Last August, two months after the Supreme Court overturned Roe v. Wade, parents in Florida's Palm Beach County School District began questioning a rule requiring student-athletes in the state to submit detailed medical history forms to their schools prior to sports participation.
The forms have included a set of optional questions about students' menstrual cycles for at least two decades. However, with abortion being made illegal in many states, there is growing concern that menstrual data could be used to identify and prosecute people who have terminated pregnancies. (Florida banned abortions after 15 weeks in 2022, and its leadership has expressed interest in further restricting access to the procedure.
This school year, the Palm Beach County school district began offering students the option of submitting the form through a third-party software product, raising concerns about data privacy. Some district parents preferred that the period questions be removed. The incident also raised broader concerns about whether any of the medical data collected by these forms should be kept by a school or district at all.
The Florida High School Athletic Association (FHSAA), which makes the rules governing student involvement in school sports statewide, has taken a hard line on both issues over the course of several meetings.
According to the Palm Beach Post, the organization's sports medicine committee recommended making the menstrual history questions mandatory and requiring students to turn in their answers to the school in January. Florida isn't the only state that requests menstrual histories from student-athletes. In fact, only ten states explicitly instruct student-athletes to keep menstrual data and other health data private.
Regardless, the proposal to require this information is extremely difficult to justify: it creates privacy risks and goes against the advice of national medical associations, and it contradicts the state's current educational trends, which prioritize parental rights over almost everything else.
Regardless, the proposal to require this information is extremely difficult to justify: it creates privacy risks and goes against the advice of national medical associations, and it contradicts the state's current educational trends, which prioritize parental rights over almost everything else.
In a microcosm, the episode exemplifies a new reality in post-Roe America: Period data should be shared only between patients and their healthcare providers.
Periods are health indicators, and people should discuss them with their clinicians
Menstrual cycles are such an important indicator of health that many doctors refer to them as the "fifth vital sign." Period changes, in particular, can indicate that a person isn't getting enough calories to offset high levels of activity.
Yes, athletes with periods should monitor and seek care for changes in their cycles, according to Judy Simms-Cendan, a pediatric and adolescent gynecologist in Miami and president-elect of the North American Society for Pediatric and Adolescent Gynecology.
“But the physician or clinician assessment of a menstrual history, and what it may or may not signify, is different than a school’s use of that information,” said Simms-Cendan . Coaches aren't typically healthcare providers, so they aren't equipped to evaluate people medically based on menstrual symptoms. However, and most importantly, schools and sports programmes are not required by federal HIPAA laws to keep health information private. (Although schools are subject to other rules regarding student data sharing, those rules allow access to data for a broader range of reasons than HIPAA does.
When evaluating an athlete prior to participation in a sport, the American Academy of Pediatrics (AAP) publishes separate forms for medical providers to complete. One form is only for the eyes of the health care provider: A physical evaluation form with a disclaimer that it should not be shared with schools or sports organizations. Then there's a separate eligibility form that the doctor must submit to the school, with much less room for detail.
The AAP keeps unnecessary medical details off the eligibility form for a reason, said Simms-Cendan. “That’s nobody’s business. You shouldn’t have to disclose it, because it doesn’t have anything to do with your sports activity,” she said.
Good arguments against (and no arguments for) sharing period information outside a clinician’s office
Parents' concerns about sharing their children's health information with schools are understandable. Without HIPAA safeguards, disclosing health information can jeopardize an individual's right to privacy.
Parents' concerns about sharing their children's health information with schools are understandable. Without HIPAA safeguards, disclosing health information can jeopardize an individual's right to privacy.
Less scrupulous period-tracking apps, as well as some apps aimed at treating addiction disorders, depression, and HIV, pose risks. In 2019, the Missouri health department's director was caught using a period-tracking spreadsheet to identify patients who may have had "failed" abortions; there's reason to be concerned that an activist state government seeking to criminalize abortion would attempt to use period information tracked online in service of that goal.
However, it is unclear why the FHSAA's sports medicine committee is so eager to collect menstrual data from Florida's student-athletes, or how that data could be used to discriminate against students.
Florida Governor Ron DeSantis reportedly favors a near-total abortion ban and signed legislation in 2021 prohibiting transgender girls from playing on girls' teams in public schools. Could the questions be designed to identify and punish students who do not conform to the gender politics of the state? It does not appear likely. The questions, which inquire about the date of menstrual onset as well as the timing and frequency of periods, do not yield the type of information that would aid in identifying teens seeking abortion services, using contraception, or being evaluated for sexually transmitted infections.
They would not be effective screening questions for identifying transgender students
Insisting on the questions’ inclusion over the objection of parents is also weirdly out of sync with the state’s Florida’s Parental Rights in Education bill, often called the “Don’t Say Gay” bill, said Simms-Cendan. “Our governor is incredibly supportive of parental control over student 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 get at by asking this information.”
Overall, Simms-Cendan considers it "really positive" that more people are discussing their periods openly. But educating students about menstrual health is one thing; assessing and analyzing someone's personal menstrual history outside of a healthcare setting is quite another.
Young people need to be aware of the risks that can arise when they lose control over that information, she said. “We call our reproductive health system ‘our privates’ for a reason.