Last August, two months after the Supreme Court overturned Roe x WadeParents in the Palm Beach County School District in Florida have begun raising concerns about a rule requiring student-athletes in the state to submit detailed medical history forms to their school prior to participation in sports.
For at least two decades, forms have included a set of optional questions about female students’ menstrual cycles. But now, with abortion criminalized in many states, there is greater concern that menstrual data could be used as a weapon to identify or prosecute people who terminated pregnancies. (In 2022, Florida passed a ban on abortions after 15 weeks, and its leadership has signaled an interest in further restricting access to the procedure.)
And this school year, the Palm Beach County School District began offering students the option to submit the form through a third-party software product, leading to a particularly high level of alarm about data privacy.
Some parents in the district wanted the period questions to stop. The episode also raised larger questions about whether any of the medical data collected by these forms should be kept by a school or district.
Over the course of several meetings, the Florida High School Athletic Association (FHSAA), which sets the rules governing student involvement in school sports across the state, has taken a hardline stance on both issues.
In January, the organization’s sports medicine committee recommended making asking about menstrual history mandatory. It is requiring students to turn in their answers to the school, according to the Palm Beach Post report.
Florida wasn’t the only state to ask student-athletes for their menstrual histories. Indeed, a minority of states – only 10 — Explicitly instruct student-athletes to keep menstrual information and other health data private.
Regardless, the proposed demand this information was extraordinarily difficult to justify: it created privacy risks and defied the recommendations of national medical associations, as well as being at odds with prevailing educational trends in the state, which prioritized parental rights above almost everything else.
In the end, the proposal failed after attracting national scrutiny and sparking debates over which entities should have access to menstrual information. On February 9, the Florida High School Athletic Association voted to adopt a new medical evaluation form that does not include questions about menstrual history. Instead, students will submit an eligibility form that does not contain medical details.
(Also on Feb. 9, Democratic Florida Representative Sheila Cherfilus-McCormick and two other representatives introduced federal legislation that would prohibit publicly funded schools from requiring students to report menstrual information.)
In a microcosm, the episode brings home a new post-war reality.eggs America: Period data should only be shared between patients and their healthcare professionals.
Menstruation is synonymous with health, and people should talk about it — with their doctors
Menstrual cycles are such an important indicator of health that many health professionals call periods the “fifth vital sign”. In athletes in particular, period changes can mean that a person is not getting enough calories to compensate for high levels of activity.
So yes, menstruating athletes should watch and seek care for changes in their cycles, said Judy Simms-Cendan, a Miami pediatric and adolescent gynecologist and president-elect of the American Society of Pediatric and Adolescent Gynecology.
“But the physician or clinician’s assessment of a menstrual history, and what it may or may not mean, is different than a school’s use of that information,” said Simms-Cendan. Trainers are generally not healthcare professionals, so they are not equipped to medically assess people based on menstrual symptoms. But also — and crucially — schools and athletic programs aren’t required to keep health information private under federal HIPAA laws. (Schools they are subject to other rules about sharing student data, but those rules allow access to the data for a broader range of reasons than HIPAA allows.)
The American Academy of Pediatrics (AAP) publishes separate forms for physicians to complete when evaluating an athlete prior to participation in a sport. One form is for the healthcare professional’s eyes only: a physical assessment form that includes a disclaimer that it should not be shared with schools or sports organizations. Then there is a separate eligibility form for the doctor to share with the school, with much less room for detail.
The AAP keeps unnecessary medical details off the eligibility form for a reason, Simms-Cendan said. “This is nobody’s business. You shouldn’t have to disclose it, because it has nothing to do with your sporting activity,” she said.
Good arguments against (and no arguments for) sharing menstrual information outside of a doctor’s office
Parents’ fear of sharing their children’s health data with schools is well founded. Without HIPAA protection, disclosure of health information can threaten individuals’ right to privacy.
Less scrupulous period tracking apps also carry risks, as do some apps aimed at treating addiction disorders, depression and HIV. In 2019, Missouri’s health department director was caught using a period tracking worksheet to identify patients who may have had “failed” abortions; there is good reason to fear that an activist state government seeking to criminalize abortion will try to use menstruation information tracked online in service of that goal.
It was unclear why the FHSAA’s sports medicine committee was so eager for Florida schools to collect menstrual data from the state’s student-athletes, or how they might use that data to discriminate against students.
Florida Governor Ron DeSantis is reportedly in favor of a near-total ban on abortion, and in 2021 he signed a bill banning transgender girls from playing on girls’ teams in public schools. Could the questions be intended to identify and punish students who do not conform to the state’s gender policy?
The questions — which ask about the date of menstrual onset and the timing and frequency of menstrual periods — would not provide the kind of data that would help identify teens seeking abortion services, using contraception, or being screened for sexually transmitted infections. They would have been poor screening questions for identifying transgender students.
(The new medical eligibility form has been revised to include a non-optional question indicating the student’s sex assigned at birth. Per the Palm Beach Post report, FHSAA staff indicated that the new form aligns with the 2021 law that restricts the participation of transgender girls in sports. .)
Insisting on the inclusion of menstruation questions over parental objection was also strangely out of sync with Florida’s Parents’ Rights in Education bill, often referred to as the “Don’t Say Gay” bill, Simms- said. cendan. “Our governor is incredibly supportive of parental control over students’ education,” and parents should also have the right to control and protect their children’s health information, she said.
“I really don’t know what they’re trying to do asking for this information,” she said in an interview before the FHSAA’s decision to change the form.
Overall, Simms-Cendan thinks it’s “really positive” that more people are talking openly about periods. But it is one thing to educate students about menstrual health and another to assess and analyze the personal menstrual history of someone outside of the healthcare environment.
Young people need to be aware of the risks that can arise when they lose control over this information, she said. “We call our reproductive health system ‘our privates’ for a reason.”
Update, Feb 10, 5:30 pm ET: This story was originally published on February 7th and has been updated to reflect that the Florida High School Athletic Association is eliminating the requirement that students share their menstrual histories and has revised the new medical eligibility form to include the gender assigned at birth. Also added is information about proposed federal legislation to ban similar requirements in other public schools.
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