In 2023, the Human Rights Ombudsman of the Republic of Slovenia (Ombudsman) on his own initiative discussed the broader issue of menstruation and its connection with issues of poverty[1], health, and human rights. Women and girls are still often faced with the experience of stigma because they are deprived[2] of access to basic services due to various life circumstances. When dealing with the issue, the Ombudsman examined various sources and turned to various stakeholders for additional explanations, which are described below. In accordance with his powers, he made recommendations at the end of the hearing (below).

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The connection between stigma, gender equality, (non)discrimination, rights to health, education and work, children's rights, and positive state measures has also been recognised by the WHO[3], the UN High Commissioner for Human Rights[4] and UNICEF[5]. At the same time, the WHO called for measures to recognise menstruation as a health and human rights issue, not as a hygiene problem, namely a health issue with physical, psychological, and social dimensions, which must be treated holistically from the period before menstruation to the period after menopause. The WHO stated that different governments have already taken different approaches on the issue. Some have eliminated taxes on menstrual hygiene products, others have focused on the challenges faced by school-aged adolescent girls in accessing these products, or introduced strategies to provide free menstrual hygiene products to populations in difficult situations, e.g. homeless people or people serving prison sentences. A few countries have also introduced laws and policies for sick leave when a person experiences pain, discomfort, and other symptoms and signs related to menstruation, according to the WHO. At the same time, the WHO took the view that governments should do more than just improve access to menstrual hygiene products. She also took the position that schools, workplaces, and public institutions should support and normalise the dignity associated with menstruation. In the context of global events, countries should also pay special attention to menstruation as part of a wider response in the areas of sexual and reproductive health of displaced people due to wars and natural disasters.

In the Republic of Slovenia, from 2021, sanitary pads, tampons and some other menstrual hygiene aids will be taxed at a lower rate. In accordance with the Regulations on the Implementation of the Value Added Tax Act, a 9.5% rate is charged for the mentioned products and not a 22% rate.

The Ombudsman followed the call of the ZPS and the March 8 Institute from 2022 for an additional VAT reduction (to a 5% rate) on menstrual aids and for the free availability of said aids in health centres and educational institutions. At the same time, the call also emphasised the higher risk of poverty in Slovenia in the case of single mothers and the Covid period, which "has deepened the gap in access to goods". ^[6]  From the list of prices of menstrual hygiene aids, which was carried out by ZPS half a year after the introduction of lower VAT, it follows that most retailers had "reduced prices, but not all or not for all products". The price of some products remained unchanged or even increased. Some dealers, however, presented the lower price as a special offer due to the VAT reduction.^[7]

According to SURS data, the poverty risk level in the Republic of Slovenia increased by 0.4 percentage points in 2022 compared to 2021, to 12.1. In 2021, the poverty risk rate was 11.7%.^[8] According to SURS data, the price of daily necessities rose by 10.0% in January 2023, while inflation was 5.8% in the same month of the previous year. "In one year, the prices of goods rose by an average of 11.1%, and the price of services by 7.9%. Daily consumption goods were 13.5% more expensive, durable goods 7.9% more expensive, and semi-durable goods 4.8% more expensive."^[9]

Regarding access to menstrual aids, the Government of the Republic of Slovenia announced in a press release[10] that it will study the possibility of financing the purchase of hygiene products for women. In response to a member's question^[11] it explained that it has "committed to regulate this issue within the framework of the Operational Programme of Material Assistance through the Ministry of Labour, Family, Social Affairs and Equal Opportunities, namely in a way that, in terms of accessibility, treats all women who cannot afford menstrual products equally”[12] and stressed that it “opposes the distribution of hygiene products according to social criteria exclusively in educational institutions, without properly developed criteria”. In the same response, the Government of the RS announced a check to see if there is agreement among the social partners for a more favourable regulation of sick leave due to recurring painful menstruation.

Based on the statistical data on the increase in the risk of poverty, the annual increases in the prices of consumer goods in the Republic of Slovenia, the insufficient effect of the VAT reduction for menstrual hygiene devices on the final prices for consumers, according to the statements and assurances of the Government of the Republic of Slovenia, and on the basis of Paragraph 2 of Article 9 of the ZVarCP and with simultaneous reference to Article 3 of the same law, which stipulates that the Ombudsman can also refer to the principles of good governance, even before the above-mentioned parliamentary initiative, the Ombudsman turned to several stakeholders for additional clarifications, namely to the Ministry for Work, Family, Social Affairs and Equal Opportunities (MDDSZ), Ministry of Health (MZ), Ministry of Education (MVI), Ministry of Finance (MF), Ministry of Public Administration (MJU), Ministry of the Interior ( MNZ), and the Administration of the Republic of Slovenia for the Enforcement of Criminal Sanctions (URSIKS).

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Opinions and recommendations of the Ombudsman

The government has also undertaken to study the possibility of financing the purchase of hygiene products and to check whether there is a consensus among the social partners for a more favourable regulation of sick leave due to recurring painful menstruation. So far, the government has failed to fulfil any of these commitments. It was only in 2023 that the first, minimal, changes occurred in individual departments due to mostly self-initiated measures.

The Ombudsman notes that of the ten ministries discussed in this group, half showed immediate readiness to approach the mentioned measures, namely the MDDSZ MVI, MVZI, MOPE and MORS.

By the end of 2023, the MDDSZ failed to realise its own predictions and study the possibilities of introducing free menstrual hygiene products in the toilets of centres for social work; check whether there is a consensus for a more favourable regulation of sick leave due to recurrent painful menstruation; financing the devices in question through the programme for the elimination of material deprivation also proved impossible.

The Ombudsman considers the activities of MORS as particularly exemplary, which ensured the availability of free hygiene products and even installed a vending machine in the administration building (even before the end of the first half of 2023).

With certain reservations, mainly in terms of finances and jurisdictional frameworks, three ministries, the MoH, MJU and MZI, expressed their readiness to join the measures.

The MNZ and the MF the did not join the initiative (MDDSZ), firstly because in accordance with the ZU and the Rules on Record Keeping, there are no such (public) institutions that could apply for the introduction of free hygiene products, and secondly, because the MDDSZ understood from the initiative that it is mainly intended for educational and health institutions and not for ministries with bodies in their composition. At this point, the Ombudsman emphasises that, despite the assessment by SURS, menstrual hygiene products for individuals can assume a large share of their spending, as the needs can vary greatly depending on the individual's personal circumstances. The monthly cost of menstrual hygiene products in practice, especially with the increase in the cost of consumer goods in the last period due to inflation, but also otherwise, can significantly exceed the amount of 2 euros. From the position of the MF, it is also clear that the effect of the measure of reduced VAT rate in this case is negligible or even negative for the consumer.

In particular about the lack of gynaecologists and issues related to menstruation and health

The Ombudsman is critical of the response and statements of the MZ. This emphasised that it can follow the gradual provision of free hygiene products, but only if it were a decision of the government, since it cannot provide any funds for these purposes. Contrary to the position of the WHO, which calls for the recognition of menstruation as an issue of health and human rights, not as a hygiene problem, the MZ insists on the position that menstruation and ensuring the availability of menstrual products are issues of poverty and hygiene problems that fall under the competence of the MDDSZ, and not in the field of health.

The Ombudsman was also critical of the MZ's statement that every woman can choose a specialist in obstetrics and gynaecology as her personal doctor, who is available without a referral, because not only are various sources talking about problems in this area, but the Ombudsman is also aware of the problem from the complaints considered. The MZ is convinced that the situation in the field of gynaecology and reproductive health is not as critical as in other specialties. It also presented a table [13], from which it is not possible to determine the number of all those entitled to a gynaecologist. The Ombudsman points out that the data from the table show that the number of unidentified women is increasing, with the exception of two years, certainly the number of unidentified women in 2022 is higher compared to 2017, while the percentage does not change significantly. In its response, the MZ focused mainly on the reasons for the lack of identification and shifted the responsibility for them to the beneficiaries – either that they do not need a gynaecologist due to their age, or that they no longer want to visit one. The MZ also explained the reasons for the lack of gynaecologists by saying that the organisation of primary health care is the responsibility of the municipalities or the management of health centres. On the basis of these explanations, the Ombudsman understands that the MZ does not perceive the lack of gynaecologists at the primary level as critical, it hardly sees reasons for its own responsibility, and shifts them to the beneficiaries and local self-government, although at the same time it admits that specialists prefer to be employed in hospitals and at the same time accepts intervention mitigation laws.

The Ombudsman also joins the call of the WHO to recognise menstruation as a health issue with physical, psychological, and social dimensions. At the same time, he reiterates that the consequences of a lack of gynaecologists for women's health can be even fatal and emphasises that the financially well-off have no problems, while the poor can have serious problems and others (e.g. those who live in remote areas, or other marginal groups (below)). Poverty can undeniably have a detrimental effect on health as well, e.g. using menstrual devices for longer than recommended, and inappropriate or alternative forms can cause infections and other health problems.

Vulnerable groups

The Ombudsman points out that certain groups may face additional obstacles in accessing menstrual hygiene products, e.g. disabled, homeless, Roma, victims of domestic violence, dependents or wards, individuals living in remote places, those with cultural/religious barriers, displaced by wars and natural disasters, etc. The Ombudsman suggests that the authorities, when preparing further measures, pay particular attention to considering any additional obstacles that the aforementioned might encounter when accessing such products.

Dignity

The Ombudsman believes that the ability to access menstrual hygiene products is essential for equality and dignity. The Ombudsman recommends that in the possible introduction of a measure of access to free menstrual products, methods that respect the personal dignity of individuals should be taken into account, above all through measures aimed at eliminating the stigma associated with menstruation and menstrual products, its normalisation, and taking into account the needs and wishes of users related to their privacy.

[1] Menstrual poverty is usually defined as a lack of access to menstrual hygiene products, education, adequate hygiene facilities, waste management, or a combination of the above.

[2] According to the World Bank, such deprivation affects 500 million women and girls worldwide. V: Cardoso, L.F., Scolese, A.M., Hamidaddin, A. et al. Period poverty and mental health implications among college-aged women in the United States. BMC Women's Health 21, 14 (2021). https://doi.org/10.1186/s12905-020-01149-5.

[3] WHO (22. 6. 2022). WHO statement on menstrual health and rights: www.who.int/news/item/22-06-2022-who-statement-on-menstrual-health-and-rights.

[4] OHCHR (21. 6. 2022). High Commissioner for Human Rights statement on menstrual health: www.ohchr.org/en/statements/2022/06/high-commissioner-human-rights-statement-menstrual-health.

[5] UNICEF (2019). Guidance on menstrual health and hygiene: www.unicef.org/media/91341/file/UNICEF-Guidance-menstrual-health-hygiene-2019.pdf.

[6] ZPS (8. 3. 2022). Slovenija naj bo država brez menstrualne revščine: www.zps.si/mediji/izjave-za-javnost-2020/1127-izjave-za-javnost-2022/11289-slovenija-naj-bo-drzava-brez-menstrualne-revscine.

[7] ZPS (8. 3. 2022). Pol leta po uvedbi nižjega DDV za menstrualne pripomočke: so cene nižje?: www.zps.si/o-nas/aktualno/11205-pol-leta-po-uvedbi-nizjega-ddv-za-menstrualne-pripomocke-so-cene-nizje.

[8] SURS (10. 2. 2023). Več prebivalcev pod pragom tveganja revščine: www.stat.si/StatWeb/News/Index/10898.

[9] SURS (6. 2. 2023). Indeksi cen življenjskih potrebščin, januar 2023, Cene višje na obeh ravneh, na letni za 10,0 %, na mesečni za 0,2 %: www.stat.si/StatWeb/News/Index/10869

[10] The public statement was made for STA on 08/05/2022: The government supports the gradual introduction of free hygiene products for women in public institutions: www.sta.si/3067911/vlada-podpira-postopno-uvajanje-brezplacnih-higienskih-pripomockov-za-zenske-v-javnih-ustanovah.

[11] Response of the Government of the RS to the parliamentary initiative regarding rights at work due to women's reproductive health no. 00105-7/2023/6, 13/04/2023. Available at:

imss.dz-rs.si/IMiS/ImisAdmin.nsf/ImisnetAgent

[12] Similar to the content of answer no. 00105-32/2021/7, on 26/04/2021, the Government also submitted a parliamentary initiative regarding the provision of free menstrual hygiene aids in public educational institutions. Available at: imss.dz-rs.si/IMiS/ImisAdmin.nsf/ImisnetAgent

[13] Table 1: Data on the number of unspecified women and the percentage of unspecified women in relation to all women who have the right to see a gynaecologist (age 13+) for the years 2017 to 2022. The data are for each year as of 31 December. (Source ZZZS)