Unfair costs and burden: How the pink tax puts women at a disadvantage
- Judith Mendiolea Lelo de Larrea
- Aug 15, 2025
- 11 min read
The pink tax puts Atlantic Canadian women at a disadvantage as they fork out cash for menstrual products and birth control
(Story originally published by PNI Atlantic News on July 15, 2025 - A series of 2 parts)
Cecilia Andrade knew something was wrong. She could feel it. Her heart would pound so hard she would hear it in her ears. Her skin drained of colour and her body trembled.
She hadn’t been living long in P.E.I. as an international student from Mexico when her health began to collapse without warning.
“I felt like I was dying,” Andrade said. “My heart was racing. I turned yellow, pale, and felt like I was about to faint.”
But the doctors didn’t see it that way.
No one ran basic bloodwork. No one asked about her family history of thyroid disease. No one referred her to a specialist. Again and again, her symptoms were dismissed as anxiety.
“They told me, ‘These are anxiety episodes,’” Andrade recalled. “The explanation was always the same: ‘That’s very common in women. You just need to meditate, exercise more, and eat better.’”
Finally, after asking several times, she convinced them to run tests. They discovered her thyroid antibodies were nearly 10 times higher than normal. She was diagnosed with Hashimoto’s disease. But after starting the prescribed medication, she felt even worse.
“There’s nothing else to do,” a nurse told her. “I can refer you to an endocrinologist, but there are none on the Island.”
After countless attempts to get help, Andrade decided to take matters into her own hands.
She turned instead to a naturopath, only made possible by her wife’s private insurance, and began travelling back to Mexico for preventive care each year.
But that’s an option many others can’t afford.
“I felt a lump in my throat,” she said. “I felt… I just felt like I never wanted to see a doctor in Canada again.”
Andrade’s experience isn’t rare.
Across Canada, women — particularly those with lower incomes — describe the same pattern: pain minimized, diagnoses delayed, care denied. In the Maritimes, where wait times for specialists are the longest in the country, that concern carries more urgency.
According to the Fraser Institute, as of 2024, the median wait time in P.E.I. between referral and specialist appointment was 39.8 weeks — more than twice the national average. And P.E.I. has no endocrinologists or , according to the Canadian Medical Association, meaning patients like Andrade often face long delays or must travel off-Island for diagnosis and care.
And when the system does finally acknowledge the problem, it often arrives too late, or at a price many women can’t afford.
This is the story of that cost.
The pink tax isn’t about razors
Across the Maritimes and nationally, women shoulder higher out-of-pocket costs for reproductive health, often for medications prescribed not only more frequently but also with less support than those prescribed to men.
The term “pink tax” has long described how consumer products marketed to women often cost more than those for men. But in health care, it’s less about branding and more about access — and who gets left behind when medications or menstrual products are categorized as “non-essential.”
One U.S. study published in Health Affairs found that women between 18 and 44 spend an average of US$1,350 more per year on out-of-pocket medical costs than men. Over a lifetime, that translates into an $8.8-billion gender disparity in prescription drug spending alone, according to the 2022 article.
Canada isn’t exempt from this disparity.
In a 2023 Statistics Canada report, women were more likely than men to report cost-related barriers to accessing prescription drugs, including skipping doses or failing to fill prescriptions altogether.
“When a pregnancy occurs, that is more often associated with the woman,” said Jillian Kilfoil, executive director of Women’s Network PEI. “There are more contraception options for women than for men... the burden is on women to make the right choice.”
That burden includes cost.
A basic hormonal IUD, which can cost several hundred dollars, may not be covered unless the patient is on income assistance or enrolled in a specific drug plan.
Other forms of contraception, like Slynd — a progestin-only birth control pill — aren’t listed at all in P.E.I.’s formulary. In Nova Scotia, patients must request it through an exceptional drug status process. Even so, these appeals can take weeks, if approved at all.
Canada lags behind many peer countries in affordable reproductive health. In the United States, the Affordable Care Act mandates full coverage of FDA-approved contraceptives. In Mexico, menstrual products have been tax-exempt since 2022. But in Canada, prescription access varies by province and by product — and many essential medications for women, such as triptans for migraines or advanced contraceptives, are not universally covered.
And for newcomer women, coverage is even less predictable.
International students in N.S. face a one-year wait before becoming eligible for provincial health coverage. In P.E.I., it’s three months. In the meantime, they rely on private insurance, which often excludes sexual health services, reproductive care and non-emergency prescriptions. And many don’t know how or where to navigate appeals.
Low-income women, especially those in part-time or precarious jobs, may not qualify for drug plans, and even if they do, they may still pay 20 to 40 per cent in copays. Youth, disabled women, and northern Indigenous communities face additional access challenges.
Statistics Canada reports that 12 per cent of racialized individuals, but only 8 per cent of non‑racialized, non‑Indigenous people, reported not adhering to prescriptions due to cost, despite universal healthcare coverage.
“We need to stop dividing products by gender when it’s not necessary — especially in 2025,” Kilfoil said. “Newcomers may not even know [about gendered marketing]… people with disabilities often earn less… youth employment opportunities are meagre at best.”
Navigating birth control insurance
Jen Nickerson has been on birth control for decades, but she still tracks every pill, every refill, every policy change. She's had to. At 39, she’s learned to assume that no system will work in her favour for long.
Nickerson, a member of the Alliance for Change and Empowerment in Saint John, N.B., experienced her first brush with systemic failure as a teenager when her family doctor denied her contraception — not for medical reasons, but religious ones.
“Only to find out that because of her religion, [the doctor] will not prescribe birth control pills or any contraceptive at all…” she said. “So as a 17-year-old, I had to go to a clinic... to get my first pap smear of my life to then be prescribed birth control pills."
Since then, she's been navigating the same maze as millions of other women: partial coverage, bureaucratic hoops, and policies that treat women’s health as optional or supplementary.
“My birth control works out to $14.39 a month... I’m paying about $3.18 a month out of pocket... yearly I would probably spend about $100 on tampons and pads would maybe be more... At least $300 a year and that's completely out of pocket because that stuff is not covered,” she said.
These aren’t huge numbers on their own. But they accumulate. Over 30 years of menstruation, contraceptive use and chronic medication management, they add up to a quiet financial and psychological toll.
Nearly half of users of hormonal methods report mood shifts, and side effects such as irregular bleeding, headaches, breast tenderness or nausea regularly push women to stop using them — 41 per cent cited these as the direct reason for discontinuation in one recent survey of more than 180 women (43.6 per cent experienced mood changes; 48.3 per cent said side effects drove them off their method), published in the National Library of Medicine.
The fact is, this disparity isn’t just the regulation’s fault.
The market itself continues to centre contraception around women, while men are offered only condoms or vasectomy.
Research into a male birth control pill in the U.K. was halted in 2016 after participants reported acne and mood swings. At least two men developed severe depression. Remarkably, similar hormonal side effects occur in women’s contraceptives, but those trials were discontinued to protect male participants.
“I’ve been using menstrual products since I was 9. So 30 years. Quite literally 30 years... just your straight up pads and tampons, there should not be tax on that.”
“It's so frustrating having to have the tax on all these extra products that are aimed specifically at women in their cycles. But you know, we still have to,” Nickerson said.
While she’s fortunate to have insurance through her husband, many women in Atlantic Canada don’t.
In 2021, the share of the population without prescription drug insurance (public or private) in the Atlantic provinces was 17 per cent in N.B. and N.L., 14 per cent in N.S., and 25 per cent in P.E.I.
Assuming women’s prescription insurance rates mirror the provincial average — women nationally are at parity with men — that would represent an estimated 200,000 women in Atlantic Canada without coverage.
“When birth control is only affordable in one form, people are forced into what they can afford, not what’s best for their health,” Kilfoil said. “It’s kind of the flip side of the gendered wage gap… Women earn less, and pay more, for products of equal value.”
Disability, dignity and the incontinence gap
For Bonnie Brayton, CEO of the DisAbled Women’s Network (DAWN) Canada, the pink tax isn’t just about tampons or contraception; it’s about who gets remembered when policy is written.
“We are footnoted,” she said. “We don't get funded as women and it just gets footnoted that people with disabilities also have problem.”
Brayton calls it “the erasure of disabled women” — a systemic failure that leaves more than 30 per cent of Canadian women aged 18 to 65 without targeted policy support. For Black and Indigenous women with disabilities, that number rises to nearly 40 per cent.
“We are not vulnerable,” she said. “We are vulnerabilized.”
One of the starkest examples is incontinence care.
While federal funding has been allocated for menstrual equity — including a $29.8-million Menstrual Equity Fund administered through Food Banks Canada — there is no comparable national support for incontinence products, which are essential for many disabled women or women after childbirth.
“If we all agree no one should have to pay for tampons, why are we fine with women paying for incontinence pads?”
In institutions across Canada, Brayton noted, disabled women are still being given long-acting contraceptives like Depo-Provera — not for birth control, but to stop menstruation.
“They think it's fine because it keeps these women from having their periods,” Brayton said. “It's just more convenient for them.”
Reports from Canadian hearings and studies indicate Depo‑Provera has been administered — often unilaterally — to women in care to suppress menstruation or prevent pregnancy.
For instance, a 2004 review by Women’s Health Protection documented “reported cases of inadequate informed consent” for Depo‑Provera, especially among women with disabilities in Ontario institutions.
More recently, a 2019 Senate report on coerced sterilization noted DAWN’s evidence that “young women with intellectual disabilities were commonly prescribed Depo‑Provera in response to family and caregiver concerns around unwanted pregnancy and menstrual hygiene.”
And for those navigating poverty alongside disability, the math gets even bleaker.
“We know that women with disabilities are choosing between maybe getting their incontinence products or their menstrual products. Their incontinence products or their food, or their drugs and their food. Or their caregiver. Or their rent,” Brayton said.
When charity fills the void
In the absence of clear policies or guaranteed coverage, a patchwork of charity has emerged across the Maritimes.
There are bins in libraries and schools. Free tampons in washrooms. Donations organized by food banks or student unions. Some cities stock period pantries, others rely on volunteers or nonprofits to fill the shelves. In some rural communities, you might not find any at all.
To Josie Baker, executive director of PEERS Alliance, a P.E.I. non-profit dedicated to AIDS prevention, these well-meaning efforts are only a symptom of the broader failure.
“What we’re seeing… something like charitable initiatives happening around like people donating or getting stuff for giveaway and whatever, what that is telling us is that there is a gap, and there is a need there that’s not being met,” she said.
Across the Atlantic provinces, that gap remains stark.
P.E.I. has the Sexual Health, Options & Reproductive Services (SHORS) program, which covers consultation and insertion costs of contraceptives, but wait times remain long.
Also, the province recently joined N.S. in offering free contraception through its public drug plan — including IUDs, pills and implants — but only as of May 2025. And according to the Drug Cost Assistance Act, these services are available only for permanent residents or citizens, leaving behind anyone living in the Maritimes under a work, study or similar permit.
In 2021, a private member’s bill — The Free Birth Control Act — was introduced in Nova Scotia's legislature, aiming to make prescription contraception free by adding it to the list of publicly insured services. Although the bill only reached its first reading, it marked a growing recognition of the financial barriers many women face in accessing birth control.
N.L., and N.B., still offer partial coverage only to eligible groups, such as those on income support.
Even in provinces where the procedure to insert an IUD is covered, the device itself can cost hundreds of dollars unless a specific plan applies. Many women are still left to navigate private insurance with copays, denials or limited formularies.
And menstrual products? They’re not guaranteed either.
N.S. leads in this area, offering pads and tampons in all public schools and libraries. N.B. and N.L. followed with school-based initiatives. But in P.E.I., the government’s 2020 promise to fund products in schools and shelters remains inconsistently implemented. Posters have been hung, but there is no documented evidence or follow-up report confirming that menstrual products are being supplied across P.E.I. schools.
The national Menstrual Equity Fund, administered through Food Banks Canada, offers some relief. But it does nothing for those who need incontinence products or require menstruation suppression for medical reasons — a frequent reality for disabled women.
At PEERS, that link between dignity and access comes up often — particularly for people who are precariously housed.
“Access to dignity is directly related to access to housing, access to money, access to things like that,” Baker said. “Certainly, like access to menstrual products.”
It’s a cascade of structural failure: when people lose stable housing, they often lose their medication routines and their ability to advocate for themselves in a system that demands paperwork and patience. Baker said this compounds the barriers already faced by those with trauma histories or intersecting identities.
“Certainly, working in a low-wage position is something that no one can really afford to live on anymore,” she said. “If you have a job that provides health [insurance], you probably have a better paying job… so that puts an extra tax on people that are already struggling financially.”
The cost of prescriptions, then, becomes more than a budget line, it becomes a wedge between someone and their health.
“We can make the most evidence-based and well-informed arguments in support of certain public health measures,” Baker said. “But if there's not the political will, then it won't happen.”
Still, Baker sees signs of progress and a vision for what’s possible.
“It wasn’t that long ago, 10 years, that women in P.E.I. were driving to Fredericton and paying $750 out of pocket for abortions,” she said. “That’s changed.”
Today, she supports universal access to sexual and reproductive care, not bound by insurance status or income.
“We advocate for absolutely no barriers… to contraception of all kinds,” she said. “In an ideal world, if a doctor prescribes it, people should have access to it.”
But in the real world, the system still pushes many women to the margins — and some, like Cecilia Andrade, to the exit.
Today, Andrade avoids Canada’s health-care system whenever she can. She travels to Mexico for routine checkups, relying on private insurance to access care she couldn’t get publicly. Jen Nickerson depends on her husband’s plan to cover contraceptives. Disabled, and elderly women pay out of pocket for incontinence products.
And across the Maritimes, menstrual supplies are still taxed or missing from public shelves.
“The worst thing is that I believed him. I felt like maybe I was being dramatic,” Andrade said. “Like maybe it really was all in my head.”
But it wasn’t. It was her health — dismissed, delayed, and nearly denied.
In Canada, the pink tax isn’t just about store shelves or soap prices. It’s in the higher cost and every gap women have to navigate for access to reproductive health. One where pads and pills are no longer charity, but policy.
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