Foreign Affairs Committee on May 4th, 2010

[Margaret Biggs]

Maybe I'll just answer in a couple of steps, if you will.

In terms of meeting commitments, the government has already met its commitments to double aid assistance to Africa. It did so last year and it will do so again this year. It will also meet its Gleneagles commitment from the G8 to double its overall international assistance, and it will do so this year, in 2010-11. So it is on track to meeting its commitments and would be looking at the G8 summit to ensure other countries are also stepping up and meeting their commitments they've made in the past.

Back to the maternal and child health initiative, as I indicated, the government would be looking to put additional resources toward that, not taking it away from existing programming. I would expect that would be done out of a portion of the increment that was announced in the budget in 2010. That would allow the government to give additional resources toward trying to advance the cause of maternal and child health in developing countries.

The third aspect of your question, I believe, was with respect to how the world is going to reach the millennium development goals of 2015. That is of course the focus of the United Nations Secretary-General's special summit on the MDGs in September, to galvanize collective action, to give it a boost in terms of trying to make sure that the world will meet those MDGs.

Now, that action has to come from developing countries themselves, from the developed countries, the donors as well. It will require additional resources, for example, as we are expecting with maternal and child health, and also the most effective use of existing resources. We know that not all dollars are equally effective in terms of the results they guarantee.

So that will be the focus of the Secretary-General's meeting in September: how the world is going to get to the MDGs by 2015.

[Johanne Deschamps, Bloc, Laurentides—Labelle, QC]

In your statement, you referred to the medical journal The Lancet in which it was said that according to a study, the mortality rate had dropped by 35%.

Could you be more specific? I also read The Lancet and it seems to me that the figures were more alarming than the fact that maternal death had dropped by 35%. Where has the mortality rate dropped? In which country?

[Margaret Biggs]

I don't have all the details in front of me. I have read the study myself, and I think you're right, there are encouraging signs in it. I drew your attention to it insofar as we do have evidence to show that if you focus on maternal and child health, you can make a difference, and we have seen progress.

That said, this is one of the MDGs that is lagging behind. We know that the progress has been uneven across countries. There has been a lot of progress in countries that have had much better success at reducing poverty and focusing on health. We also know that it's uneven within countries. We know that the poorest and the most vulnerable, often those in the rural areas, are the most disadvantaged, and it is their outcomes that we still need to focus on.

I was pointing to The Lancet as a glimmer of hope and progress, that we actually know we can make a difference and we can move these thresholds. On the other hand, I would agree with you that there is a long way to go.

That's why putting a focus on maternal and child health is something that... I think there's a huge consensus in many countries to do it.

[The Chair, Conservative, Dean Allison]

Thank you very much, Ms. Biggs.

Thank you, Madame Deschamps.

We will move over to Mr. Abbott, for seven minutes.

[Jim Abbott, Conservative, Kootenay—Columbia, BC]

Good.

Ms. Biggs, thank you very much for attending.

If I may, I will just take 30 seconds on politics, then we'll get more into your area.

I must say that I have been dismayed and disappointed at the fact that Mr. Ignatieff and the Liberals have decided to introduce a topic into this issue that has nothing to do with this issue, and the fact that it, in turn, will create a massive disservice to the women and children of the developing world by us being diverted and the amount of ink that there has been on this issue as a result of him introducing an absolute red herring, a bogus issue, into this debate.

That said, I must say that I'm very impressed with your statement, if I may read it:

With proper planning and resource mobilization, it is within the reach of many developing countries to prevent the deaths of mothers and children by strengthening health systems, training health workers and providing simple solutions like inoculations, insecticide-treated bed nets, and better nutrition.

This is what the original thought was of the Prime Minister, and certainly of our government.

I was particularly impressed, because this morning all of us received the chair's summary of the G8 development ministers meeting, which I think will go an awful long way to answering the concerns of Mr. Rae about foreign nations making comments about the topic that he chooses to bring up.

I'll take look at clause 11 of the chair's report:

In terms of scope, Ministers agreed that improving maternal and under-five child health requires comprehensive, high impact and integrated interventions at the community level, in country, across the continuum of care from pre-pregnancy through delivery to the age of five, including such elements as: antenatal care; post-partum care; family planning, which includes contraception; reproductive health; treatment and prevention of diseases; prevention of mother-to-child transmission of HIV; immunizations; and nutrition.

This is an awfully big basket we're talking about, to be able to come up with some funding that will work in that direction.

I would like to ask you about current programs CIDA has in the areas of inoculations and/or better nutrition, and how they may be fed into this initiative that we're talking about.

I should say that I had a briefing last night by a doctor from a totally impoverished country. The statistics from that country show that 93% of the population suffer from gonorrhea, and just a hair under 100% suffer from syphilis. The frustration of the indigenous doctor from that country was the fact that particularly the syphilis could be answered by a matter of inoculations and that kind of thing. Indeed, this is the kind of work that Canada is into and that I think all Canadians should be proud of.

I would like to give you an opportunity to give us a very quick idea on inoculations and also in the area of micronutrients, as to where we are going with that at this point.

[Margaret Biggs]

Thank you very much for the question.

I'm going to ask my colleague Diane Jacovella to talk about some specifics around what Canada and CIDA have been doing with immunization and micronutrients. It is an area where Canada has been a leader, and we are also a leader in terms of malarial bed nets. We were one of the first out the door.

In terms of your general point, and referring back to the chair's statement from the G8 development ministers meeting last week, one of the things I'd like to point out is the shift that I think has to happen. In the past number of years we've had a focus on a number of diseases in particular—whether it's malaria, HIV, AIDS, or polio—on which we all know we can produce results through immunization. We know we can produce results through antibiotics and treatment of infectious diseases. We all know we can produce tremendous health results through adequate nutrition and micronutrient supplementation. But what often doesn't happen is their integration into one package. We know that if they are integrated into a package that a local, trained health care worker can deliver, we can have substantial improvements in terms of the outcomes for mothers and for children.

I think the key now is to look at it as an integrated approach. We did this with the catalytic initiative with children in terms of front line health workers having a basket of things that we know have high impact in terms of treating infectious diseases, in terms of treating diarrhea, in terms of immunizations, in terms of nutritional supplements, and we know that it can work. It's very cost-effective, high-impact, and not that complicated. But you do have to have the health system behind you to ensure that on the ground it is delivered in that way. That's what I think the development ministers focused on: how everybody supports that integrated, comprehensive approach.

Going back to the specific things that Canada has done, as I mentioned, CIDA has been a leader in terms of the micronutrient initiative. Canada has also been one of the leaders in terms of the global fund for AIDS, tuberculosis, and malaria, which has saved millions of lives.

I'm just going to ask Diane perhaps to give a few more facts on some of the key things that you asked about.

[Diane Jacovella, Vice-President, Multilateral and Global Programs Branch, Canadian International Development Agency]

Thank you.

Ms. Biggs has already answered a lot of the questions, but in terms of immunization, we've been working really hard with the World Health Organization and UNICEF to make sure that the basic immunization package that any child in Canada or North America would have would be available.

We've also been working with other donors, and the World Bank, and GAVI on what we call the “advance market commitments”, to try to entice the private sector to develop a vaccine for pneumococcal disease. This is something new, what we call “innovative financing”, to try to generate some interest and a vaccine that would work for children in developing countries.

In terms of polio, that has been a signature project. In the Afghanistan program, we've been having great success despite the difficult security environment.

In terms of micronutrients, the three key partners that we've been working with are the Micronutrient Initiative, which is a Canadian-based organization; Helen Keller International, a U.S. organization; and UNICEF. We try to work with all three to make sure that vitamin A is available for children. We integrate this and some of the other interventions that these players are making.

We're also working really hard with countries to iodize their salt, and we've had huge success in this area.

One of the new things we are exploring right now is the incorporation of zinc in oral rehydration for diarrhea, which seems to be having a lot of success. We are again working with Canadian partners here to try to advance this with our multilateral players.

[The Chair, Conservative, Dean Allison]

Thank you very much, Mr. Abbott.

We're now going to move it back over to the NDP.

Mr. Rafferty, welcome back to the committee. The floor is yours, sir, for seven minutes.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

Thank you very much, Chair.

The 2005 World Health Organization report Make Every Mother and Child Count says that the leading cause of maternal death is hemorrhaging, bleeding. But it also says that the second leading cause of maternal death is unsafe abortion. I'm surprised that some say here that it's not part of what we're talking about today, but the second leading cause is very important.

My question is a policy one. The government claims to be making maternal health a key priority in the G8 meeting, and CIDA says that it seeks to improve sexual and reproductive health and rights and reduce maternal morbidity and mortality. Does it not make sense for our government and CIDA to try to reduce or eliminate the second leading cause of maternal mortality in developing countries, that being unsafe abortions?

[Margaret Biggs]

Thank you for the question.

Well, the primary killer of mothers is at birth: it is the complications, the hemorrhaging, and the various things around birth. So that, I think, would privilege the importance of having skilled attendants in the lead-up to the birth, during birth, and shortly after, because that's when lives are lost for mothers and also for newborns. So that's a critical window of importance for maternal and child health.

It is true that a large percentage of women die because of unsafe abortions. The primary way to avoid that is for them to have family planning. If they had access to family planning and contraceptive commodities, and the ability to time and ensure that they had safe pregnancies and deliveries, that would be the single most important thing. That would be something that Canada could focus on, that we have done in the past and we could do in the future.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

While I'm on policy, I don't like to leave Mr. Garson out, because he did come all the way here to be part of this. This is an opportunity to be candid and straightforward. I will let Ms. Biggs off the hook for the moment.

It's sort of a personal question.

[Margaret Biggs]

So you know it's dangerous.

[Voices]

Oh, oh!

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

You are the policy director for the G8 summit, right?

[Ron Garson, Director, Summit Policy Division (G8/G20) , Department of Foreign Affairs and International Trade]

For the G8 and G20.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

Right.

Do you think that funding clean, modern facilities, and funding groups that provide safe abortion services to women who are pregnant in developing countries--who want the services in countries where it's legal--would help reduce maternal mortality?

[Ron Garson]

I am the policy director for the G8 and G20, but I will say that the kind of details you're asking are not those that I get into in my job. Were I to do that, I would never have any time...basically, to sleep.

I tend to work at a more general level, so I think I would refer that to Ms. Biggs.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

Well, then, Ms. Biggs--

[Margaret Biggs]

Back to me.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

--back to you, yes.

I mean, you can be brief. A yes or no would be okay here, I suppose.

Would funding clean, modern facilities, and funding groups that provide safe abortion services to women who are pregnant, help reduce maternal mortality?

[Margaret Biggs]

I'll go back to the points that I made before, in terms of saving mothers' lives. The number one focus can be on pregnancy and good delivery and the immediate ante and postpartum period. That is the single most important focus in terms of saving mothers' lives.

In terms of family planning, if women had access to family planning as they needed it, you could reduce the percentage of unsafe abortions by 75%. That's according to the UNFPA. That would be the single most important thing that we could do in terms of giving them access to planning and contraception and the ability to prevent unsafe pregnancies. That would be a very important way to save mothers' lives.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

In the most recently available statistics--2006 are the statistics I have--Canada provided access or funded abortion services 91,377 times in this country. Presumably the government chooses to continue this funding, this access to abortion, because it believes in a woman's right to choose and that by providing and funding these services to women there are positive impacts on maternal health.

I applaud them for accepting this and for not reopening the domestic debate at this time. But what about the government's position internationally? There's a bit of a disconnect here. I have to wonder what kind of signal you think it sends to women in developing countries when our government claims to want to help them, but then refuses to provide the same services to them, which are proven to reduce maternal mortality. They're the same services as our own citizens get.

Now, you said that CIDA never has had a policy on funding or promoting or increasing access to safe abortion services in developing countries. Am I right in that?

This was from the conversation earlier with Mr. Rae.

[Margaret Biggs]

CIDA does not, has not, will not fund abortion services directly.

[John Rafferty, NDP, Thunder Bay—Rainy River, ON]

Okay. And it's never had a policy on promoting or increasing access.

[Margaret Biggs]

The international consensus is that abortion is not viewed as a form of family planning, so it's not promoted as a method of family planning. That's agreed by all parties and all international organizations. Canada adheres to that.

CIDA doesn't fund abortions directly. It hasn't and it won't. However, on your question, just as the Government of Canada funds provinces indirectly through transfers to provinces, and provinces run their health systems, Canada can support developing countries' health systems, and we will continue to do so. It's their choice as to what basket of services they provide.

So I don't see the issue. There's no change in policy. But the Prime Minister and the minister have made it clear that for Canada's G8 initiative, we will not include anything that directly supports--