Grow and Learn/Screenshot by NPR
Something few people talk about since Roe vs. Wade was knocked down is how abortion restrictions will affect young girls across the United States.
Around the time of their first period, many young people learn the basic mechanics of managing their period, such as how to put on a pad or tampon and that it happens once a month. Traditionally, they may also receive a reprimand for keeping their rules hidden. Young people can get information about menstruation from a family member, friend or teacher, or by searching the Internet.
But often it’s only later that they really learn and understand the more intricate details of the menstrual cycle. This includes advice on regular and irregular patterns and when to seek medical attention for any changes in timing, duration or overall experience, including the severity of menstrual pain or heavy bleeding. These conversations also have clear implications for prevention of ovulation and pregnancy.
Now with the reversal of Roe vs. Wade, young people starting to menstruate will also need to learn early on to recognize a missed period as soon as possible. In the past, a young person’s delay in mentioning that they had a late period or missed a few months might not have been of particular urgency. However, in the future, in settings where abortion beyond a very short period of weeks exists, even a missed period could have serious consequences for a young person’s life.
Conversely, it is essential that young people know that irregular periods can be normal and are not always alarming.
I was research young people’s experiences with menarche — the onset of menstruation — in the world for almost 20 years. In 2018, my team began exploring American girls’ experiences with their periods, including their recommendations for what every young girl needs to know when they enter puberty and begin menstruating.
Based on these suggestions and ideas, we have published A girls guide to puberty and periodsa body-positive illustrated graphic novel-style book that includes early period stories, tips and questions written by girls.
Overall, I learned that girls growing up in Africa, Asia, and here in the United States often receive inadequate information and support about their periods.
Information about menstruation is insufficient
Menstrual Health Literacy, or the person’s understanding of the menstrual cycle and its intersection with her health and well-being, is essential from the period preceding the first menstruation until menopause.
Both American College of Obstetricians and Gynecologists and the American Academy of Pediatrics recommended that just as doctors and nurses check a person’s blood pressure or temperature at every visit, they should also ask about periods.
These professional societies suggest that health care providers prepare girls and their families for the onset of menstruation and ensure that they understand variation in menstrual patterns.
My team’s US study focused on teenage girls in Los Angeles, New York and Chicago. Our findings, along with research on state education standards on menstruation across the country, suggest that the United States falls far short of providing people with knowledge about menstrual health. Our research indicated that many girls either received no guidance before their first period or received information that seemed outdated and difficult to understand. Think of the educational videos made in the 1990s.
A recent publication from the United States Centers for Disease Control and Prevention revealed that the median age of onset of menstruation decreased from 12.1 years in 1995 to 11.9 in 2017. This means that many girls these days are in primary school when they get their first period.
For this reason, it is clear that young people in grades four or five need to receive health education that deals with menstruation. Girls who do not receive an education or support – especially those who get their first period at a young age – are more likely to suffer from depression and low self-esteem. Low-income and minority girls are particularly vulnerable.
Yet many American girls still don’t learn the basic facts about their menstrual cycles at home, at school, or from healthcare providers. As our study revealed, parents are often awkward chat periodsperhaps because he feels too tied to sexuality.
Our research too captured american girls early period stories in 25 states and found that many young people are scared and ashamed and don’t know who to turn to for advice when their periods start.
Missed opportunities abound
The Internet and social media, which are important sources of information and orientation for many young people, can spreading misinformation or reinforcing menstrual stigma. And a 2020 study of members of the American Academy of Pediatrics found that 24% of pediatricians surveyed do not regularly provide advice before the first period. In addition, 33% do not discuss their periods with their menstruating patients. Male pediatricians were also less likely to assess a patient’s menstrual cycle and provide information, possibly due to discomfort with the topic.
Schools may also not provide the necessary guidance. In New York State, where I work, there is no requirement to provide menstrual health education and sex education is not required to be taught or to be medically accurate. Only 30 states and Washington, DC mandate sex education in schools, but not all require medical clarification.
It’s unclear if many states even include menstrual health in the program because data is limited and public information isn’t always available. I believe that, given the critical importance of some menstrual health literacy at the end of primary school, schools could consider providing puberty education – including menstrual health – separate from sex education. This is especially true in states that are reluctant to mandate sex education.
Menstrual health literacy translates into health literacy
A survey of women of childbearing age suggested that only about 50% knew the average number of days in a regular menstrual cycle. Not knowing what is normal or abnormal in relation to an average menstrual cycle – ranging from how often you have your period to the extent of bleeding or pain you feel – increases a teenage girl’s health risk or a woman’s.
Health, including menstrual health, is a fundamental human right. For those who menstruate, this means a right to knowledge about menstrual health, as well as the ability to seek treatment for the myriad of menstrual and reproductive health conditions. These range from dysmenorrheaor severe pain, endometriosis, a condition in which endometrial tissue grows outside the uterus and can cause menstrual irregularities and significant discomfort. Both require diagnosis and treatment.
Menstruation is a public health issue and one for a long time for increased attention and resources, starting with – but not limited to – menstrual health literacy. The fall of deer reinforces the urgency of this public health priority.
This story originally appeared in the online magazine The conversation. Marni Sommer is a registered nurse, associate professor of sociomedical sciences at Columbia University and receives funding from the Bill & Melinda Gates Foundation to develop guidance on indicators and related metrics to improve national-level tracking of health progress and menstrual hygiene worldwide.