Florida has backed off its effort to force athletes to give their high schools information about their menstrual cycles after the debate sparked opposition nationwide, and now, the state is facing questions about whether the plan was based on politics or policy.

Doctors often ask students about their periods to figure out whether they are healthy enough to compete. But the issue exploded when the Florida High School Athletic Association proposed using a form that called for providing that information directly to schools, rather than just to health providers.

Critics questioned whether there were political motives as Republican Florida Gov. Ron DeSantis weighs a run for the presidency. Opposition to abortion and transgender female athletes are core GOP tenants, and DeSantis has signed bills on both issues.

Amid the backlash, the association voted Thursday to recommend that most personal information revealed on medical history forms stay at the doctor’s office and not be stored at school. The new form, though, was changed to ask athletes their sex assigned at birth, rather than just their sex.

Here is a guide on the conflict, what experts have to say about it and the lack of data on what other states have been asking families to share.

WHAT CHANGES WERE PROPOSED?

The proposed revisions to the form included four mandatory questions about menstruation: if the student has ever had a period, the age they had their first period, the date of their most recent period and how many periods they’ve had in the past year.

An earlier version had asked questions about periods, too, but answering them was optional.

WHO WAS BEHIND THE PUSHBACK?

Anger erupted over the proposal, with Democratic state lawmakers sending a letter calling the requirement “highly invasive” and American Federation of Teachers President Randi Weingarten decrying it as “dystopian” in a tweet.

Hundreds also went online to sign a Change.org petition called, “Privacy. Period!” Petition writer Jenn Meale Poggie said her 16-year-old, soccer-playing daughter was moved almost to the point of tears when she heard about the proposal.

“That,” Poggie said, “is how profound these young girls are emotionally affected by this type of policy.”

Questions about transgender athletes and abortion added to the debate.

“If this is being used to screen for risk for abortion or transgender, it’s a really misguided screen,” said Dr. Judith Simms-Cendan, a pediatric-adolescent gynecologist in Miami, noting that irregular periods are commonplace among young teens.

DeSantis thrust himself into the national cultural debate over transgender rights in 2021 when he signed a bill restricting participation in girls sports in public schools to athletes identified as female at birth. He also signed into law last year a ban on abortion after 15 weeks of pregnancy.

The association’s spokesperson has said the proposed changes were not in response to concerns about transgender athletes competing in women’s sports, as some social media users have said. And association president John Gerdes stressed that neither the governor nor politics played a role in the discussions

WHY DID THE COMMITTEE WANT THE CHANGES?

The association’s medical advisory committee said it recommended making menstrual histories mandatory based on guidance from groups like the American Academy of Pediatrics.

The pediatrician group, though, insisted that they never intended for information about menstrual histories to be provided to schools. “They’re not following our guidance,” said Dr. Rebecca Carl, the chair-elect of the AAP’s Council on Sports Medicine & Fitness.

Gerdes didn’t immediately respond to emails from The Associated Press asking why the association had misstated the medical group’s guidance.

WHAT DOES THE MEDICAL COMMUNITY RECOMMEND?

The American Academy of Pediatrics worked with sports organizations to come up with a set of forms that doctors could use to evaluate would-be athletes, said Carl, also a professor of pediatrics at Northwestern University in Chicago.

One form, designed to be filled out by athletes and their families, inquires about things like drug use, eating disorders, mental health and menstrual histories. Period questions are important because heavy exercise can make menstruation stop temporarily, lowering estrogen levels and increasing the risk of broken bones, Carl said.

But only a medical eligibility form — with no information on menstrual histories — is intended to be provided to a school or sports organization, and it states that clearly. That form includes a spot for the doctor to include information about allergies, medications and whether the student is healthy enough to compete.

There are 26 states that use the latest version of the pediatrician group’s forms. Another 23 states and the District of Columbia use a variation of it. Only one state, New Hampshire, does not have a stated preferred form, said Andrea Smith, a nursing professor at Auburn University, who researched which forms states use as part of a study on cardiac risks in athletes.

The National Federation of State High School Associations recommends that each state has an evaluation process, but doesn’t have details on what has been put in practice.

Carl, the pediatrician, said that there is variation.

“But,” she stressed, “they really should only be asking for this medical eligibility form. The AAP has been very clear and consistent on this.”

WHAT IS THE CONCERN ABOUT PRIVACY?

Even making menstrual history questions optional, as they were in the earlier form, raised alarms this fall. The Palm Beach County School District asked the association to ditch the menstruation questions altogether because it was offering a digital option for submitting the forms. In the past, the district maintained the records only in paper form.

“Our concern is really that this is the information for health care providers,” Carl said. “So where does it go when it goes to the schools? I mean, it could go to a third party to store it online. It could go into a filing cabinet that’s not protected adequately.”

That was exactly the concern the American College of Obstetricians and Gynecologists expressed in a statement, noting the information supplied to schools isn’t subject to HIPAA, the federal privacy rules that govern the health care industry.

Simms-Cendan, a fellow with ACOG, said she spends lots of time instructing adolescents to even be careful about which period-tracking apps they use to ensure their data stays private.

“There are really unscrupulous people out there,” she said.

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Mike Schneider in Orlando, Florida, contributed to this report.

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