Thursday 7 September 2017

A Policy A Day: Funding Sanitary Products

In the lead-up to the election, we are examining a policy a day. We're exploring a variety of policy areas, explaining the background and analysing some of the policy options, with a mixture of technocracy and values-based approaches. Inevitably, some opinion will make its way in and we make no apology for that - after all, we're voters too. A list of all the articles is available hereEnjoy!

Today's post is by Bhen Goodsir

Gender inequality has deep roots in poverty and institutional inequality. The causes and solutions for inequality are complex and often inherently tied into the power structures and institutions of our society. Sometimes though, there are obvious problems with obvious fixes, and no clear answer for why we’re not doing more.

We saw in the news last year that some women aren’t able to go to work or school, and some university students are having to choose between not going to class and not eating, because they couldn’t afford the sanitary products. When it comes to closing the gender wage gap and breaking the poverty cycle, we are never going to make any progress if women in poverty can’t make it to class or a job interview.

There can be significant natural variations in the length and frequency of a woman's period. This means that a woman can need anywhere between 63 and 730 products a year (at a cost of $19 - $230 a year). For many women, this can be a huge financial burden. There are some charities doing good work to provide support and in 2014, the government gave KidsCan $25,000 to provide sanitary products in schools. But despite continued funding, the problem persists.

We can do better. Sanitary products should be affordable and accessible to all who need them, no questions asked. They aren’t just a convenience, they are needed to participate in society and the economy with dignity.

So how do we make sanitary products affordable?
A couple of years ago my flatmate came home with a carton of 12 boxes of condoms under their arm. They had got them from the pharmacy for only $5 with a prescription from their doctor. Based on the supermarket price, that’s a saving of $160. Leaving aside the fact that many of these boxes are still in a cupboard at the flat, it was pretty good value. It also makes sense; we want people to be able to finish their education and get a job, so they can have kids when they’re ready. While the history and context of condom funding has its roots in the AIDS crisis of the 1980s, part of its legacy today is a generation of young people who don’t have to question whether they can afford safe and effective birth control.

The condoms were funded by PHARMAC - New Zealand’s government funding body for pharmaceuticals and medical devices. PHARMAC can fund medicines and medical devices which offer a "therapeutic benefits relating to a health need". Last year, PHARMAC rejected an application to fund sanitary products. PHARMAC argued that sanitary products are not medical devices and that “normal monthly bleeding is a normal bodily function”.

PHARMAC has left the door open to fund sanitary products for a “relatively small and targeted group of women” - if therapeutic benefits could be shown - but for many, the decision was disappointing.
Ultimately, PHARMAC has the unenviable job of allocating their budget as efficiently as possible, in order to provide the best health outcomes for New Zealand. Currently, money spent on sanitary products would mean less money spent on other important medicines and devices. What we need is a government who can change the law to ensure sanitary products qualify for funding and commit to increasing PHARMAC’s budget to cover the cost.

How do we make it accessible?
Securing PHARMAC funding for sanitary products alone doesn’t solve the issue. PHARMAC funded products still require a visit to the doctor so she can prescribe it, which can still be costly for some. Fortunately, there are two tools the government can use to get around this.

A Practitioner’s Supply Order (PSO) allows people other than doctors to prescribe a specific product. For example, the Government’s Rheumatic Fever Prevention Programme allows nurses to prescribe antibiotics to patients in certain high-risk categories. The government should ensure that nurses, social workers, and WINZ staff are all able to provide a PSO for sanitary products for the women in their care who need them.

Similarly, a Bulk Supply Order (BSO) allows an organisation to order a large quantity of a product. Normally, you would see Hospitals and DHBs using a BSO to restock their medical supplies, but recently organisations like the NZ AIDS Foundation have been included in the scheme so they can order the condoms they need.

Allowing some key charities like the Salvation Army and Kids Can to order sanitary products with a BSO would cut the amount of time they would have to spend applying for grants. This would mean that anyone turning up to school or university could be sure that they would have the products they need.

Another big advantage of funding through PHARMAC is that it means the government can purchase the sanitary products at wholesale rates. KidsCan estimates that it costs about $25 a year to supply women with sanitary products. This means it would cost the government between $2.5 million and $3 million, per 100,000 women per year. It’s hard to guess how many women would choose to use the government funded products (even though there are government funded condoms, not everyone uses them), but if we aim for a 30% uptake then we’re looking at an annual cost of about $10 to $12 million.

It’s an easy win
Funding tampons and pads is good policy. It’s a simple idea that solves an important problem. It’s the sort of headline grabbing policy that’s sure to get people talking, and it shows that a party is taking concrete steps to improve the lives of women in New Zealand. Parties can spin it however they like – improving education; helping people moving into work; ending poverty; tackling gender inequality – so long as someone is willing to stand up and do the right thing.

Bhen Goodsir recently completed his law degree at the university of Auckland and is currently studying at the University of Paris-Sorbonne. In his spare time, he listens to many podcasts and sends Snapchats of dogs he sees to his friends. He tweets at @bhenelliott. Many thanks to Claire Black for her input and advice on this piece.

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