Foreign Affairs Committee on May 6th, 2010

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

Okay.

On a completely different note, Mr. Fox, you said that since 2000, tangible progress has been made. Clearly, because of the financial and economic crisis, we have experienced setbacks when it comes to making progress and reaching the previously-set goals, the Millennium Development Goals. Is it realistic to believe that, since all the goals are interrelated, we cannot neglect one goal without adversely affecting another?

The target date of 2015 is quickly approaching. If we do not increase funding to the level needed to meet that target date of 2015... The needs are critical, and we should also not ignore the issue of climate change; rather, we need to adapt. You told us about a staggering amount invested in aid. I am not sure, but I believe that the amount is in the order of $710 billion per year.

The Government of Canada will freeze its aid budget starting in 2011. Therefore, the future does not look very promising. It looks good for the moment, since commitments are being made. What are your thoughts on the matter?

[Robert Fox]

There's no question that if we're dividing too small a pie, we're not going to get the results, we're not going to feed the people who need to be fed, right? So it isn't a question of picking one thing in competition with the others. It is absolutely legitimate to identify priorities, but to the extent we're identifying priorities, we need to ensure there's a concerted global response so critical pieces of this puzzle aren't falling without attention.

Certainly in terms of the responsibility that Canada has with respect to funding climate adaptation, that does arise from our official development assistance obligations. It arises from the fact that we are one of the largest emitters of greenhouse gases on the planet, and given that fact we have a responsibility to contribute to the global response there, at the same time recognizing that our collective response, globally, is far short of what our own governments have committed to.

At the meetings we had with the sherpas the week before last, they admit we're $18 billion off target. Our figure is somewhere at $30 billion, so I won't even argue the difference, but what is their plan in June, in Muskoka, to identify the $18 billion that we're short?

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

Mr. Chair, do I have any time remaining?

[The Chair, Conservative, Dean Allison]

You have two minutes left.

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

I have two minutes. I would like to go back to Goal 5, maternal health, and I would also like to talk about child health. Yesterday, I attended the meeting of the Standing Committee on the Status of Women, where several experts spoke.

The consensus seems to be that if we do not include in maternal health all the initiatives and tools for reducing mortality—to clarify, the whole issue of safe abortions and contraceptives that, in my opinion, should be included in family planning—we will not reduce mortality.

The goal is to reduce mortality by 75%. If we do not implement all the elements for achieving that result, we will miss the target completely once again. The money will be invested, but the problem will remain. All the elements must be implemented if we really want to reach the goal we have set.

[Robert Fox]

Certainly that's been our position. When we look at maternal deaths, one woman dies every eight minutes as the result of a botched abortion.

Abortions are going to happen, and that's not what is at question. The question is are they going to happen safely as part of a medical system where people's needs are being met? And our view has been very much that it is the full and comprehensive range of sexual and reproductive rights and services that need to be addressed as part of this if we are to have the maximum efficiency, maximum impact, and maximum effectiveness.

[The Chair, Conservative, Dean Allison]

A quick response, please. We're almost out of time.

[Teresa Chiesa]

I just wanted to clarify, Madame Deschamps, that family planning is not abortion. Family planning is planning your family, how many children you want to have and when, and birth spacing. Abortion is part of reproductive health, and 85% of maternal deaths have nothing to do with abortion. If we put more money and resources into family planning we would have far few abortions. So we can avert those abortions if we reinvest in prevention and providing women with access to safe family planning.

[The Chair, Conservative, Dean Allison]

Thank you very much.

Mr. Lunney, seven minutes.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thank you, Mr. Chair.

Thank you to our witnesses for joining us for this meeting today. The background of this meeting of course is Canada's leadership with G-8 and G-20 this year, which is why you've been invited to speak to us today. And of course I wanted to make reference to the G-8 meeting that just took place a week or so ago in Halifax.

I'm looking at the report of the chair's summary of that meeting in preparation for the upcoming meeting. Canada has chosen goals four and five out of all the goals the G-8 has set. They all have merit. They're all deemed as worthy pursuits for G-8 nations. Canada chose to focus on goals four and five, which were sadly lagging way behind any progress in the other spheres, as laudable as all of the efforts might be. And of course we've been soundly criticized in the process for doing so. It seems to have created a measure of controversy.

I'm reviewing the objectives right out of the G-8 meeting for maternal and child health. These were referred to earlier by Elly Vandenberg, I believe. In your comments you related the goals for women: antenatal care for maternal health; postpartum care; family planning, which includes contraception; reproductive health; treatment and prevention of diseases; prevention of mother-to-child transmission of HIV; immunization; and nutrition.

In your brief--again, I think it was Ms. Vandenberg--you related to “affordable interventions needed to stop these deaths”. And I heard numbers go by. I guess we've heard these numbers a few times. But we're talking about three million babies who die in the first week of life, nine million children who don't make it to age five, and half a million women who are dying in childbirth-related events that are avoidable. In terms of affordable interventions, one of the things at the top of the list is trained community health workers. We're going on from there to other things like micro-nutrients, breastfeeding, and emergency obstetric care. All of these things have demonstrated results.

But I want to focus on the first one, and that's the issue of skilled health workers. I see, for example in Mali, we have.... CIDA was here the other day. In western Mali, for at least half of the births now, a trained worker is available, if I got that right. But there are different aspects. I heard a little bit of discussion in the comments today about what a trained worker is. In Guatemala we worked with the Society of Obstetricians and Gynaecologists, for example, and trained over 700 workers there. And we had some measure of success.

But I think I heard from Ms. Chiesa that a trained worker is not enough; you need a skilled worker. So I don't know that we're talking about having to put obstetricians and gynecologists in the little remote communities everywhere, but I wonder if you would address your perspective on how we address this, what level.... I'm sure any level of training helps, even a midwife--not “even”, I don't mean to put that down, a midwife of some kind. What kind of training, actually, is involved to make this necessary first intervention?

[Teresa Chiesa]

Thank you.

It would be ideal to have obstetricians and gynecologists in most of these countries, more than just the ones who usually exist. It's not realistic, unfortunately.

In our coalition, when we talk about skilled or trained health workers, we're talking about the same group of people pretty much, people who have gotten an education, have been through a formalized system that is recognized either nationally or by the WHO, and have the skills and the knowledge to be able to deal with either child mortalities or maternal mortalities.

When you're dealing with maternal mortalities, skilled and trained health workers could be doctors, nurses, or midwives. And in a lot of African countries what we're hearing more and more about now are what are called “health extension workers”. Ethiopia has them. Nigeria has them. I believe Mali has more of these people. These people are an extension of the health care system. They receive a year to two years of training, and then they're placed out in the communities. They usually come from the community, and they have been trained well enough to be able to provide promotive and preventive services to women. A lot of them may receive basic life-saving skills so that in the event of a pregnancy they would know how to deal with it and would be able to give drugs to help postpartum hemorrhage.

So we're talking about the same thing. We're talking about getting somebody out in that front-line position, living within the community or working within the community, somebody who's got a background of knowledge and skills and the ability and understanding to use medicines and drugs safely in order to accurately and appropriately prescribe medicines where needed or treatment where needed, and able to intervene in the case of death.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

I don't think there's going to be a simple answer of one size fits all for all areas. I imagine that we have to look at the resources that are available in each situation, in each country of interest. There may be training available within that country. Maybe nearby there are facilities. But perhaps you're talking not only about ways of augmenting what training and education are available to ensure quality care, but also about selecting suitable people from the communities involved and bringing them to that centre and making sure they get the training and getting them back out there. Of course I think I see tremendous cultural advantages when people actually know the language, know the community, and know what it's like there. Bringing in people from another culture creates other kinds of challenges.

But I wonder, since you both have experience in the field, whether you would be able to provide specific examples from your own experience in the field of programs of this nature.

[Elly Vandenberg]

Teresa might want to talk more specifically, because she has more specific expertise.

The point I wanted to make is that it's not just about their being trained, but also equipped and motivated. All of this is integrated: you can't have health workers who have training but no equipment, or who aren't paid well, or not paid at all. So it's connected to national health systems and the national plan. It's all interrelated.

I just wanted to make sure that was well understood as well.

[Teresa Chiesa]

Let me continue on the point. For the child survival project that I work with in Zambia, where the government does not have health care workers on the ground, all of the groups now, UNICEF included, have looked at training people within the community on community-integrated management of childhood illnesses. This skilled UNICEF and WHO-proven training allows people from the community to be able to accurately diagnose and treat children under five who have malaria, pneumonia, and diarrhea, the three main problems children are facing—as well as sepsis.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thank you.

I do have a lot more questions, but I'm afraid my time is gone.

[The Chair, Conservative, Dean Allison]

Unfortunately, it goes all too quickly here.

Mr. Dewar, sir, for seven minutes.

[Paul Dewar, NDP, Ottawa Centre, ON]

Thank you, Chair, and thank you to our guests for coming today. I think most people would appreciate having more time with all of you, but we'll take advantage of the time that we do have, considering that the G-8 and G-20 meetings are around the corner and the issues are many.

I'd like to start with the issue of child and maternal health to try to clarify some of the debate that has been going on—at least here. I want to understand the comments that both of you made about the importance of an integrated approach, where you said that to have a real effect on outcomes, we need to have an “integrated basket”, as you put it, and that separating out any of the component parts would probably do a disservice. I'm saying this because I think that most people who are looking at this issue get the fact that you have to invest in critical areas on the ground to expand capacity and, just as we just heard from Mr. Lunney's questions and your responses, to have the appropriate people there, and to find creative ways of matching the resources with the people who need the help.

So what I'm wanting to get from you is whether you know of any NGO or any country in the G-8 or G-20 that has recommended separating out reproductive health from an integrated approach. If so, who are they, and why have they stated that?

[Teresa Chiesa]

Mr. Dewar, I don't know, because reproductive health can either be an umbrella, with maternal and child health as part of that, or maternal, newborn, and child health is the umbrella and reproductive health is part of that.

So I have not heard of countries separating this out.

[Paul Dewar, NDP, Ottawa Centre, ON]

I ask you that with all sincerity, because if we are going to have an impact, we want to get it right. Mr. Lunney has intimated that there is a criticism of the government for taking on this initiative; I'd say that contrary to that, we've seen accolades right across the board, right across the floor, for the government taking on this initiative.

I asked you that question because if we are going to take this on, we want to get it right. The only person I've heard advancing the government's position that you can separate out abortion within reproductive health was Charles McVety, who spoke yesterday. I don't know his background well enough, but I'm going to say it's safe to assume that he is not an expert in child and maternal health. It disturbs me when I hear the government saying that they want to go down this path, which I like, but that they're going to separate out one component of child and maternal health. Maybe the government can enlighten me afterward, but the only validator that I know of who has said this is a good path is McVety, who was on yesterday saying that we shouldn't be doing this.

That's why I'm asking you the question. If we're going to take this issue on and we're going to do it right, I think we need to be singing with the choir. If the choir is saying we should do child and maternal health in a comprehensive way, as you've stated, then we should do that.

I think of some of the challenges that are faced. One of the things I've looked at that wasn't touched on has to do with adolescent women in particular. Anywhere from 10% to 48% of adolescent women report that the first sexual experience is forced upon them. I call that rape. In the case of the DRC, 14 women are raped every day. That's a study done by the Harvard Humanitarian Initiative along with Oxfam.

These women are young women. You've mentioned the risks at that age. If we can't figure out how to deal with unwanted pregnancies, particularly when you're talking about rape and particularly when you're talking about rape as a weapon of war, which has been established by everyone, then I don't know how you deal with outcomes without dealing with it in a comprehensive manner.

How do you respond to or deal with what is clearly a war against women in the world and in the developed world on top of what we have when we have meagre resources? How do you deal with it in conflict zones? How do you deal with what I'll call a gender war when you have 14 women raped in DRC every day and you have these astonishing statistics that say adolescent women's first sexual experience is basically rape? How do we make headway in those areas particularly?

[Elly Vandenberg]

Let me take a stab at this, Mr. Dewar.

To underline what you said about meagre resources, we have a consensus around which interventions are effective and also have a low cost and a high impact. We have consensus about them. That's what we join together on.

It's not denying anything you've said, but areas where we have international consensus and no Canadian public debate are where we think we should focus. We don't want to lose this opportunity to have a real impact at the G-8 by focusing on something that we don't have consensus on.

[Paul Dewar, NDP, Ottawa Centre, ON]

What I'm trying to say, though, is that we have a consensus in the world on this issue of maternal and child health. We have a consensus that the first sexual experience of women who are at a certain age is basically what I would call rape. I mean, what is forced sexual experience? Those are things we can make a difference on. We have had numerous reports and numerous ways of dealing with it have been advanced. We've already heard that when you're talking about real outcomes, you have to have the whole package. I don't think there's any debate on that.

Even the government says, “Well, fine; we'll cherry-pick out what we don't want to fund”. I agree that I don't want to get stuck in that; I just want to see the advice the government's getting and your policies put on the table, because if we're going to do this right, we have to base it on evidence and hopefully we have to base it on what the rest of the world is saying. I just want to put it on the table and get with the program.

We won't be out standing in our own field. We'll be with the choir if we do reproductive health along with all the other areas of maternal and child health. That would actually be sensible to do.

[Elly Vandenberg]

I found the session that you had with Ms. Biggs, from CIDA, very helpful at clarifying that. The CIDA policy has not changed and that's helpful to know that.

This particular G-8 initiative is going to focus on certain interventions.

[The Chair, Conservative, Dean Allison]

Thank you. That's all the time we have.

We're going to switch gears here and we're going to go to five-minute rounds.

We'll start with Mr. Goldring.

[Peter Goldring, Conservative, Edmonton East, AB]

Thank you, Mr. Chair.

And thank you for appearing here today, ladies and gentlemen.

I want to mention one of my first concerns, because it seemed to have been a debate in the House of Commons of late. I was asked to be part of the Canadian Association of Parliamentarians on Population and Development. I was asked to be vice-chair of that. And the purpose of that was to meet and study the millennium development goals. I believed it was to study them all and possibly make recommendations after a conference some time this summer, which might be helpful to be following.

In the course of this, as I wasn't familiar with the group, I started on some conference calls, getting some feeling that maybe it wasn't as broad-based as they claimed it might be. And I started narrowing down to these two points, the MDG 4 and 5. So I decided to look into it a little bit and see who comprised this group and organization, and I found that some of the foreign groups that comprised it were definitely pro-choice groups, and that concerned me greatly. So I decided to resign from this and I put in my letter of resignation, stating that I was very sorry that I had to resign, that I was very much concerned that their narrowly focusing on specific sensationalism issues could very well derail the good work that could come out of this, by this government initiative.

And I appreciate the comments commending the Prime Minister of Canada for this initiative and I full well believe that it probably has to do with hesitancies from some countries wading into the MDG 4 and 5 because of some of the controversy.

Now, when this went to the House two days later, by an opposition motion, it became very clear. The motion itself was innocuous; it really didn't say too much. But from speech after speech after speech, they clarified that they wanted to narrowly focus on the sensationalism of abortion.

I appreciate your comment here.

And thankfully, a few members of the opposition party decided not to vote with their party on it, so their motion did not pass. But it really disturbed me greatly, because when you're talking about the value of what is being presented with the value of the initiative that is being put forward here....

You mention here an important statistic, where you're saying that even of the maternal deaths, 85% of them have nothing to do with abortion. That would say to me that's 85% of the maternal deaths. So I would have to speculate that, on the overall, you have the maternal deaths, you have the health and welfare, you have the nutritional, and you have all of these other things that will even help to bring about a better economy. If you have healthier citizens, you have a better economy.

Could you elaborate a little further on that statistic, on your assessment, and put it in relation to the initiative here by the Prime Minister and the good work that it can do? And it's my feeling that it's not necessary to go down that road. The millennium development goals themselves don't mention the “abortion” word. That may, however, be some part of it somewhere, but it's not necessary to go down that road, because it is a contentious issue. Could you tell me what this initiative is, the relative percentage here, how small of a percentage this is by trying to bring in that sensationalism? If it derailed this effort here, I think that would be just shameful.

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

A point of order, Mr. Chair. There are not many women at this table, I may be the only one. I'm sorry, but I don't see abortion as a sensationalist topic. We are not trying to be deliberately controversial when we talk about abortion. I feel that it was somewhat inappropriate for my colleague, the member opposite, to talk about abortion as if it were a sensationalist subject. I really don't know what to say. In Canada, abortion is an acquired right. For a woman, abortion means being able to make decisions about her own body, and it is not an issue that can be seen as sensationalistic.