By Helen Vuong
Editor’s Note: Helen Vuong, a fourth-year osteopathic medical student at California Health Sciences University, completed the FACTS Fertility Awareness Medical Student Elective this past fall. In this article, she summarizes and reflects on the study “Reproductive Health Literacy Among Adolescent Women in Utah” by Logan Waechtler, which explores adolescent reproductive health literacy, fertility awareness education, and the role of fertility awareness-based methods (FABMs) in helping young women better understand their reproductive health.
To address the need for body literacy education, we are delighted to introduce FACTS organizational member, Katie Vidmar of Elevate, who just launched The Body Literacy Project this week. With resources for advancing body literacy education standards, as well as an open-and-go body literacy curricula for middle school girls and boys, The Body Literacy Project seeks to partner with like-minded individuals across the country to ensure that every student in America receives the knowledge of their bodies that they need and deserve. You can learn more at www.thebodyliteracyproject.org.
Introduction
Understanding one’s own body should be a basic skill, yet many young women enter adulthood without a clear understanding of how their reproductive system works. In “Reproductive Health Literacy Among Adolescent Women in Utah,” Logan Waechtler examines this issue among Utah’s adolescent population, focusing on how cultural, educational, and systemic factors influence understanding of one’s reproductive health.[1] This research offers a thoughtful examination of why fertility awareness and body literacy remain underemphasized in mainstream education and how empowering young women with accurate, body-based knowledge could enhance reproductive autonomy and, consequently, overall health literacy.
Waechtler’s work begins by recognizing that reproductive health literacy is an essential but often overlooked component of women’s health. Adolescents are at a formative stage of learning where misinformation can have big effects on decision-making, self-image, and confidence in managing family planning or fertility. In Utah, discussions about reproductive health can be limited due to cultural sensitivities, which can hinder access to comprehensive health education. Waechtler emphasizes this barrier: when reproductive health knowledge is incomplete or moralized, adolescents may instead rely on peers, or social media (which may be inaccurate) to fill in the gaps.[2] This could lead to confusion, stigma, or even fear about normal bodily functions.
“Reproductive health literacy is an essential but often overlooked component of women’s health. Adolescents are at a formative stage of learning where misinformation can have big effects on decision-making, self-image, and confidence.”
Methodology
This study examined survey data from qualitative interviews among adolescent females age 15-19 across the state of Utah, recruited from schools, youth programs and health centers. The surveys assessed reproductive health knowledge, awareness of FABMs, and perceptions of their own confidence in being able to recognize signs of fertility.[1]
Results
The survey results revealed significant gaps in reproductive health knowledge. Many participants were able to identify menstrual bleeding as part of the cycle, but they were not sure about the time of ovulation, or fertile window. Only a few understood that cervical mucus changes throughout the cycle or that mucus consistency can signal ovulation. Most participants thought cervical discharge was a sign of infection rather than part of a normal physiological process. This misconception is also noted in studies on fertility awareness among college-age women.[3] These common misunderstandings highlight the lack of comprehensive education on ovulation biomarkers.
Further results of this study emphasize how embarrassment and social discomfort can lead to misinformation. Participants expressed reluctance to discuss menstruation or fertility openly, even with friends or family. Many said that their school health classes talked about abstinence and general anatomy, but they did not teach any details regarding fertility tracking or cervical mucus. One participant even shared how she thought ovulation occurred randomly based on what she saw online. Narratives such as these show how structural and cultural barriers reinforce gaps in medical knowledge, leaving adolescent females unaware of their personal fertility patterns and the role they play in family planning and overall health.[1]
“Many said that their school health classes talked about abstinence and general anatomy, but they did not teach any details regarding fertility tracking or cervical mucus.”
Discussion
In his discussions, Waechtler writes that the lack of knowledge about cycle biomarkers, such as cervical mucus or basal body temperature (BBT), is not only due to educational oversight but also due to cultural discomfort with female reproductive health. FABMs can help women understand their cycles, which can help them achieve or avoid pregnancy, as well as help identify other potential health problems. However, this study states that most female adolescents in Utah had never been introduced to these methods, believing that fertility is something outside their locus of control rather than a biological process they can understand, observe, and manage.[1]
This study highlights the power of fertility awareness as a foundation for family planning. By understanding the role of cervical mucus, ovulation, and hormones in reproductive health, women gain power over their reproductive choices. The findings uphold the notion that body literacy builds confidence and promotes a more holistic view of reproductive health. However, integrating these lessons into mainstream health education requires overcoming institutional and societal resistance.[1]
“By understanding the role of cervical mucus, ovulation, and hormones in reproductive health, women gain power over their reproductive choices… Body literacy builds confidence and promotes a more holistic view of reproductive health.”
A major barrier that this study identified is the misconception that fertility awareness or FABMs are the same thing as the rhythm method or that they are ineffective compared to hormonal birth control. These misunderstandings have hindered the addition of FABM education to public health education. They also show the broader need for clinical education, as physicians are often the first source of reproductive advice for young patients.
A limitation of this study is its limited geographic scope. The study’s geographic focus on Utah, a state with strong religious ties, can limit generalizability.[1] Still, it’s a valuable case study for understanding how the intersection between education structures and community beliefs shapes reproductive health education.
From a fertility awareness perspective, the implications are profound. If adolescents are not taught to recognize ovulatory biomarkers, then they may miss their opportunity to better understand their bodies before entering relationships or making reproductive decisions. Having fertility awareness-based education in middle and high school can normalize discussions about female physiological processes, reframing them as health literacy rather than sexual behavior. For medical professionals, this means advocating for evidence-based women’s health education that balances cultural sensitivities.
Conclusion
Reflecting on this article during the FACTS elective emphasized the importance of bridging the gap between science and accessibility. Understanding changes in cervical mucus and ovulatory biomarkers can also help identify hormonal or gynecological concerns. Many conditions, such as PCOS, thyroid disease, or luteal phase defects, can first manifest as cycle irregularities that can be identified using female cycle chart as a vital sign of health.[4] The study’s findings underscore how improving body literacy early can lead to earlier diagnosis, better health outcomes and a more empowered patient population.
Future research should explore how schools can integrate fertility awareness education while still respecting religious and cultural norms, and how healthcare professionals can be trained to confidently teach cycle tracking to adolescents. Additional research is also needed to examine how incorporating fertility awareness into patient education and public health policy may equip adolescents with the tools to better understand their bodies and develop greater agency over their reproductive health.
References
[1] Waechtler, L. (2022). Reproductive Health Literacy Among Adolescent Women in Utah. Utah Women’s Health Review, 3(1), 12–18. doi: 10.26054/0d-32cm-2k4h
[2] Kenny, R., & Whelan, J. (2020). Social media and adolescent sexual health: Challenges and opportunities. Current Opinion in Obstetrics & Gynecology, 32(5), 321–326
[3] Espey, E., et al. (2018). Fertility knowledge and awareness among college students. Contraception, 98(5), 358–362.
[4] Peña, A., & Homburg, R. (2020). Polycystic ovary syndrome and adolescent menstrual health. Best Practice & Research Clinical Obstetrics and Gynaecology, 68, 90–101.
ABOUT THE AUTHOR
Helen Vuong is a 4th-year osteopathic student at California Health Sciences University. She plans to pursue residency in Family Medicine and is passionate about health equity and education.
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