS, which she describes as white middle class women. However, she states, “When Heather [Stephenson] asked me to write this chapter, I tearfully accepted because I realized that OBOS was committed to expanding the breadth and depth of its audience by becoming more inclusive of young women, women of color, and trans and queer people” (184). Through Linsey’s example, we can see how OBOS has recently attempted to expand its conception of who counts as “we.”

Inclusion of Technologies

In various updates through the years, OBOS has also worked to include new and emerging technologies and the discussions around them as a means to keep their readers informed about feminist healthcare practices. McPhearson discusses the importance of updating OBOS through revising the “textbook feel,” updating the anatomy chapter to be more supportive of vulvovaginal self-examinations, and the challenges of including hot topic reproductive issues in such a way for them to remain relevant in print. In particular, McPhearson concentrates on the eighth edition update of OBOS by giving attention to menstrual suppression through the technological advancements of the birth control pill. In explaining her rhetorical decisions on how best to address menstrual suppression, McPhearson states, “Many other public spheres give attention to menstrual suppression drugs. I thought that OBOS could be a space for a broader debate about suppression in a feminist voice, both in terms of safety and desirability” (194). This shows the attention paid not only to including new technologies within OBOS updates, but also to the importance of including the debates, opinions, and information that surrounds these technologies.

Inclusion of Activist Movements

The inclusivity that OBOS has strived for is also apparent in the relationship variations of the text have had with feminist activist movements like that of menstrual activism. Through tracing the history of menstrual activism via key events, Chris Bobel argues that menstrual activism in the 1970s began with gratitude, seeing menstrual products as conveniences; however, due to the rise of Toxic Shock Syndrome (TSS) in 1971 to 1992, that gratitude transformed into skepticism. Through the discussion of key events in the history of menstrual activism, Bobel explains how the Boston Women’s Health Collective marked transformations and updates to each edition of their health literacy text and how menstrual activism has shaped the progression of OBOS as a text. Today, Thinx is arguably at the forefront of the modern menstrual activist movement because of the company’s commitment to inclusivity and dedication to challenging pervasive menstrual stigma.

The Embodied Feminist Subject

Texts like OBOS have the potential to create what Kathy Davis describes as feminist embodied subjects. More specifically, she states that OBOS creates an “embodied, situated subject who can actively participate in the feminist knowledge project that it represents” (142). Through Dorothy Smith’s “sociologically informed methodology” (143) for text analysis, Davis explains that there is “…the active and constitutive relationship between texts and readers, as well as the role texts play in organizing and regulating power relations” (143). This type of analysis, Davis states, provides a way to understand OBOS in terms of how it “activates readers” to become embodied subjects who are situated in such a way as to participate in “feminist politics aimed at empowering women in matters concerning their bodies and health” (143). For example, Davis illustrates this argument through her focus on how the first chapter of the ninth edition of OBOS, “Understanding Our Bodies: Sexual Anatomy, Reproduction, and the Menstrual Cycle,” hails the reader. This chapter calls a reader to action in exploring their anatomical parts via a mirror, rather than just explaining female sexual anatomy to the reader through medical information and depictions about and of bodies.

OBOS includes detailed diagrams to provide readers with visuals as a point of reference. These particular visuals are interesting in comparison to visuals one might see in other health resources because they depart from a sterilized depiction of female sexual anatomy. Instead, the renderings are based in realism and provide details of female sexual anatomy that often go unnoticed. With one depiction in particular, the reader has access to a labeled diagram of human vaginal anatomy, but the visualization also demonstrates using a mirror in a way that will allow a person to explore and examine their own reproductive parts. Again, the text invites the reader to be an active participant in understanding the body, rather than a passive recipient of information about it. Additionally, OBOS includes anecdotal accounts of women describing their experiences with exploring their own bodies. These accounts include multiple experiences, including those that might be positioned as non-normative. For instance, among the anecdotes included in OBOS one states:

I don’t menstruate, and have actually always felt kind of alienated by the way in which female experiences are sometimes centered around menstruation—the idea that menstruation makes someone a “real” woman for example, or that menstruation is such a quintessential experience that if you haven’t menstruated, you don’t know what it’s like to be a woman.


Narrative accounts like this one further invite readers to actively participate in exploring their own bodies alongside reading trusted medical information. The text encourages a reader not just to absorb the text, but to experience their body through it.

In addition to inviting readers to learn and explore female sexual anatomy, the first chapter in OBOS describes the menstrual cycle in great detail, covering everything from menarche to details about ovulation, ovaries, and the cervix. This chapter also briefly covers certain menstrual products that can be used to catch blood flow. One section in particular, however, specifically covers the stigma around periods. In this subsection entitled “It’s Your Period–How Do You Own It?” the editors state, “We may hear jokes about it on television, or we may see advertisements for menstrual products, but rarely is menstruation talked about in honest terms.” Further they ask, “When’s the last time you heard menstrual blood even mentioned?” and they state, “Being ‘fresh’ or ‘clean’ is emphasized, and the fact that we menstruate is hidden” (22). Through deep descriptions, direct statements, and bold questions, OBOS challenges menstrual stigma to encourage an agency amongst its readers.

Like OBOS, Thinx engenders this agency through challenging menstrual stigma. We can see this in Thinx ad campaigns, and in their ability to collaborate with users and other like-minded organizations both nationally and abroad to assemble and mobilize their aims and goals. In their ad campaigns, Thinx does not avoid using images of real blood, and they take on direct discussions of menstruation via their website. This agency can also be constructed through the wearing of Thinx’s menstrual products, which I argue in accordance with Davis creates embodied feminist subjects. In the next section of this article I want to further expand upon how wearing Thinx underwear can aid in the creation of an embodied feminist subject.

Understanding Thinx as a Feminist Embodied Rhetoric

In this section I use Jack’s framework to analyze Thinx underwear as a wearable technology. I expand on these three factors to setup a framework for considering Thinx panties as a wearable technology. In drawing from Pedersen’s framework for analyzing wearable technologies Jack explains that the following three qualities to consider are movement, interactivity, and beingness.


Jack states that movement requires that a wearable run constantly in the background but not interfere with our day-to-day activity. With the “signature leak-fighting tech” that Thinx boasts, these undergarments have the potential to augment a wearer’s experience by stifling blood flow and odor, and through limiting trips to the bathroom for the purpose of checking or changing filled menstrual products. As advertised on their website, Thinx claims that every pair of underwear is made with their “…signature 4-layer technology for ultimate period protection” (Thinx). Fig. 1 shows how this technology works together by way of a moisture-wicking layer, an anti-microbial lining layer, a super-absorbent fabric layer, and finally a leak-resistant barrier layer. Each layer of the underwear takes on a specific aspect of combating the elements of menstruation that have moored menstruators historically and still do presently. In this sense, Thinx underwear as a wearable technology can allow for free movement and unwanted interruptions during a menstrual cycle just like any other menstrual product promises.

Fig. 1. Thinx’s patented four-layered technology. (Image courtesy Thinx, Inc.).


Interactivity in terms of wearable technologies, Jack explains, requires that technologies become present when we call upon them, otherwise they should exist in the background without much notice. With menstruating bodies there is a probability that these undergarments can become present much more frequently than a wearer might like. Often, menstrual cycles cause the stress and worry of leakage and with this stress comes the thought of protection against it. Because of this stress, there is a likelihood that this technology is called upon more times than the wearer might want, especially if a wearer is experiencing this technology for the first time, or has a flow that cannot be accommodated by Thinx’s patented technology alone. In this sense, the interactivity of Thinx underwear as a wearable technology becomes complicated. Interactivity differs in the context of wearable technologies and menstruating bodies because menstrual fluid can function as a catalyst that frequently calls attention to the technology. The involuntary experience of menstruating can be physically felt throughout the day as the menstrual fluid exits the body. This sensation is a consistent reminder that forces a menstruator to consider the level of fullness a menstrual wearable might have.


Jack explains the quality of beingness through how wearable technologies allow us to exist in the world. Along with this comes the question of whether these technologies are helpful or harmful. For this final criterion Jack specifically states, “…one might consider how a wearable technology becomes  akin to an additional bodily organ that functions automatically” (209). For this, she draws on Pedersen’s example of “breathing, swallowing, or perspiring” (194). In this article I add bleeding to the list just as Jack added breast milk. The question here, then, becomes about how wearable technologies are attuned to bodies, or how bodies attune to the act of wearing the object. With Thinx underwear in particular we should consider how the act of menstruating is often described in terms of being uncomfortable, an annoyance, or painful. Discomfort and annoyance from menstruation, in part, comes from levels of menstrual flow, constantly tracking the fullness of menstrual products, and the fear of leakages. Because of these negative experiences the state of beingness a menstruator could achieve when wearing Thinx technology has different potentials depending on how a person’s menstrual flow allows them to move or interact in and with the underwear.

Micro-performances of Gender, Status, and Identity

In addition to the qualities of movement, interactivity, and beingness, Jack further argues that wearable technologies can enable micro-performances of gender, status, and identity (209). Although it is a natural bodily function that can be a signifier for healthy bodies, menstruation has historically been an involuntary act that has held back those who menstruate. How menstruation has held people back varies between negative social constructions of feminine coded bodies and actual physical disadvantages that can come with menstruation. In terms of physical disadvantages, menstruators have always had to deal with the pain and overall negative bodily feeling that can accompany a person’s menstrual cycle, but menstruators have also always had to deal with how they might move through their everyday lives without bleeding through their clothing and onto furniture and other objects.

Understanding this often-fraught experience of menstruation is one that requires us not only to analyze its texts, but also its technologies and their ecologies. Hallenbeck claims that a feminist rhetorical project “…ought to undertake the work of identifying the impacts of material arrangements and seemingly nondeliberate arhetorical embodied activities on gender norms” (12). While we have typically studied written and spoken communication, Jack contends, “It is not only ideas and beliefs that must change, but also material arrangement of bodies, spaces, and time” (300). To this end, I argue that both objects and textual artifacts must be studied more closely in order to understand the arrangement of bodies, spaces, and time that affect the experience of menstruation in everyday life. Because products like Thinx underwear and texts like OBOS allow menstruators to actualize their bodies and bodily functions in more positive ways, an understanding of these artifacts in terms of micro performances of gender is paramount. This type of understanding is particularly important for menstrual technologies because of the long and persisting stigma that surrounds the involuntary bodily practice.

Menstrual stigma is often used to other menstruating bodies. For example, Janice Delaney, et al. in their 1979 book The Curse: A Cultural History of Menstruation, point out that menstruation has been stigmatized, undervalued, and all together erased from cultural histories. They state, “In our own culture…women continue to suffer the taboos of centuries. Law, medicine, religion, and psychology have isolated and devalued the menstruating woman” (2). Delaney, et al. additionally discuss the deeply embedded cultural stereotypes that exist around the figure of the menstruating woman. They contend that, “Women who experience the debilitating mental or physical pain of menstruation are made prototype for all; and in the face of statistics to the contrary, women are still considered unreliable workers and unstable human beings at that time of the month” (2). In these descriptions Delaney, et al. show how ingrained cultural understandings of micro-performances of gender, status, and identity can come to be. Hallenbeck, in relation to this argument, explains that we ought to begin our, “…investigations with an everyday practice because the mundane nature of many everyday practices means they are likely to become naturalized activities that escape human scrutiny in their role of re-inscribing or challenging gender norms” (22). By examining Thinx and other technological objects through their use in practice, we can highlight how technologies are responsible for enacting or subverting power relations, binary gender distinctions, and problematic social categories.

How Thinx Extends the Legacy of OBOS

As with the commitment OBOS had to accounting for change with each update, it is apparent that Thinx is similarly committed to accounting for the consistent changes and updates that relate to feminist healthcare needs. Taking on a responsibility like this requires that the creators and designers regularly reconsider what types of bodies their technologies must accommodate. Thinx’s commitment to striving for accessibility for bodies of all types is evidenced in the varied styles of underwear that range in levels of absorbability and through the sizes they offer for each style of underwear, which range from XS to 3XL. The dedication Thinx has to inclusion is evidenced in their Thinx BTWN line, developed especially for new and young menstruators (see Fig. 2). This example in particular also highlights the commitment Thinx has to encouraging positive body literacy from a young age.

Fig. 2. Thinx underwear styles. (Image courtesy Thinx, Inc.).
Fig. 3. Thinx advertisement featuring transgender model Sawyer Devuyst. (Image courtesy Thinx, Inc.).

Moreover, attentiveness to body literacy and inclusion can be recognized in the introduction of their boy shorts style, which was released in honor of Transgender Awareness Week and advertised by Sawyer Devuyst, a transgender model who menstruates (see Fig. 3). With the assortment of styles and sizes that Thinx offers for their underwear and their attention to bodies, it can be argued that Thinx’s products are both well designed technologically and in terms of recognizing the potentiality for the multitude of shapes and sizes among menstruators. With this potentiality there is the chance to refigure assumptions about who menstruators are and what their needs might be. Further, the inclusivity commitment of Thinx is not just related to exploring the body but also to interacting with bodies through extensions that value how wearable technologies work with bodies.

Complicating Thinx as an Extension of OBOS

Even after its discontinuation, OBOS survives as a text that encourages its readers to have agency over their bodies both personally and politically. However, while the Boston Women’s Health Collective, who helped in the authorship and printing of OBOS, has always been a nonprofit organization, Thinx has been since its inception a for profit company. Thinx may offer a reusable and sustainable product, which is unlike disposable tampons and pads, but their garments are costly nonetheless. With expensive wearable technologies like Thinx underwear, it is not uncommon for potential users to be priced out of the possibilities for experiencing more positive ways of movement, interactivity, and beingness. The expense of these products can also hinder menstruators’ abilities to learn about their bodies and about different experiences surrounding reproductive health because of how these educational practices are so deeply embedded in the market practices of companies like Thinx, as a for profit company that has an interest in education and issues of social change. Additionally, while Thinx has from the beginning been controversial due to their products, advertisements, and overtly feminist commitment to supporting menstrual equality around the world, the company has also been met with controversy brought on by potentially problematic practices of their former “SHE-eo” Miki Agrawal. Amid allegations of sexual harassment, workplace nudity, and claims of creating a hostile work environment, Agrawal stepped down as the CEO of the company in 2016. These allegations brought against Agrawal highlight how dissonance between the feminist values associated with a brand and potentially problematic leaders in companies can arise.

While it might seem like people have so much more at their fingertips than they did in the past in terms of body literacy, Thinx shows that issues of feminist health literacy access are not necessarily diminishing, but rather are changing form. Thinking about menstrual wearable technologies in relation to these ideas is crucial to better understand the consideration of the lived experiences of menstruation. While OBOS has influenced bodily literacy practices for the past forty-five years, moving forward, we need more research that not only helps individuals to better understand the experience of using wearable menstrual technologies, but also research that helps menstruators to understand how the presence and use of wearable technologies can shape how people come to understand their own bodies. Feminist rhetorical perspectives can help inform a more critical approach in this area by making room for tracing the complicated connections between (dis)empowerment that might be created through the use of wearable menstrual technologies.

When reading texts like OBOS or in wearing products like Thinx, there is the potential to construct an embodied, situated feminist subject who can actively participate in the knowledge production of their own bodies; however, health texts or health technologies also have the potential to create obverse affects. Further research in this area might draw upon critical, rhetorically informed qualitative approaches to studying menstruation technologies in use. This kind of research should contribute to the idea that for genuine inclusivity to occur in the context of feminist rhetorical research practices we need a broader conception of the kinds of technological artifacts that can be studied from an embodied perspective. We also need an expanded conception of what a wearable technology is and how these technologies can both encourage and complicate knowledge production about feminine coded bodies. What this allows for is work that considers rhetorical artifacts old and new from a mediated technological perspective that takes up matters of movement, interactivity, and beingness.

In doing this work, we can trace what has and has not counted as technology through a feminist perspective as a way to point out how menstruation technologies have not gained the same recognition, respect, and attention that other technologies have. Katherine T. Durack makes a similar point when she states that because scientific inquiry and technological innovation have primarily been the work of men the “contributions of women have consequently been subsumed, lost, or overlooked” (250). In each of its iterations, OBOS has been committed to recognizing menstruation technologies as a way to inform readers about feminist healthcare practices. But in the discontinuation of OBOS, we must constantly reconsider both what we deem as an important and innovative technology and what impact and power these technologies can have on our bodies and in our everyday lives.

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