Knowledge, Attitudes, and Behaviors Toward the Menstrual Cycle and Menstruation Among Elite African Women Football Players, Coaches, Health Personnel, and Referees

Despite cross-cultural differences in knowledge and attitudes toward menstruation, most studies on menstruation in women’s sport have been conducted in high-income countries, such as in Europe, and none have been conducted in Africa. The aim of this study was to explore the knowledge, attitudes, and behaviors of African elite women football players, and their support personnel toward the menstrual cycle and menstruation. An anonymous questionnaire was distributed to all participants (n = 564) at two African women football tournaments. Ultimately, 238 women football players, 44 coaches, 18 health personnel, and 17 referees completed it. From 317 questionnaires analyzed, 17%, 27%, 56%, and 0% of players, coaches, health personnel, and referees, respectively, knew at least one menstrual cycle hormone; 91%, 95%, and 100% of players, coaches, and referees, respectively, did not know at least one menstrual cycle phase. Over 70% of health personnel believed that menstruation negatively affects women’s performance in sports compared with 36% of players; 18%, 28%, and 18% of players, health personnel, and referees, respectively, believed that, for convenience, the menstrual cycle should be changed by drugs like contraceptives; and 54%, 61%, 62%, and 40% of players, coaches, health personnel, and referees, respectively, were confident providing advice about the menstrual cycle to teammates. Minimal knowledge of the menstrual cycle has implications on the development of menstrual cycle considerate training environments and educational materials in African women’s football. Furthermore, the relatively low perceived effect of the menstrual cycle on sporting performance and belief in the use of contraceptives may be attributable to differences in communitylevel religiocultural and social contexts which influence menstrual experiences, and shape behavioral expectations.