A Government that supports safe sex and family planning is to be celebrated. However, writes Emma Espiner, it raises a contradiction in Pharmac’s position on sanitary products

There was a really cool and slightly batty Al Jazeera story a few months ago called ‘India’s Menstruation Man’. It’s worth a watch just for the hilarious love story between the man and his wife.

But if you’re like me and mostly read your news on your phone and have about three spare minutes in which to do so, the Twitter summary (140 character limit) is:

‘Entrepreneurial man creates cheap sanitary pads for women in India after noticing his wife had to use dirty rags during menstruation because she couldn’t afford to buy sanitary products’.

When I saw this story I really felt for the women. The piece claimed there were 300 million women in India without access to safe menstrual hygiene products. I thought some unkind things about India’s abysmal track record in women’s rights generally and had other similarly unflattering thoughts about deprivation in developing countries and inadequate access to essential healthcare.

It was an ugly shock to see a story not long after, here in New Zealand, about girls missing school because they couldn’t afford sanitary products. They didn’t want to face the embarrassment of bleeding all over the place at school so they just stayed home. And there are women too, working women for whom the cost of tampons or pads is the final straw sliding off the camel’s back of the monthly budget. For these women, a healthcare essential has been shunted into the ‘luxury’ category.

Digging a little deeper, despite the story being news to me it has been a growing problem in New Zealand – especially for girls in education. There have been pockets of activity trying to resolve the issue with community groups collecting and distributing sanitary products locally, the Ministry of Social Development provided a small amount of funding in 2014 to support KidsCan to put tampons and pads in schools and some supermarkets are collecting sanitary products from their customers or directly donating them.

The issue bubbled away with sporadic media attention and no real progress until an anonymous applicant put the issue to the Pharmaceutical Management Agency (Pharmac) late last year requesting that the Agency consider subsidising tampons and pads. Last month, Pharmac’s Director of Operations Sarah Fitt told RNZ they had considered the request carefully, but menstruation is a natural process experienced by all women and subsidising sanitary products would be outside Pharmac’s remit to fund products with a therapeutic benefit related to a health need.

At the time I thought Pharmac had made the right call. It seemed reasonable to expect our drug-buying agency, specifically tasked with getting value for the public health dollar spend, to be judicious about ensuring it only subsidises products and devices with ‘therapeutic benefit related to a health need’. This was until I had a look through the pharmaceutical schedule and saw chocolate flavoured condoms were subsidised.

I have no particular problem with condoms being subsidised, nor do I think it inappropriate to subsidise contraception. Chocolate condoms wouldn’t be my cup of contraceptive tea but each to their own. Sexually transmitted infections and unwanted pregnancies are significant health and social issues. A Government that supports safe sex and family planning is to be celebrated, particularly in the context of a discussion about women’s rights. However, it does raise a contradiction in the agency’s position on sanitary products.

Pregnancy and sex are as natural as menstruation, are far more voluntary by nature, and yet their consequences are prevented by products subsidised by Pharmac.

There doesn’t seem to be much political will to do something about this. In the case of Pharmac, although it’s frustrating in the apparent contradiction with funding contraception, I am comforted by the silence. I get nervous when politicians talk about fiddling with the agency’s decision-making autonomy. Pharmac’s independence has played a major role in getting New Zealand to the bottom of the per capita drug spend tables in the developed world. Politicians rarely intervene in Pharmac’s decisions with solely pure intentions and Pharmac has too important a role in our health system to be used as a political tool.

The Minister of Health likes ‘controllable’ targets. In an interview for The Listener last year (disclaimer: my husband Guyon was the interviewer) Coleman talked about why he wouldn’t set a target to reduce the incidence of obesity:

“We could have said we are going to decrease the rate of obesity by x% over a given time, but then we can’t control what you are serving your kids each night.”

Like any good medical researcher he wants baseline data (what’s the extent of the existing problem), and then the only variables to be ones that he can control, so that any success can be quantified and duly claimed by the Government.

This attitude worries me on an issue like access to sanitary products. Discussions about menstruation are subject to social and cultural norms which could under-represent the scale of the problem. This makes it difficult to establish a baseline problem to solve. If there’s no baseline, you can’t set a target and is that going to make the problem invisible to this government?

If Pharmac can’t be convinced to treat tampons and pads like condoms, IUDs and the contraceptive pill, we need to look for other options. Surely the fast moving consumer goods (FMCG) industry could be influenced to do a good thing, get some good PR and partner the Government to at least provide tampons and pads in all state schools.

Perhaps Coleman should be bypassed, and pressure applied to the new Minister of Education Nikki Kaye. Theoretically Kaye is a good fit. She holds the Youth portfolio in addition to Education, and has shown herself to be responsive to community concerns in the past – even when those concerns require a principled rather than a party-political response. It would be a powerful stance for an incoming minister to commit to supporting equity of educational access to New Zealand children regardless of their sex.

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