Menstrual health literacy essential in era of abortion ban: Shots

Writer and health educator Marni Sommer is co-author of A girls guide to puberty and periodswhich aims to help young people aged 9 to 14 understand the changes that occur during puberty and what to expect when.

Grow and Learn/Screenshot by NPR

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Grow and Learn/Screenshot by NPR

Menstrual health literacy essential in era of abortion ban: Shots

Writer and health educator Marni Sommer is co-author of A girls guide to puberty and periodswhich aims to help young people aged 9 to 14 understand the changes that occur during puberty and what to expect when.

Grow and Learn/Screenshot by NPR

Something few people talk about since Roe vs. Wade has been overturned 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 ovulation and pregnancy prevention.

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 have researched young people’s experiences with menarche – the onset of menstruation – around the world for almost 20 years. In 2018, my team began exploring American girls’ experiences with their periods, including their recommendations for what all young girls need to know as they enter puberty and start 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 a person’s understanding of the menstrual cycle and its intersection with their health and well-being, is essential from the time before the first menstrual period through menopause.

The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics have 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 adolescent girls in Los Angeles, New York, and Chicago. Our findings, along with research on state-level menstruation education standards across the country, suggest that the United States is falling far short of providing the population 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 has increased from 12.1 years in 1995 to 11.9 years in 2017. This means that nowadays, many girls 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 don’t receive any education or support – especially those who have 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 uncomfortable discussing periods, perhaps because it seems too sexually related.

Our research also captured the first period stories of American girls in 25 states and revealed that many young people are afraid and ashamed and don’t know who to turn to for advice when their period begins.


Missed opportunities abound

The internet and social media, which are important sources of information and referral for many young people, can spread misinformation or reinforce menstrual stigma. And a 2020 study by members of the American Academy of Pediatrics found that 24% of pediatricians surveyed do not regularly provide premenstrual counseling. 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 does not have to be taught or 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 basic 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 dysmenorrhea, or severe pain, to 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 that has long deserved 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 an 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 monitoring of progress in health and menstrual hygiene around the world.


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