Florida student-athletes’ health information is too easy to misuse

Last August, two months after Roe v. Wade was overturned by the Supreme Court, parents in Florida’s Palm Beach County School District began to raise questions about the rule requiring state student athletes to submit a detailed medical history form to the school before sports participation.

For at least two decades, the form has included a set of optional questions about students’ menstrual cycles. But now, with abortion criminalized in many countries, there is growing concern that menstrual data could be used to identify or prosecute people who have terminated pregnancies. (In 2022, Florida will ban abortions after 15 weeks, and its leaders have signaled interest in limiting access to the procedure.)

And this school year, the Palm Beach County school district began offering students the option to submit forms through third-party software products, leading to particularly high levels of alarm about data privacy.

Some district parents want to question the time lost. The episode also raises the larger question of whether the medical data collected from the form should be held by the school or the district.

During several meetings, the Florida High School Athletic Association (FHSAA), which creates rules governing student involvement in school sports statewide, has taken a hard-line position on both questions.

In January, the organization’s sports medicine committee recommended that menstrual history questions become mandatory and requiring students to turn in their responses to the school, according to a Palm Beach Post report.

Florida isn’t the only state asking athletes about their menstrual history. In fact, a minority of countries – only 10 – clearly instruct student-athletes to keep menstrual information and other health data private.

Regardless, the proposal for require This information is extraordinarily hard to justify: It creates privacy risks and defies the recommendations of the national medical association, and it is at odds jarring with the country’s educational trends, which have prioritized parental rights over almost everything else.

In microcosm, the episode brings a new reality of post-Roe America: Period data should only be shared between patients and health care providers.

Periods are a sign of health and people should talk about them – with their doctors

The menstrual cycle is such an important sign of health that many health care providers refer to the period as the “fifth vital sign.” In athletes in particular, a change in timing can signal that a person is not getting enough calories to compensate for the high level of activity.

So yes, period athletes should watch and work on changes in their cycles, says Judy Simms-Cendan, a Miami-based pediatric and adolescent gynecologist and president-elect of the North American Society for Pediatric and Adolescent Gynecology.

“But a doctor’s or a doctor’s assessment of menstrual history, and whether or not it’s applicable, is different from the use of that information in schools,” Simms-Cendan said. Trainers are not health care providers, so they are not equipped to medically evaluate people based on menstrual symptoms. But also — and importantly — schools and sports programs are not required to keep health information private under the federal HIPAA law. (School that is subject to other rules about sharing student data, but those rules allow access to data for broader reasons than HIPAA.)

The American Academy of Pediatrics (AAP) publishes a separate form for medical providers to complete when evaluating athletes before participating in sports. One form is for health care providers only: A physical evaluation form that includes warnings not to be shared with schools or sports organizations. Then, there is a separate eligibility form for doctors that can be shared with the school, with more details.

The AAP keeps unnecessary medical details from eligibility forms for a reason, Simms-Cendan said. “This is nobody’s business. Needless to say, it has nothing to do with your sports activities,” he said.

There are good arguments against (and no arguments for) sharing period information outside of the doctor’s office

Parents’ fears about sharing their children’s health data with schools are well-founded. Without HIPAA protections, disclosing health information can threaten an individual’s right to privacy.

Less thorough time-tracking apps also pose 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 spreadsheet to identify patients who might have “failed” abortions; there is good reason to fear that activist state governments trying to criminalize abortion will try to use online tracked period information for that purpose.

That said, it’s not clear why the FHSAA’s athletics committee wants 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 has reportedly favored a ban on abortion, and in 2021, signed a bill banning transgender girls from playing on girls’ teams in public schools. Are these questions able to identify and punish students who do not conform to the country’s gender politics?

It doesn’t seem likely. The questions – which ask about the date of onset of menstruation and the timing and frequency of periods – do not provide the type of data that would help identify adolescents who seek abortion services, use contraception, or are evaluated for sexually transmitted infections. It would be a poor screening question to identify transgender students.

Insisting on the Inclusion question ‘through the objection of parents is also strangely out of sync with the state of Florida Parental Rights in Education Bill, often called “Don’t Talk Gay” Bill, said Simms-Cendan. “Our governor is incredibly supportive of parental control over student education,” and parents should have the right to control and protect their children’s health information, he said.

“I really don’t know what we’re trying to do by asking for this information,” he said.

Overall, Simms-Cendan thinks it’s “very positive” that more people are talking openly about periods. But it’s one thing to teach students about menstrual health, and another to assess and analyze a person’s personal menstrual history outside of a healthcare setting.

Young people need to be aware of the risks that can occur when they have no control over the information, he said. “We call our reproductive health system ‘our private’ for a reason.”