New research into the wellbeing of New Zealand’s top sportswomen has some surprising revelations, that should help lead a change in culture for happier, healthier, better performing female athletes. Ashley Stanley reports.
Almost three quarters of New Zealand’s top female athletes in a new national survey feel elite sport is putting them under pressure to look a certain way, potentially damaging their health.
One in four of the Kiwi sportswomen at the top of their game have been diagnosed with a stress fracture at some point in their careers.
And nearly a quarter have been iron deficient, while a third reported their menstrual cycle was affected by their training volume.
These are some of the findings just released from research carried out by a team of experts in New Zealand, published in the Frontiers in Sport and Active Living journal.
The WHISPA (Healthy Women in Sport: a Performance Advantage) group behind the research includes members from fields like sport medicine, physiology, nutrition, sociology, coaching, psychology, endocrinology and former athletes. It’s a High Performance Sport New Zealand initiative formed in 2017 to focus on women’s health, wellbeing and performance following the 2016 Rio Olympics – the first Games where there were more women than men representing New Zealand.
The research involved 219 female survey participants, either carded athletes – those who receive funding from HPSNZ – or development sportspeople in high performance pathways across a number of sports codes in New Zealand.
Holly Thorpe, the socio-cultural lead of the research, acknowledged a survey has strengths and limitations, but the group decided it was the best way to get a snapshot of female athlete health in New Zealand at a point in time. The research aimed to identify factors influencing elite female athletes’ health, wellbeing and performance.
“This survey was not about diagnosing athletes with anything,” says Thorpe, a sport sociology and physical culture professor at the University of Waikato. “It’s really about mapping across the sport sector and athletes to really identify key trends, that we can use to start being more focused in directing change initiatives.”
The survey is unique, because there is next to no data in this area of sport. “I feel very confident in knowing that this kind of multi-disciplinary approach around female athlete health is world-leading. No one else is doing it like this,” Thorpe says. “And this has been the ethos of the WHISPA group from the very beginning.”
Many of the participants also added comments to the survey responses to give more context to their answers. “I take that as a sign that the athletes wanted to have a say on some of these issues. And to be able to do that anonymously went well,” says Thorpe.
Bruce Hamilton, the initiator and connector of WHISPA, says most of the data is “pretty consistent” with international trends, but there were surprises in being able to quantify some of the issues.
“I don’t think anybody who works within a high performance sport environment would be too surprised by the topics and the areas we covered,” he says. “Some of the numbers may surprise people though.”
Hamilton is the director of performance health at HPSNZ – a role responsible for the health care provision across all carded sports in New Zealand. And he also holds a dual position with the New Zealand Olympic Committee as the health team leader, responsible for preparing the health care needs of the team heading to Tokyo later this year.
One of the biggest revelations to the group was the difference in what individuals were being diagnosed with, says Hamilton. “And what we’re actually seeing from the symptoms they were describing.”
Conditions like oligomenorrhea (irregular menstrual cycles) and amenorrhea (the absence of menstrual cycles) which were diagnosed previously in 12 percent of participants, but in this study half of the athletes mentioned symptoms consistent to those diagnoses. “I think that’s a real area that highlights to us the need to be able to diagnose and support women comprehensively,” Hamilton says.
Another of the figures which surprised Hamilton was 23 percent of our female athletes have been diagnosed at some point in their career with a stress fracture.
“That’s a pretty significant number – one in four,” he says. “While that is not outside the realms, I think when you see that number in the cold light of day, it has quite an impact.”
The research shows stress fractures and iron deficiency were closely connected with oligomenorrhea and amenorrhea, menorrhagia (menstrual bleeding that lasts for longer than a week) and disordered eating practices.
“Forty-seven percent of elite female athletes have been diagnosed with iron deficiency sometime during their career,” says Hamilton. “And while there is a good academic basis as to why that is, I think that number certainly reinforced what we saw, but was probably higher than what we thought it might be.”
On the other hand, Thorpe says the research data and findings did not surprise her. One of her areas of interest is women in sport, and she has already conducted research interviewing female athletes in three different sporting cultures, including weightlifting and endurance sports.
“I’ve heard these things before,” says Thorpe. “But it was really great for the socio-cultural side of the survey to be able to put numbers across sports and the significance of some of these issues that elite female athletes are facing.”
One of the findings that was “pretty striking” to Thorpe was 73 percent of all athletes believed elite sport was putting pressure on them that was damaging their overall health.
“And 54 percent of the athletes believed or felt pressures to conform to a particular notion of femininity,” says Thorpe. “So the idea around beauty that wasn’t associated with performance, but they felt those pressures.”
Eighty percent of those women reported the biggest cause of that was social media and 15 percent tried disordered eating methods to reach those societal standards. Other factors in conforming to looking a certain way are the general public, media and the athletes’ own perceptions.
Thorpe has already completed international research focusing on elite female athletes and social media, but not in New Zealand.
“[Social media] is really helpful in terms of building their brand, audiences and promoting their sport,” she says. “But with that can come various forms of online abuse and trolling. And it can, overall, increase body image pressures which is clearly evidenced in our survey.” This was mentioned more than any other performance-related pressure by participants.
The survey is the tip of the iceberg, says Thorpe. “These are elite carded sportswomen in Aotearoa. I feel very confident that underneath are much bigger issues that are being experienced by non-carded athletes, in more developing athletes.” This research somewhat supports this notion with more injuries seen in developing participants in comparison to senior athletes.
Hamilton points out there isn’t just one factor causing pain points for women athletes.
“To be honest, I think it’s a number of factors we want to address across the board,” he says. “I think understanding, education, and communication of everybody – athletes, medical staff, nutrition staff, psychology staff, coaches, all of the support staff – around individuals.”
Athletes reported barriers to communicating issues they experience include the lack of quality health information available and to a lesser degree, the gender of coaches and support staff.
On top of communication issues, socio-cultural components, such as cultural and organisational factors, can impact the effectiveness of health and performance support for female athletes.
This research has reinforced WHISPA’s desire to make a difference and have a positive impact on women’s health and wellbeing. And they’ve already started driving some initiatives within HPSNZ and outside the organisation.
A number of educational forums and conferences have been held over the last couple of years for the general public, athletes, parents and coaches as well as presenting research and the group’s expertise at international forums.
They’re also connecting key experts from areas like physiology, endocrinology and sport medicine with national sports organisations, so those individuals are working closer together, developing relationships and sharing knowledge.
A PhD scholarship has just been announced to help with further research on the back of this survey. It was part-funded by Orreco (the international company that created the FitrWoman app) and the University of Waikato.
The release of this research seems like perfect timing as HPSNZ’s 2024 strategy is being launched soon, which includes a wellbeing programme. Hamilton knows things will take time “but we’ve started the ball rolling, largely around education and trying to support best practice.”
So where can the biggest gains be made?
“How do you motivate change when our athletes, coaches and sports organisations are already at capacity? This is more. We need to do more,” Thorpe says. “But it needs to be a must do, a need to do, not a nice to do. This actually needs to happen.
“I think we can connect the dots over recent years, and see elite sporting culture is highly problematic in terms of the power relations and in the effects on male and female athlete health and wellbeing. So I think we need a cultural shift. But how to bring that about is strategic.”
She says people need to be brought along with the change. “Rather than pointing fingers or telling people they are doing it wrong. I don’t think that brings people with us.”
Highlighting and encouraging examples where athletes and coaches are already being proactive in this space and leading in a healthy way is one option. “I think there are assumptions that to really perform, you need to be deep in the pain and putting up with a lot of horrible stuff,” says Thorpe.
“When actually our athletes are going to be better, they’re going to stay in sport longer, their bodies are going to keep moving and be healthy well into their older years if we can look after them in these environments.”
There are performance advantages in having healthy and happy athletes, adds Thorpe. “We don’t have to have unhappy, unwell athletes for them to perform.
“So this is actually a big change, this is culture change. And I see this survey as a little, but very important part, in bringing disciplines together and getting a united message that is backed by hard data.”