PHANZ Policy Spot #98

Policy challenges of the digital divide in Aotearoa

Government to mandate folic acid in most bread-making flour to protect babies

Low folate levels in mothers cause neural tube defects that result in the death of babies, or life-long disability. New Zealand currently has around 10.6 neural tube defects per 10,000 births, compared to 8.7 in Australia, which mandated fortification in 2016. Cheaper white bread lacks folate, meaning poorer women, notably Māori and Pacifica women are at more risk of being folate deficient.

In 2018 Sir Peter Gluckman and Royal Society Te Apārangi published a review of the health benefits and potential risks of adding folate (folic acid) to packaged bread to reduce the rate of neural tube birth defects in New Zealand. The evidence supported mandatory fortification.

Public opposition to the idea of large-scale mandatory fortification exists in NZ, representing a barrier to achieving the goals of folic acid fortification. Political discourse and media coverage have framed the debate around:

ethics (freedom of consumer choice, or opposition to “mass medication”),
necessity (is the government and the baking industry responsible for ensuring pregnant women get sufficient folic acid?) and
safety (concerns about adverse effects of dietary folic acid).

Industry concerns over consumer reluctance, increased costs and loss of revenue represented a significant barrier to fortification when participation in the scheme was voluntary.

However, an Examination of barriers and enablers to uptake of folic acid fortification of bread in New Zealand found that consumer reluctance (mainly centered on folate being an artificial or processed additive) was relatively minor. As folate is not mandated in organic and wholegrain bread, wealthier consumers may choose alternatives.

In mandating fortification, science and health equity have been chosen over industry concerns.

The selection of Lauren Hubbard, the first openly transgender athlete ever to compete at the Olympics, generated a fierce debate on gender, sexism, and sport. To her supporters, the 43-year-old's selection is a decades-in-the-making milestone that exemplifies the Olympic spirit of inclusion and could inspire transgender athletes who are underrepresented in sport at all levels. Others, including some other athletes (none of whom are privy to her personal journey), have been vocal and hateful in their responses.

The IOC rules -- agreed on in 2003 and known as the Stockholm consensus -- allowed transgender women and men to compete in the Olympics, as long as they had "surgical anatomical changes" (including having their testes or ovaries removed), obtained legal recognition of their assigned sex, and underwent hormone therapy for sufficient time to "minimize gender-related advantages."

Kristen Worley became the first athlete to undergo an Olympic gender verification process when she tried to represent Canada in track cycling at the 2008 Olympics in Beijing, with devastating results. Scared and traumatized after the years-long processes and invasive intimate examinations, she quit, losing her career, health, and wellbeing. "When you're violated in that way ... you never forget it. You just learn how to manage it," she told CNN in a Zoom interview. The way her gender identity was publicly discussed destroyed her: "It made me feel like I was less than half a human being."

While participation in elite sport is the pinnacle of achievement for a tiny few, such debate can also sow division and have a chilling effect on participation for all. Acceptance of womens' participation in sport, with the resulting physical, emotional and psychosocial benefits that follow, has been hard-won, and we are still very far away from equality in sport.

Racism, sexism, misogyny and homophobia are rife in sport at all levels. Insistence on the depiction of "ideal' feminine bodies (especially the insidious effects of sports sponsorship and their PR / image manipulation) can lead to body dysmorphia, anorexia, damage self-esteem and can deter girls and young women in particular from pursuing sports. Stoking fears that they might get swept into questions of sexual or gender identity will not help.

People transition to truly be themselves and to make themselves feel comfortable, not to take advantage in a sport. They have a passion to compete and play. They certainly do not deserve the hate.