Balancing Faith, Culture, and Performance: Understanding the Role of Religion and Cultural Practices on Health Monitoring for Energy Deficiency in Female Footballers

Footballers from diverse cultural and religious backgrounds navigate complex intersections of sport, identity, and health in high-performance environments that are often structured around Western norms. This qualitative study explores the lived experiences of elite and subelite female footballers living in Australia (n = 12), focusing on perceptions of health monitoring, nutrition, low energy availability, body image, and menstrual health. Semistructured interviews, analyzed thematically within a critical realist framework, revealed recurring barriers including cultural exclusion, identity conflict, microaggressions, and Western-centric fueling practices. Participants described pressures to conform to expectations of body composition and energy availability, namely, to maintain lean physiques and strict fueling practices, which frequently clashed with cultural beliefs around modesty, fertility, and nutrition. Many athletes also expressed discomfort with male staff handling sensitive health data and highlighted the importance of culturally responsive approaches to menstrual tracking and body composition assessments. Parental involvement in health-related decisions emerged as a key theme, reflecting intergenerational influences on medical autonomy. Although current literature suggests that low energy availability is more prevalent among Western athlete samples, this may reflect biases in detection and reporting rather than actual prevalence. Findings indicate that culturally diverse athletes may face heightened risk of low energy availability due to systemic neglect, cultural misalignment, and limited psychological safety within their sporting environments. To promote equitable care, football organizations must move beyond tokenistic inclusion and codesign culturally safe health practices that center the diverse realities of the athletes they serve.