LECKHNA PARAS CHAJED
Gillian Keegan
Secretary of State for Education
House of Commons
London
SW1A 0AA
Dear Gillian Keegan,
RE: A call to improve the quality of menstrual education in UK schools
I am writing today to discuss the dire state of menstrual education in the UK and offer recommendations for how it can be improved. I am a medical student at University College London, currently intercalating in Medical Anthropology, but more importantly, I am someone who menstruates and, has passed through the state school education system in England.
Menstrual education is a legal requirement under current educational guidance, and is commonly taught across both science, and RSHE curricula. Yet, significant aspects are missing from the national curriculum, including key medical conditions and the social effects of menstruation (Maslowski et al. 2023; Siva 2022). Menstruation does not accurately fit into a specific medical speciality and social and cultural beliefs surrounding it are in constant flux (Siva 2022). I understand that this ambiguity can make teaching difficult, but does this mean we leave young people to fend for themselves, and learn about their bodies through potentially inaccurate sources? PLAN International UK’s qualitative study found that 14% of girls were unclear on what menstruation was when they first started their period, and 1 in 4 did not know what to do next (Tingle et al. 2018). Several other ethnographies have drawn similar conclusions and explore how most girls receive little positive teaching about menstruation, and feel unprepared (e.g., Cooper & Koch, 2007; Costos et al., 2002). There is a problem in the UK that we must tackle, and I believe that education is our solution.
Menstrual education is a key part of sexual health education for young people (Chang, Hayter, and Wu 2010). The Department of Education and Employment’s (2000) Sex and Relationship Education Guidance, outlined that PSHE teaching was non-statutory for Key Stage 3 and 4 pupils. The lack of consistency meant that Ofsted’s report Not Yet Good Enough found that this teaching “required improvement or was inadequate in 40% [of schools]” (Ofsted, 2013:4). Despite this, the official guidance was not updated until recently, with the Department of Education’s (2020) statutory implementation of a compulsory Relationships, Sex and Health Education (RSHE) curriculum. This means that until four years ago, it was not compulsory for all students to be taught about matters relating to their sexual and reproductive health, even though both UNESCO and WHO have emphasised the importance of comprehensive sex education teaching as part of national curricula (UNESCO et al. 2009; World Health Organisation 2010). It is critical that students have the knowledge to make informed decisions about their health, but without a comprehensive education, they are unable to do so – leaving them vulnerable and underprepared (Maslowski et al. 2023).
I am appreciative of the fact that the Department of Education’s updated guidance (2020) was developed in collaboration with various stakeholders, including students, parents, teachers, policy makers and healthcare professionals. A collaborative approach supports the inclusion and consideration of various perspectives in guidance such as this, and ensures that everyone benefits (Schensul, Beck, and Maida 2017). Nonetheless, whilst other aspects of sex education teaching have seen dramatic improvements, that will benefit students if implemented appropriately, menstrual education was skimmed over. In the 50-page report published, the only mention of menstruation, which is a critical part of reproductive health education, was the following:
“89. The onset of menstruation can be confusing or even alarming for girls if they are not prepared. Pupils should be taught key facts about the menstrual cycle including what is an average period, range of menstrual products and the implications for emotional and physical health. In addition to curriculum content, schools should also make adequate and sensitive arrangements to help girls prepare for and manage menstruation including with requests for menstrual products. Schools will need to consider the needs of their cohort of pupils in designing this content” (Department for Education 2020:31).
This does not provide schools, and other educational institutions with sufficient guidance, and detrimental holes in menstrual education continue to persist. I will outline some of these gaps below, before going on to offer suggestions on steps we can take to improve.
- Lack of appreciation of individual experiences of menstruation.
There is a concern that current menstrual teaching focusses too heavily on the scientific aspects of menstruation, even though it is a multi-faceted processes that is influenced by an individual’s social and cultural context (Brown et al. 2022; Chang, Hayter, and Wu 2010). In her ethnography, Britton (1996) highlights how menstrual education has focussed on “biology and reproductive functions” whilst ignoring “individual variances of experience and the social influences” (1996:1). Although this study may be outdated, unfortunately, little has changed today. In a qualitative study of menstrual education in New Zealand it was found that most of the teaching is still based around menstrual discharge and maintaining femininity (Agnew and Gunn 2019). This gap in teaching creates a dichotomy between the physical process of menstruation, and the way individuals embody their personal experiences, furthering the existing stigma and silence around experiences of menstruation (Britton 1996; Csordas 1990).
- Persistent gaps in the scientific curriculum.
Despite the above criticism, the scientific teaching still fails to cover some critical areas of menstruation (Maslowski et al. 2023). Endometriosis and polycystic ovarian syndrome are incredibly common health conditions, that have knock on effects for fertility and self-esteem, as well as chronic conditions such as diabetes and hypertension (World Health Organisation 2023). Around 10% (Rogers et al. 2009) and between 8-13% (World Health Organisation 2023) of the reproductive aged population experience these conditions respectively, yet they are not covered in the science or RSHE curriculum, in any country within the UK (Maslowski et al. 2023). On average, patients are diagnosed with endometriosis eight years after the onset of symptoms (All Party Parliamentary Group on Endometriosis 2020). A significant contributor to this delay is a lack of awareness amongst young people about these conditions, and what a normal and abnormal period may look like (Siva 2022). Allison (2011) explores the silence in Irish society around struggles with fertility. Amongst a variety of other confounding factors, stigma, and a fear of not fitting in play a big role – many women discussed how they felt lonely, and isolated as they went through their journey (Allison 2011). Reproductive health conditions are a common cause of infertility, and better education would encourage women to seek support earlier and ensure they do not feel alone or that they are to blame.
- Sex divided approach to menstrual teaching.
There is no mention of inclusive teaching on menstruation as part of the new guidance. From my own experience of menstrual education when I was in Year 5 (2012-2013), we were all separated by sex. Whilst I am hopeful that teaching has since become less binary, it is critical that the importance of all students learning about menstruation is highlighted to teachers. Chella Quint explains how this separation “alienates transgender and non-binary kids….boys who need to know, and….girls who need to see all genders’ conversations about reproductive health happening in front of them” (Tingle et al., 2018:16). It is not just young people who identify as a woman who menstruate, and it is not only those who menstruate who are affected by periods. Making assumptions about the sex of a student and continuing with teaching methods that separate in this binary way can exclude students from critical teaching. Furthermore, it was noted that in certain schools, boys made participants feel uncomfortable about their periods, and students believed that having inclusive menstrual education would support in mitigating this concern (Wigmore-Sykes, Ferris, and Singh 2021). It is not fair that people who are menstruating feel uncomfortable or ashamed in an environment which is designed to be supportive, and open.
- Lack of clear guidance or training for teachers
Under the new guidance, schools “retain freedom to determine an age-appropriate, developmental curriculum” (Department for Education, 2020:41) which meets the needs of their students, and communities. This aspect of the guidance is critical, as the flexibility means that schools can ensure that the specific needs of different demographics are taken into consideration. Despite this, the openness is also a cause of concern for some teachers. They feel unprepared, and potentially underqualified to teach students about menstruation, as they have received minimal training and guidance (Brown et al. 2022). Educational institutions continue to propagate common narratives that menstruation is shameful, and should be hidden, most likely due to a lack of awareness on how these discourses may be deconstructed (Agnew and Gunn 2019). Additionally, menstruation is a culturally embedded phenomenon, and appropriate support must be given to teachers to include this as part of their teaching.
Sadly, schools in deprived areas are most likely to be impacted by this lack of training. Commonly, these schools receive decreased funding and have fewer resources, and as a result designing a curriculum may be difficult. Further to this, many of the students attending schools in deprived areas will be from lower socio-economic backgrounds, and vulnerable in a variety of ways. An ethnography of sex education in America found that sexual and reproductive health literacy is even more crucial for vulnerable students, as they already face the brunt of varying health disparities (Roach 2022).
As demonstrated, there are various gaps in England’s menstrual teaching. I outline some recommendations for change below:
A comprehensive review, focussing specifically on the content and delivery of menstrual education across England should be conducted. It is necessary to gather a thorough understanding of the current concerns, and what needs to be done for improvement in different areas and schools of England. The most effective way to do this is through a participatory, ethnographic approach. This is a qualitative research method that aims to conduct research in collaboration with stakeholders and consider factors that are salient to them (Schensul, Beck, and Maida 2017). Following an ethnographic methodology will enable us to hear various perspectives and combine these to design a solution that is non-hierarchical (Inhorn 2006). We cannot hope to create comprehensive guidance, without gathering individualised perspectives of where gaps exist, and how we can solve them.
Alterations need to be made to the current curriculum and modes of delivery. The scientific curriculum must be modified to include teaching about associated medical conditions, what a medically and personally abnormal period may look like and how to manage period symptoms. An increasingly lived experiences approach to teaching should be adopted, with a focus on students’ menstrual experiences, instead of “objective” biological functions (Britton, 1996:646). Agnew and Gunn’s (2019) ethnography in New Zealand concluded that a collaborative pedagogy to teaching menstruation, rather than a traditional class dynamic that creates power hierarchies was beneficial, and we should adopt this in England. Teaching must be made inclusive as a priority, to ensure that no one is forgotten, or isolated and that everyone in society is able to support and be understanding of those around them who are menstruating.
Finally, and perhaps most importantly, teachers should be supported in their delivery of the menstrual education curriculum – it is unfair to place the entire responsibility on them. Various studies have highlighted the crucial contributions trained professionals such as school nurses can have in delivering menstrual education (Brown et al. 2022; Chang, Hayter, and Wu 2010), and this support should be standardised across England. This will be particularly beneficial for schools in socioeconomically deprived areas, who may have fewer resources to design their entire menstrual teaching alone. Providing standardised teaching across England will ensure that all students, regardless of their socioeconomic or cultural background, receive the same level of menstrual education.
Thank you for taking the time to read this. Improving menstrual education and changing narratives around periods is something I am incredibly passionate about, having conducted a study into this topic for my dissertation this year. I hope we can work together to formulate a more comprehensive menstrual curriculum in England.
Kindest regards,
A concerned student
References
Agnew, Shire, and Alexandra C Gunn. 2019. “Students’ Engagement with Alternative Discursive Construction of Menstruation.” Health Education Journal 78 (6): 670–80. https://doi.org/10.1177/0017896919835862.
All Party Parliamentary Group on Endometriosis. 2020. “Endometriosis in the UK: Time for Change.”
Allison, Jill. 2011. “Conceiving Silence: Infertility as Discursive Contradiction in Ireland.” Medical Anthropology Quarterly25 (1): 1–21.
Britton, Cathryn J. 1996. “Learning about ‘the Curse’: An Anthropological Perspective on Experiences of Menstruation.” Women’s Studies International Forum 19 (6): 645–53. https://doi.org/10.1016/S0277-5395(96)00085-4.
Brown, Natalie, Rebekah Williams, Georgie Bruinvels, Jessica Piasecki, and Laura J. Forrest. 2022. “Teachers’ Perceptions and Experiences of Menstrual Cycle Education and Support in UK Schools.” Frontiers in Global Women’s Health 3 (February). https://doi.org/10.3389/fgwh.2022.827365.
Chang, Yu‐Ting, Mark Hayter, and Shu‐Chen Wu. 2010. “A Systematic Review and Meta‐ethnography of the Qualitative Literature: Experiences of the Menarche.” Journal of Clinical Nursing 19 (3–4): 447–60. https://doi.org/10.1111/j.1365-2702.2009.03019.x.
Cooper, Spring Chenoa, and Patricia Barthalow Koch. 2007. “‘Nobody Told Me Nothin’: Communication About Menstruation Among Low-Income African American Women.” Women & Health 46 (1): 57–78. https://doi.org/10.1300/J013v46n01_05.
Costos, Daryl, Ruthie Ackerman, and Lisa Paradis. 2002. “Recollections of Menarche: Communication Between Mothers and Daughters Regarding Menstruation.” Sex Roles 46 (1): 49–59. https://doi.org/10.1023/A:1016037618567.
Csordas, Thomas J. 1990. “Embodiment as a Paradigm for Anthropology.” Ethos 18 (1): 5–47.
Department for Education. 2020. “Relationships Education, Relationships and Sex Education (RSE) and Health Education. Statutory Guidance for Governing Bodies, Proprietors, Head Teachers, Principals, Senior Leadership Teams, Teachers.”
Department for Education and Employment. 2000. “Sex and Relationship Education Guidance.”
Inhorn, Marcia C. 2006. “Defining Women’s Health: A Dozen Messages from More than 150 Ethnographies.” Medical Anthropology Quarterly 20 (3): 345–78.
Maslowski, Katherine, Michael J. Reiss, Rina Biswakarma, and Joyce Harper. 2023. “Reproductive Health Education in the Schools of the Four UK Nations: Is It Falling through the Gap?” Human Fertility 26 (3): 527–39. https://doi.org/10.1080/14647273.2023.2216395.
Ofsted. 2013. “Not yet Good Enough; Personal, Social, Health and Economic Education in Schools.”
Roach, Catherine M. 2022. “AFTERGLOW: Where We Go from Here Toward Better Sex Education in America.” In Good Sex: Transforming America Through the New Gender and Sexual Revolution, 235–48. Bloomington: Indiana University Press. https://doi.org/10.2307/j.ctv2tp748h.27.
Rogers, Peter A. W., Thomas M. D’Hooghe, Asgerally Fazleabas, Caroline E. Gargett, Linda C. Giudice, Grant W. Montgomery, Luk Rombauts, Lois A. Salamonsen, and Krina T. Zondervan. 2009. “Priorities for Endometriosis Research: Recommendations From an International Consensus Workshop.” Reproductive Sciences 16 (4): 335–46. https://doi.org/10.1177/1933719108330568.
Schensul, Jean J, Sam Beck, and Carl A Maida. 2017. “Community-Based Research Organizations: Co-Constructing Public Knowledge and Bridging Knowledge/Action Communities Through Participatory Action Research.” In Public Anthropology in a Borderless World, 1st ed., 36–65. Berghahn Books.
Siva, Nayanah. 2022. “Menstrual Cycle Education in the UK.” The Lancet Child & Adolescent Health 6 (9): 602–3. https://doi.org/10.1016/S2352-4642(22)00218-8.
Tingle, Chloe, Shailin Vora, Mandu Reid, Janie Hampton, and V’cenza Cirefice. 2018. “Break the Barriers: Girls’ Experiences of Menstruation in the UK.” London.
UNESCO, United Nations Population Fund, Unicef, World Health Organisation, and Joint United Nations Programme on HIV/AIDS. 2009. International Technical Guidance on Sexuality Education: An Evidence-Informed Approach for Schools, Teachers and Health Educators. Paris: UNESCO.
Wigmore-Sykes, Madeleine, Michelle Ferris, and Surinder Singh. 2021. “Contemporary Beliefs Surrounding the Menarche: A Pilot Study of Adolescent Girls at a School in Middle England.” Education for Primary Care 32 (1): 59–60. https://doi.org/10.1080/14739879.2020.1836678.
World Health Organisation. 2010. “Standards for Sexuality Education in Europe, A Framework for Policy Makers, Educational and Health Authorities and Specialists.” Cologne.
———. 2023. “Polysytic Ovary Syndrome.” World Health Organisation. 2023.
Image Source
https://unsplash.com/photos/person-holding-red-and-white-card-gTRchqNZzzg, accessed 25.06.2024