Staff perceptions of support for early menarche in Australian primary schools: a qualitative study

ABSTRACT

The age of the onset of menstruation, termed menarche, has been declining for decades worldwide. Approximately 12% of Australian girls reach menarche between eight to 11 years of age. Current health and physical education subject guidelines from the Australian Curriculum Assessment and Reporting Authority state that puberty education should be introduced to students between year levels five to six (ages 10–12) when many have already begun puberty. To explore how girls experiencing early menarche are currently supported in Australian primary schools, semi-structured telephone interviews were conducted with 15 primary school staff from separate schools, including teachers, principals, a school services officer, and a school counsellor. Thematic analysis identified three main themes, (1) the prevalence of deficit models of early menarche and children’s capacity to know; (2) gendered gatekeeping of menstruation knowledge; and (3) systemic barriers and inconsistencies in menstruation education. Our analysis complements but extends recent calls for improvements to menstruation education in Australian schools. Affirmative menstrual support practices and facilities are needed in primary schools to normalise and encourage conversations with students about menarche and menstruation irrespective of age, gender, class or culture.

KEYWORDS:

• Menstruation
• early menarche
• primary education
• support

Introduction

The average age of the onset of menstruation, termed menarche, has been steadily declining for decades across Western nations (Anderson and Must 2005; Demerath et al. 2004; Flash-Luzzatti et al. 2014; Yu et al. 2020). The worldwide average age of menarche is approximately 12.5 years (Parent et al. 2003; Biro et al. 2018; Leone and Brown 2020; Marques, Madeira, and Gama 2022). In Australia, the current average age of menarche is approximately 12.9 years (Steffens and Nguyen 2017). Around 12.4% of girls in Australia reach menarche between eight to 11 years of age (Steffens and Nguyen 2017) which is classified as ‘early menarche’ (first menstrual period at under 11 years old) (Cesario and Hughes 2007; D’Aloisio et al. 2013; Ibitoye et al. 2017).

The declining age of menarche points to the need to reconsider the timing and availability of support and facilities for menstruation in school settings. Currently in Australia, according to the Australian Curriculum Assessment and Reporting Authority (ACARA), menstruation education is not formally included in the primary school health and physical education curriculum until year levels five to six, when students are aged between 10 and 12 (Australian Curriculum Assessment and Reporting Authority 2015). Whilst evidence exists of the need for better support for menstruators in Australian high schools, there is no research on how staff support menstruating students in Australian primary schools. This paper reports on a qualitative study that sought to address this gap and demonstrates the need for affirmative menstrual support in schools, particularly for younger menstruators.

The school environment can play a key role in reproducing stigma associated with early menarche. Adverse psychological and behavioural outcomes for girls with early peer-relative pubertal timing (Hoyt et al. 2020) highlight the impact of social comparisons during childhood development. As social comparisons often occur in classrooms (Carter, Blazek, and Kwesele 2020), the school environment is central in psychosocial development during puberty. Widespread social stigma exists about menstruation, creating challenges for managing periods in public spaces such as schools (Johnston-Robledo and Chrisler 2020; Young 2005). Whilst menstruation is not universally stigmatised, recent research has demonstrated the ways structural and systemic factors can contribute to the perpetuation of menstrual shame for those who menstruate in contemporary Australia (Connolly and Commissioner for Children and Young People South Australia 2020; Pilat 2021; Ryan, Ussher, and Perz 2020; Ussher, Hawkey, and Perz 2018; Moffat and Pickering 2019).

Our study resonates with the work of Bowen-Viner, Watson, and Symonds (2022) who call for more research that acknowledges the connections between the ‘material’ (i.e. the biological or physical) aspects of menstruation, and the ways in which physical experiences are always embedded within and interacting with social and relational contexts. Ryan, Ussher, and Perz (2020) explain how for women in their study, cultural constructions of unrealistic standards of beauty and concealment intersected with embodied, material experiences of menstrual cycles resulting in body shame and menstrual dissatisfaction. There is significant research that demonstrates how young people navigate public discourse and embodied experience in ways that result in ‘menarche and menstruation being concealed to avoid stigma’ (Ussher, Hawkey, and Perz 2018, 114). This is evidenced by 29% of 659 menstruating Australian students aged 10 to 18 years old being concerned they would be teased at school for having their period (Pilat 2021). Those who start their periods earlier are also more likely to be subjected to bullying and victimisation, compared with those that experience normative and late menarche (Su et al. 2018). This suggests that period stigma is more pronounced for those with early menarche.

Crockett et al. (2019) argue that schools have a critical opportunity to teach comprehensive puberty and menstruation education. School-based education is important for equalising gaps and variation in home education. It is important to recognise that the needs of students in the classroom are not homogenous and differ in relation to intersections across class, gender and culture. Boydell et al. (2020) call for more nuanced and intersectional understandings of the ways stigma and marginalisation are produced, negotiated and resisted. Research from both Australia and the USA identifies the systemic socioeconomic barriers that restrict access to menstrual knowledge (Herbert et al. 2017; White 2013) which, combined with earlier pubertal onset and menarche (Hiatt et al. 2021; Sun et al. 2017), compounds the harmful impacts of stigma and marginalisation. Through the use of social media, young people can access a mix of information that can be up-to-date, empowering and strengths-based, but also information that is out of date and stigmatising. To counter this, the onus is on schools to provide equitable, destigmatising and timely menstrual education to ensure that all young people are adequately prepared for, and supported through, menarche (Ferfolja et al. 2023).

Currently, ACARA does not explicitly mention ‘menstruation’ or ‘periods’ in any online curriculum resource (Australian Curriculum Assessment and Reporting Authority 2015, n.d.-a, n.d.-b). Rather, in reference to curriculum content that relates to ‘practices that support reproductive and sexual health’, only ‘ … changes and transitions associated with puberty … ’ (ACARA 2015) is specified. Whilst it may be assumed that this encompasses the topic of menstruation, without explicit mention of menstruation or periods, it is likely that what is taught on the topic is variable and insufficient across classrooms in Australia.

The structure of the Australian curriculum indicates that gaps exist in RSH education. The presence of these gaps has also been identified by South Australia’s current Commissioner for Children and Young People, Helen Connolly, who argues that a more comprehensive RSH curriculum is necessary across all school year levels in Australia to encourage more thoughtful conversations and deepen understanding about menstruation (Connolly and Commissioner for Children and Young People South Australia 2021). Key findings from a separate report drawing on children’s voices highlight that menstruation education in schools is inconsistent, untimely and not comprehensive (Connolly and Commissioner for Children and Young People South Australia 2020). Similarly, results from a national Australian survey of 4,202 females aged 13 to 25 years found that only 23.8% understood if their period was normal based on what they had learned in school (Armour et al. 2021). Current research therefore demonstrates that menstrual health is not adequately addressed in Australian students’ school experience.

In parallel with the trend of menarche occurring earlier, there has been some success in shifting public and media discourse about menstruation from stigma and taboo towards more affirmative, body positive framings (Gottlieb 2020). For example, critical menstruation studies scholars have documented how menstrual activism can be the catalyst for unpacking the politics of intersectional discrimination (Bobel et al. 2020). It is with the broad field of menstrual activism that we align ourselves in exploring and advocating for affirmative support for menstruators of all ages in schools. Koskenniemi (2023) has mapped important key campaigns across the field of existing menstrual activism and our study resonates with the central goals of both ‘breaking menstrual taboos’ and ‘ensuring equitable access to products, facilities, and information’. However, achieving this requires affirmative action on the part of institutions such as schools. Yet currently there is no literature on how school staff support early menarche in primary schools, or on the role of primary schools in creating affirmative, body positive environments for young menstruators.

As part of a multi-method project, the current study aimed to interview Australian primary school staff in order to:

1. Explore what support is available for early menarche in primary schools through education, facilities, sanitary products, and staff training.

2. Understand staff contexts and perceptions to recommend actions to better support students that experience early menarche.

Methods

Study design and setting

Our study used a critical qualitative approach, incorporating semi-structured telephone interviews and reflexive thematic analysis (Clarke and Braun 2014) as part of a larger multi-method project examining early menarche in primary schools. Fifteen interviews were carried out with Australian primary school staff working in government, Catholic, and independent schools in major cities, inner and outer regional, and very remote areas across South Australia (SA), New South Wales (NSW), Australian Capital Territory (ACT), Queensland (QLD), and Victoria (VIC). A semi-structured interview guide was developed (Mason 2017) which aimed to identify key aspects of how students with early menarche are supported in primary schools. Questions related to (1) school facilities, access to sanitary products, menstruation education for both students and staff; and (2) staff experiences with students who had experienced early menarche. The interview guide was piloted with a primary school teacher known to the researchers and then modified slightly following discussion and debriefing between OB and JS.

We received ethical approval from Flinders University Human Research Ethics Committee (Ref. 5257). This interview study was part of a larger project that included a parallel study surveying staff in SA primary schools. The survey was designed as a follow up to a previously administered survey sent to secondary schools in SA to allow for State-related comparison and analysis, and questions were adapted for the primary school context. Whilst the survey study sought to gather data across SA primary schools, the separate study using interviews was intended to gather perspectives nationally. Both studies will contribute to better understandings of early menarche in primary schools. However, the survey results will be reported in a separate paper to focus specifically on the SA context and include a comparison of the results with secondary school data from Connolly and Commissioner for Children and Young People South Australia (2020).

Participants and recruitment

Participants were recruited through advertising via social media platforms such as Facebook and Instagram, email dissemination by teachers’ organisations, and through the opportunity to opt-in for the interview once completing the online survey. Approval was obtained from Catholic Education SA (Ref. 202223) to allow email dissemination of the survey to all 90 girls’ and co-educational Catholic schools in SA. Approvals were not required for independent primary schools; thus, all 62 relevant schools in SA also received the survey. Study participants were eligible for the interview if they were working within a primary school that included female students (i.e. girls’ or co-educational school) at the time or within five years of recruitment. Consent was obtained from participants at the start of the interview registration form.

Data collection

Interviews were conducted via telephone between August 16 to 19 November 2022. Interviews were audio-recorded and transcribed verbatim, with the duration ranging from 11 to 36 minutes. The duration of interviews reflected both the limited time staff were able to contribute and the focused nature of the interview schedule. Participants received a twenty-dollar voucher as compensation for their time and contribution.

Reflexive thematic analysis

Qualitative analysis was guided by Clarke and Braun’s (2021) six phases of reflexive thematic analysis. Transcripts were coded by OB using NVivo (Release 1.3). The initial codes were used to develop themes by OB. Both OB and JS worked together to review, discuss, and refine the themes conceptually. The interviewer (OB) was a researcher who experienced early menarche in 2006 during her Australian primary schooling. Her personal understanding of undergoing early menarche during primary school in Australia drove the study conceptualisation, and informed reflexive discussion of themes between the researchers. JS was the parent of a teenager who had recently experienced menarche and found access to period products in school difficult. Our study acknowledges the ways embodied and subjective knowledge – particularly lived experience of early menarche – contributed to conceptual development of the themes. The themes reflect collaborative meaning created through our analysis, acknowledging our own experiences, and incorporating this into a conceptual interpretation of the language and perceptions of participants.

Results

The total interview study sample comprised 15 participants working in Australian primary schools, and included teachers (n = 10), principals (n = 2), an assistant principal (n = 1), one school services officer (SSO) (n = 1), and a school counsellor (n = 1). Participants worked in government (n = 9), Catholic (n = 4), and independent (n = 2) primary schools in major cities (n = 10), inner regional areas (n = 3), an outer regional area (n = 1), and a very remote area (n = 1). Here we report on three themes developed from the analysis: (1) the prevalence of deficit models of early menarche and children’s capacities to know, (2) the gendered gatekeeping of menstruation knowledge, and (3) systemic barriers and inconsistencies in menstruation education. Participant quotations are embedded within the text with their respective roles (i.e. teacher, principal, SSO), school type (i.e. government, Catholic, independent) and a numeric code to maintain confidentiality (i.e. P01, P02).

The prevalence of deficit models of early menarche and children’s capacity to know

Staff expressed their surprise at how many of their students had begun to menstruate in years four and five. Participants shared how they perceived early menarche disadvantaged some of their students and the challenges those students face from beginning menstruation so young.

I’ve got one student that experiences quite bad cramps every month, so then it affects her attendance. You can almost guarantee for the week she has her period that she won’t be at school … she’s only ten … I think that doesn’t have a good impact on her mental health … I think it can definitely knock their self-confidence, you know, if they’re not mature of the mind … they might be physically maturing but … if they’re, you know, quite baby-ish in year four, or five, then it can be difficult for them to deal with … self-management of going to toilet regularly and checking or changing a pad, that kind of stuff can be overwhelming for some of the girls. (P03, Teacher, Government)

This quote from P03, in its concern for the wellbeing of the student, situates the problem in a mismatch between the student’s age, ‘maturity’, and ability to manage the material realities of menstruation, rather than a problem of the external support available. One participant described how period stigma and taboo in school may be especially pronounced for those that experience early menarche when menstruation is not openly discussed and normalised in what they see or experience around them.

… it looked like she was just extremely sort of distressed and felt isolated, I don’t think she felt comfortable to talk to her friends about what was going on … I think maybe this age group was sort of like year four, year five, a lot of them don’t feel comfortable to share that, because they’re not sure if their friends are dealing with the same thing. Maybe they don’t want to be considered different. (P07, Teacher, Catholic)

All participants voiced the need for earlier education about menstruation for students in primary school. Participants also suggested that teaching students in a more comprehensive and ‘matter-of-fact way about body changes that their classmates are going to go through over the next couple of years … ’ (P07, Teacher, Catholic), could enable students to be better prepared for menarche. ‘I think we’ve got to take it down to years three and four and be a lot more specific than we have been, because you are going to get more and more being younger’. (P12, Teacher, Catholic).

… making sure as well that education is done earlier, so that, you know, if it does happen and a girl starts their period really early, that they have some idea of what it is and how to manage it as well. (P02, Teacher, Government)

Despite a common call for earlier education, children were constructed by some school staff as only having capacity to talk about and understand menstruation at a particular age. Participants alluded to the need for age-appropriate education yet also expressed concern about how to determine what this meant in terms of content and at what age to introduce it. In discussion with some participants, there was an obvious concern for whether girls of a certain age would be able to emotionally cope with learning about periods, reinforcing a deficit model of children and their capacity to understand and learn about their own, and others’ bodies.

You don’t want to scare young girls, you know, like seven- and eight-year-olds…if it is happening earlier, it needs to be talked about earlier. But that’s a hard one because a lot of girls … aren’t really mature enough to understand … (P01, Teacher, Catholic)

I kind of think probably going year three, going with the girls having that conversation is probably a bit too much … you don’t want to traumatise the child … some of the kids are quite genuinely a little bit scared about what it will be like, will it hurt, all that kind of stuff. (P03, Teacher, Government)

The same sentiment was shared by other participants when they described how discussion with students about menstruation often centred on the non-menstrual use of sanitary products, ‘I feel like it [menstruation] is only discussed when something goes wrong in the bathrooms … like, the girls are being grubs in the bathroom … ’ (P11, Teacher, Government), ‘ … we had to have a long chat then with all the girls, that they’re [tampons], you know, not to be used as nose plugs … ’ (P15, Principal, Government).

Gendered gatekeeping of menstruation knowledge

Several participants explained how timely and proper menstruation education was not just important for those who menstruate, but for all children. The delivery of menstruation education to boys in the classroom was variable among participants, with some describing how, in their experiences, some primary schools did not teach male students about female puberty at all, pointing to the commonplace segregation of boys and girls for RSH education. As one teacher explained, ‘Like, it is a discussion that’s been done where they don’t really include the boys in it, in the past when I was in another school’. (P11, Teacher, Government).

… I actually found the whole unit extremely frustrating with how it was addressed where the boys were actually separated from the girls when the topic about the female elements of puberty were addressed, which really frustrated me that the boys were deprived of that teaching … (P07, Teacher, Catholic)

There were mixed opinions across interviews about the best way to address menstruation with boys in the classroom. A few participants said that some boys were not capable of taking on knowledge about menstruation without using it in ways that would be disruptive and result in stigmatising or bullying others. Therefore, they considered it necessary to separate them from the girls for those lessons,

… even to the point of teasing … like they’re [boys] not mature enough to deal with that content and they might be like ‘oh, I found your pad!’…so whether to handle it, you know, like separate them out for that … (P04, SSO, Independent).

One participant described the way she used education to promptly address male students when they teased the female students about their periods.

Did the boys tease them [girls] … Maybe. But only once because I’m very straightforward and I would say, ‘boys, come on, you must be wondering what happens when a girl gets their period so we’re going to go and have a lesson about it’, and they weren’t so keen on it, but I was happy to give it. And we talked about respect, and that there’s differences between girls and boys. And thank goodness that there is! (P13, Retired Principal, Government)

Another participant felt that teaching girls and boys about menstruation together was a positive experience. This discussion highlighted the potential benefits of including students of all genders in an open conversation about sexuality to clarify and normalise biological changes that occur during puberty, so as to promote understanding and build empathy.

… when we do our [sexual health education provider] session, we have the boys and the girls together. … and I know previously that wouldn’t have happened…I think it’s really a good, positive change that boys are also being taught about female menstruation. (P15, Principal, Government)

The importance of education about female puberty and menstruation for adult men was also discussed by participants. ‘Some male teachers, some older male teachers probably haven’t had the conversation [about periods] with anyone, let alone with a child … ’ (P13, Retired Principal, Government) One teacher described how a male colleague’s lack of understanding about early menarche impacted a student who was experiencing it, highlighting the ways in which negative male attitudes towards periods can promote discomfort, shame, and prejudice.

We had one girl in particular who was a year five and very, very developed for her age and she had her period for I would say, a good year or so already. And really struggled with her periods … they were really heavy and painful and made her quite unwell. And the P.E. [physical education] teacher was really dismissive of that and made comments that she was faking it to get out of lessons and she felt really uncomfortable speaking to him about it so … she would quite often have behavioural issues because she wouldn’t want to go to P.E. (P02, Teacher, Government)

Another participant articulated the consequence of depriving young boys from factual and appropriate education about female puberty and menstruation, as similarly depicted in P02’s above anecdote. This teacher highlighted the potential for gender segregation to breed misinformation and negative attitudes towards periods.

I found it really frustrating that we’re giving young men who are eventually going to be in workplaces and potentially in positions of leadership, who are being deprived of these matter-of-fact moments of teaching [about menstruation] where they’re going to sort of pick up these things through like hearsay through sort of uneducated conversation, it just sort of triggered me a bit. Why not inform them now? (P07, Teacher, Catholic)

Systemic barriers and inconsistencies in menstruation education

Across interviews, inconsistencies in how different primary schools across Australia manage RSH education were noted. Several participants attributed the lack of RSH education in their school to, as one teacher described, ‘ … the attitude of the executives’. (P10, School Counsellor, Government) She continued:

They have a lot of power, so some schools do it really well and others don’t cover it at all. The bare minimum. It [mandating menstruation education] would take away that decision, they’d just have to do it … (P10, School Counsellor, Government)

Across interviews, participants spoke about how school staff in leadership positions often did not care for matters relating to RSH. One teacher conveyed their frustration when male students at their school were not taught about menstruation, ‘I actually complained to senior leadership, my team leader … but no one was interested’. (P07, Teacher, Catholic).

As argued by Moffat and Pickering (2019), social and cultural shame around menstruation leads to a continued silence around menstruation in public spaces like schools, and rests on the imperative that to achieve menstrual etiquette, ‘men must not know’ (2019, 770). As noted by participants it is important that ‘ … the leadership are accountable, that growth and development is being taught properly’. (P14, Teacher, Government), and that:

… it’s in curriculum and there’s an expectation that it’s taught because I know a lot of teachers don’t teach it, particularly in the education department … I don’t think a lot of, you know, leadership staff, actually check to see if it is being taught … (P01, Teacher, Catholic)

Although having acknowledged the importance of menstruation education for students, one teacher also spoke about increasing workloads for teachers.

I’m just conscious of how much teachers are expected to take on in terms of curriculum delivery. And, you know it’s already an extremely crowded curriculum and then you turn around and say, ‘All right, well now you’ve got to teach this and then you’ve got to teach that’. And a lot of these things should be taught at home … to be honest, when we go through university, we don’t do any psychology training … our skillset is just expected to grow and grow and grow. (P15, Principal, Government)

In contrast, several participants discussed initiatives by themselves or other staff members to help prepare and support menstruating students. Such initiatives were not required by the school curriculum or policy. For example:

… we created a girls’ group, years five and six it was … it was called GEMS … I can’t remember the acronym stood for – Girls Empowered something, something … where kids can feel free to talk about periods and many other things. (P13, Retired Principal, Government)

… I have girls in grade four, five and six, so, at the start of the year … I essentially ask them if they have their period or not, just so that I’m aware of that … and then we have what I call a ‘Girl’s Only Box’ that I keep in my back room, that has like liners and pads that I keep stocked … the girls are always allowed back there if they do need anything … the teacher that previously had the role before me did it and she told me that it worked really well, so that’s something that I continued. I haven’t been told to do it or anything but, it works well. (P06, Teacher, Government)

One teacher’s feelings of unpreparedness for teaching RSH prompted her to organise a classroom education session with an external service provider and found this to be beneficial not only for the students’ learning, but also to better prepare herself for teaching the content. All but two participants were aware of whether students had access to sanitary products at school, with several participants even keeping their own supply for students in their classroom. Despite these initiatives, it is notable that this support was provided by individual teachers and was not reflective of systemic in-built education and support consistent across schools.

This lack of understanding within schools about sanitary supports for students may have the effect of participating in what Moffat and Pickering (2019) call the ‘double burden of menstrual etiquette’, whereby girls and women are tasked with the responsibility of keeping menstruation ‘invisible’, while at the same time not being provided with the infrastructural supports (like sanitary bins and products) that assist in maintaining invisibility. Indeed, concerns for ensuring students had access to sanitary products were apparent across the interviews, ‘ … there is a lot of talk about period poverty. That does worry me … it is not like I would necessarily find out about that … they might just stay home for a week’. (P08, Teacher, Government).

On a practical level, schools need to have a constant open-door policy about giving supplies to the girls, no questions asked. No, ‘you’ve had two this week, you can’t come back’, or whatever. I don’t believe in any of that judgement … (P13, Retired Principal, Government)

Discussion

The aims of this study were to understand staff contexts, perceptions, and the availability of support for early menarche in primary schools in Australia. Participants’ accounts highlight how lack of timely and consistent support for early menstruators in Australian schools is underpinned by dominant social constructions about children’s perceived lack of capacity to know about menstruation, based on gender and age. In this way, current school practices appear to reinforce a deficit model of menstruation, and particularly of early menarche and children’s capacity to know. To draw on research from within the field of childhood studies, this gatekeeping of knowledge is heavily tied up in the negotiation and performance of generational ordering (Punch 2020) whereby primary school children, and particularly non-menstruators are constructed as ‘not yet adult’ enough to comprehend and hold or create legitimate knowledge about their own bodies (Murris and Haynes 2020). Through what staff told us about their experiences and their schools, the problem is constructed as early menarche itself, and on children’s perceived lack of intellectual capacity and emotional maturity, rather than on a lack of affirmative, normalising, or co-created practices in school spaces.

These restrictive notions of when and with whom it is deemed appropriate to discuss menstruation result in the gatekeeping of important knowledge for children of all ages and genders. The intersection of age-related and gendered gatekeeping can cause profound marginalisation of girls and gender diverse children, compounding the restriction of access to human rights (Taefi 2009). In addition, a crowded curriculum, and a lack of consistency in training and facilities for supporting early menarche in primary schools are significant systemic barriers to menstrual equity for younger menstruators. Improving facilities and access to period products in primary schools are important but these practical aspects need to be embedded within comprehensive social normalisation and destigmatisation strategies that include but are not limited to primary school settings. As part of this, we echo the call for relational sociomaterial research (Andreasen 2023; Bowen-Viner, Watson, and Symonds 2022) that seeks to explore more deeply the lived experiences of children who are early menstruators. Such research would have the potential to engage children in creative, material explorations of their own embodied knowledge and thus contribute to co-creation of pedagogical approaches and content (Murris 2016).

Young people are calling for better policies and practices to address the impact of menstruation on wellbeing at school (Connolly and Commissioner for Children and Young People South Australia 2020), yet there is currently scarce research with young people who specifically experienced early periods in primary school. Listening to the voices of young people would enable the design of menstrual wellbeing policies that consider how children from various cultural, relational, and social contexts perceive their material bodies (Esser et al. 2016). Students in classrooms across Australia have needs that are diverse and that are influenced by geographic, cultural, or religious factors. Accounts from migrant and refugee women in Australia have described inadequate pubertal education from their families and at school, which resulted in a complete lack of preparation for menarche (Hawkey et al. 2017). In addition, as noted by Krusz et al. (2019), a range of inequities around menstrual health exist for girls and women in urban, rural, and remote communities. Early menarche for all students may lead to psychosocial stress, including anxiety, depression, and body dissatisfaction (Mendle, Ryan, and McKone 2018). Therefore, it is important that cultural specificities are considered so challenges associated with early menarche are not exacerbated (Krusz et al. 2019).

In addition to understanding children’s perspectives and the need for destigmatisation, our analysis also highlights the systemic barriers and inconsistencies faced by and within schools in terms of delivering consistent and comprehensive education and support. Despite the need for more comprehensive RSH education, Australian schools face numerous pressures. Reports of stress and burnout among Australian primary school teachers are high with the associated challenges of teacher shortages and an overcrowded curriculum (Australian Curriculum Assessment and Reporting Authority 2020; Carroll et al. 2022). Added stressors and responsibilities for teachers to provide more comprehensive RSH education may be mitigated by utilisation of other school staff, such as nurses or counsellors. A recent US study proposed that with further professional development, school nurses could be well positioned to teach menstrual health and hygiene to primary school students (Sweeney, Fisher, and Adkins 2022). Considering not all Australian states follow a model that utilises nurses in schools, further development of staff roles such as school counsellors or wellbeing coordinators may be useful for support and management of menstrual health in schools. Implementation of such dedicated staff could also help to lessen some of the current teacher workload.

However, to address systemic challenges, it is important for policymakers, educators, and healthcare professionals to work together to promote affirmative and culturally sensitive RSH education in schools. There are examples of menstrual education in other countries that are accessible across ages, partnered with resources to support the development of menstrual competence in adults who work with children and young people (MENSEN n.d.; Fahs and Perianes 2020; Kuan 2022; Office of the State Superintendent of Education 2023; Quint 2022). Such materials could be adapted and integrated with other high profile body positive initiatives to inform the development of resources for Australian primary schools.

Andreasen (2023, 238) has described the role of ‘affirmative menstruation pedagogies’ as a useful framework to consider in schools. Where participants in this study were unable to identify features of accessible menstrual education, Andreasen (2023) provides suggestions such as simply talking about menstruation as an affirmative act, creating spaces and opportunities for children to share their own menstruation stories, and having menstruation education sessions that include all genders and both menstruating and non-menstruating children.

Conclusion and recommendations

Our results raise critical questions about access to knowledge about menstruation in primary schools. We argue that current staff perspectives and school practices reinforce the idea that menstruation and early menarche are problematic. Our study supports current calls for structural and cultural change that prioritises menstrual wellbeing in the policies and practices of institutions. We suggest the notion that menstrual education is only appropriate for certain ages perpetuates harmful stigma and myths that menstruation is shameful, crude, and scary (Moffat and Pickering 2019). This, combined with restricting access to education by gender (for both students and staff), demonstrates the intersecting ways in which gatekeeping of menstrual knowledge occurs in schools and poses a risk to the wellbeing of those who experience early menarche. In addition, such gatekeeping happens amid systemic barriers where facilities and support for primary school students who menstruate are inconsistent and reliant on initiatives of individual staff or school leadership. We argue that the development of mandated policies, practices, and facilities is needed across all primary schools to normalise menstruation and build menstrual competence in school staff to improve menstrual wellbeing for all students, irrespective of age, gender, class or culture.

Acknowledgments

We thank Jonathan Karnon and Jackie Roseleur, both at Flinders University, for in-depth discussion during the design of this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Flinders Foundation Health Seed Grant (Shipman, 2021).