Third Report - Health barriers for girls and women in sport

Girls face a number of distinctive health and physiology-related barriers to participation in, and enjoyment of, sport and physical activity, from early years to post-puberty. Existing programmes and interventions from the Government and other bodies, while welcome, do not yet go far enough in addressing these barriers and are yet to reverse alarming downward trends in girls’ enjoyment of PE. They also lack specific age group-related targets for participation in and enjoyment of PE and school sport.

Key anxieties for girls include concerns around periods, yet education on the menstrual cycle, despite being mandatory, is only being delivered in half of schools. It is shocking that around 50% of schools are disregarding a vital, and mandatory, element of the curriculum. Where it is being delivered, in most cases, it is part of a biology lesson and years after most girls will have started their period. As we have found in our other work, this is typical of current teaching on reproductive health, which is inadequate, irrelevant to girls’ needs, and delivered too late in girls’ development. These failings are having obvious consequences for girls’ confidence and, in terms of participation in and enjoyment of PE and sport, leading to withdrawal from necessary, healthy activity.

The Department for Education must urgently review the quality and timeliness of education on girls’ health and physiology, including the effects of puberty, the menstrual cycle, and periods in the context of PE and school sport. Whether part of PE or PSHE, or ideally both, this education needs to be delivered more effectively and much earlier. Teachers need to be better trained to deliver it, including around how to have effective conversations with girls and support them during this significant life stage. Education on reproductive health is a positive, not a barrier to overcome. Our recommendations reflect what girls are asking for and are straightforward to implement. The DfE must make clear to all schools that not delivering education on the menstrual cycle is unacceptable and set out in response to this Report the steps it will take to ensure 100% compliance with the current requirements, with a clear timeframe to achieve this. We further recommend the DfE supports pilots of new approaches, such as the enhanced, four-week lesson plan being developed by Swansea University, and commits to rolling out an improved offer across all primary and secondary schools within the next 12 months.

The evidence on girls’ anxieties around PE kit is overwhelming. We recommend the Department for Education and National Physical Activity Taskforce review guidance for schools on school PE kit, with the aim of ensuring all schools permit the widest possible choice for girls. That guidance should include advice to schools on use of sports bras by girls taking part in PE and school sports.

We recommend Sport England launch a new strand of the “This Girl Can” campaign aimed at parents, tackling early years gender stereotypes around physical activity and sport. This should include a specific focus on the positive role fathers can play in encouraging girls in sport and exercise. Sport England should also work with the Health barriers for girls and women in sport 39 Department for Education to roll out the “Studio You” platform across all secondary schools, with the aim of reaching all girls meeting the Government’s definition of inactive in Key Stages 3 and 4. The DfE should further update its School Sport and Physical Activity Action Plan to include measurable targets for closing the “enjoyment gap” in PE between boys and girls.

Given the very distinctive issues for girls, and to ensure their needs are not overlooked, we recommend the Minister for Women and Equality Hub officials attend the National Physical Activity Taskforce, alongside organisations with data and expertise in this area, including Youth Sport Trust and The Well HQ. The Taskforce must consider as a priority the best available evidence, including from the Youth Sport Trust’s “Girls Active” survey series, on which to base interventions designed to address girls’ health and physiology-related barriers. (Paragraph 37) Midlife and menopause

Women in midlife face specific health-related barriers to participation, including but not limited to the symptoms of perimenopause and menopause. These occur after many have experienced barriers at earlier life stages, including in early years and at school during puberty. Many women at this life stage will have dropped out of sport and physical exercise many years previously. These barriers are compounded by the convergence of gendered social factors, including caring responsibilities for children and ageing parents, leaving them particularly time poor. Encouraging and facilitating women in midlife to become more active is therefore a challenge that requires a thorough understanding of their needs and specifically designed interventions. Current efforts, including the Government’s “Get Active” strategy, are inadequate for this group. The strategy lacks detailed analysis of the issues, measurable targets, and specially tailored interventions. This must be rectified.

We recommend Sport England prioritise another phase of the “This Girl Can” campaign focused on women in midlife, showing real life examples of women in the 40- to 60-year-old age group participating in a wide range of sports and physical activities, to inspire others.

We recommend the DCMS update its “Get Active” strategy for the future of sport and physical activity in relation to women in midlife. It should work with organisations including Women in Sport and The Well HQ to include an analysis of the key barriers faced by women in this age group, measurable targets to increase their levels of activity, and specifically tailored interventions. (Paragraph 46) Sports and exercise research

There has been a slow and disparate response to disproportionately high rates of ACL injury in women’s football. We have no doubt that a health issue of similar magnitude affecting elite male footballers would have received a faster, more thorough, and better coordinated response. We agree with Karen Carney that the 40 Health barriers for girls and women in sport issue is indicative of systemic gender inequality in sports and exercise research, which is still overwhelmingly conducted by men, looking at issues affecting men.

While there are positive signs of change in the sports and exercise research sector, a more concerted and coordinated, cross-sector approach is required to achieve equality of attention to health and physiology-related issues affecting sportswomen, including those arising from kit and equipment. We note the Government’s acceptance of Karen Carney’s recommendation for it to convene a cross-sector group to consider these issues, but its response needs to go much further than its current commitment to a single round table meeting.

It is symptomatic of gender inequality and sexism in the sports sector that the first football boot in the world designed around female feet came to the market less than four years ago. Since then, limited progress has been made by the largest sports brands, who between them have produced only a handful of football boots designed specifically for the needs of girls and women. Some of those that are available are at a price many people cannot afford. It is also disappointing that Sports Direct, the UK’s largest sports retailer, appears unwilling to promote football boots to women and girls in store and does not stock a wide a range of boots designed specifically for women. Girls and women at all levels of sport deserve kit and equipment properly researched and designed for their health, wellbeing, and performance needs. At a time of soaring interest in women’s sport, the sector must do better. The aim must be to provide an equal range of sports kit and equipment designed to meet girls’ and women’s needs, at a comparable range of price points, as is available to boys and men.

We recommend the DCMS and DfE establish a taskforce, including UK Sport, the UK Sports Institute, women’s health and fitness experts including The Well HQ, sport and exercise research institutes, and the UK divisions of leading sportswear and sporting goods brands, to develop a long-term strategy to tackle sportswomen’s health and physiology-related issues. The strategy should set out key priorities for research; actions to increase availability of suitable, female-specific sportswear and kit (and given the associations with discomfort and injury, football boots must be a priority); and steps to achieve equal representation of women, as authors and study participants, in the field of sports and exercise research. We recommend this strategy be published within six months. (Paragraph 79) Coaching

The level of knowledge and support for sportswomen’s health needs varies greatly between individual coaches and coaching teams. There are also wide variations in the adequacy of support across different sports. The national governing bodies we heard from were each taking their own steps to address this. While we support these actions, women’s sport would benefit from greater coordination and sharing of best practice across the sports and exercise sector to ensure that all girls and women receive adequate support from appropriately qualified coaches.

We recommend that UK Sport, Sport England, UK Coaching, the Chartered Institute for the Management of Sport and Physical Activity and the national governing bodies Health barriers for girls and women in sport 41 come together to convene a female health in coach education working group. It should draw on emerging best practice from programmes such as NETBALLHer to develop a strategy to better educate coaches at all levels in female health, including, where appropriate, through mandatory qualifications, alongside an action plan setting out how this will be achieved. The strategy and action plan should be published within six months.

Public weighing and body-shaming of girls and young women is wholly unacceptable. That this should have occurred in a sports environment, in which girls already face barriers to participation, is deplorable. Swim England must restore trust in swimming’s coaching practices and culture, and Sport England must oversee the change process until this is achieved. Sport England must, in response to this Report in no later than two months, update us on its assessment of Swim England’s response to the issues and the steps it is taking to oversee the situation.

Issues of bullying, harassment, abuse, and discrimination are not limited to swimming, with issues emerging across several sports in recent years. We welcome the DCMS’s call for evidence on integrity in sport, which closed three months ago, and expect to see tangible actions as a result. In response to this Report, the DCMS should set out in detail: • insights from the call for evidence on integrity in sport; • the proposed the next steps in improving how concerns and grievances are dealt with in the sector; • its evaluation of the effectiveness of the Sport Integrity pilot; and • a timetable for further change in the sports sector. (Paragraph 104) Pregnancy and maternity

A long-overdue culture change is taking shape in sport around pregnancy and maternity. While policies and practices being adopted in funded Olympic and Paralympic sports and, to a lesser extent, in some professional women’s sports are welcome, there is still a long road to travel, both in maternity pay and leave and the wider culture of supporting pregnant women and mothers. These issues are key to women’s equality in sport, as they are across society, and, as such, we believe the Government should take a role in supporting best practice.

We recommend the DCMS, UK Sport, Sport England and the sports’ national governing bodies establish a permanent working group on best practice in pregnancy and maternity policy, including maternity leave and pay and wider policies to support pregnant sportswomen and returning mothers. This working group must consider a road map to equal access to leave and funding/pay in line with statutory maternity rights, across all international sports. (Paragraph 121) 42 Health barriers for girls and women in sport