Foreign Affairs Committee on Feb. 16th, 2023

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Chair.

Welcome, Ms. Bowden.

I think what is distressing about the statistical data with regard to the whole aspect of sexual and reproductive health, the comprehensive nature of it, is that back in 1995—and I am long enough in the tooth to have been at the Beijing conference—it was Canada that brought forward the fact that unsafe abortions around the world represent a public health emergency.

I am now hearing—and we now know—that 25 million women around the world do not have access to safe abortions. We also know that it's not simply having access to safe abortions. When you have unsafe abortions, a woman may not be able to have children after that because of the morbidity, and her reproductive organs are all infected, etc.

What do you see as the barriers to initiating sexual and reproductive health and rights around the world? We can talk about the developing world, but what do you see as the barriers?

I have a second question, and then I'm going to let you answer them. What is the difference between non-conflict countries and conflict countries, where we see rape now being a strategy, a tactic of war, and what are the barriers in both instances to achieving the full range of sexual and reproductive health and rights?

Thank you very much, Ms. Bowden.

[Kelly Bowden]

Thank you.

I will first speak to barriers to abortion access in particular. I mentioned that fundamentally, one challenge is that SRHR services are not being integrated as a foundational part of health care in countries around the world. If you think about somebody who is looking to access a doctor to get support on any range of medical services, that point of service won't necessarily be one where they can access abortion or other sexual health services.

A big element of being able to ensure the provision of these services is to see them integrated fully into universal health care. This is not only abortion; this is also access to contraception. I think that's a big piece, on the abortion access in particular. I think Canada's investments in advocacy for SRHR can play a very critical role in this.

For example, I met with an organization called Resurj in Mexico earlier this year. It is a women's rights organization that is supporting community-led initiatives to bring people from rural communities into Mexico City, where they can access dispensing locations for medication abortion.

You can see community initiatives like this that are helping to fill the gaps in the existing health care systems in these countries. Those kinds of initiatives can be scaled up. By working with partners, they can also advocate towards their governments to help them understand that these are the stopgaps they're putting in place to address the lack of access that is apparent in the health care system. That's on the first point around abortion access.

On the differential challenges in fragile and conflict-affected settings, I think there is fundamentally an erasure of provision of services that happens there. When we prioritize what a humanitarian response looks like, it is often blind to the inclusion of SRH services in the face of that. We look at water, sanitation and infrastructure. Fundamentally understanding that people not only need access to food in those times, but they also need access to health care, is an important part of being able to address those settings in particular.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you.

In this committee, when we looked at Ukraine and the illegal war there, we heard from various people that many Ukrainian women were raped by Russian soldiers. Then, many of them are going to neighbouring countries as refugees, where they do not have access to abortion services. That is a real concern in terms of conflict.

One reason I brought forward this motion was that I am very concerned that we are not seeing a lot of access to the full range of sexual and reproductive health services globally. You are absolutely right when you say that this should be part of an integrated health service, but we know that in many countries where it's not part of an integrated health service it's because of a lack of health infrastructure. It's a lack of clinics, doctors, nurses, midwives, and a lack of all sorts of information.

What recommendation would you make so that we can ensure that women have access to those rights that they need, especially in conflict areas like Ukraine? What can we do to help women have access to abortion after they have been raped?

[Kelly Bowden]

To your point, this goes back to why it's important to have not only an integrated and comprehensive approach to health care systems—integrating this into building up those programs through our development assistance—but also stand-alone programming to help ensure access to these services in times of great need.

In situations like Ukraine and other humanitarian situations, it's about ensuring that we are providing direct financing to organizations and initiatives that are delivering access to safe abortion care in those settings and are providing and distributing comprehensive contraceptive supplies. Those are the types of initiatives that Canada can finance to intervene immediately in those cases and ensure those supports are in place.

[Hedy Fry, Liberal, Vancouver Centre, BC]

How much time do I have, Chair?

[The Chair, Liberal, Ali Ehsassi]

You are literally out of time, Dr. Fry. You're on the dot.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thanks very much.

[The Chair, Liberal, Ali Ehsassi]

Thank you.

We now go to Mr. Bergeron.

You have six minutes.

[Stéphane Bergeron, Bloc, Montarville, QC]

Thank you, Mr. Chair.

Ms. Bowden, on your website it says that in 2019 you called on the Government of Canada to increase access to contraception around the world by funding supplies for the United Nations Population Fund, UNFPA.

Has this call in 2019 been followed up with concrete action by the Government of Canada?

Do you feel that, since 2019, access to contraception has improved around the world?

Has Canada increased its contribution to UNFPA, as you requested?

What other international agencies should receive more funds from Canada for this purpose?

[Kelly Bowden]

Thank you for the question.

As of 2020-21, we know that Canada has made significant investments in UNFPA programming. We've made contributions to UNFPA core funding. We have also made investments in the UNFPA supplies mechanism, which is the multilateral institutions' specific contraception provision services. With the last investment in UNFPA supplies in particular, we saw an increased one-time, $20-million commitment over a period of four years. It's a slight increase from the sort of annual commitment we had been making to the supplies initiative in particular.

If you look historically at the trajectory of Canada's funding to UNFPA, we've had a consistent core investment of between $15 million and $17 million. We've seen a significant growth in programming investments. UNFPA also does a significant amount of programming in fragile and humanitarian settings, so I think there is a big portion of the programming that is addressing that direct need in fragile states.

Where we continue to see less movement around investment in the neglected areas is in relation to abortion and comprehensive sexual health education specifically. Of the $104 million I was speaking of that is in the neglected areas right now, about $40 million is in contraception services. Another good chunk is in advocacy towards SRHR, and a very minor amount is in abortion and CSE.

[Stéphane Bergeron, Bloc, Montarville, QC]

I understand from your answer, Ms. Bowden, that on the issue of abortion there has been a reduction or a slowdown, if I may say so, of Canadian support.

How do you account for that reduction or slowdown?

[Kelly Bowden]

Only in 2021 have we been able to concretely see the number of investments that Canada has made in abortion services. We can't say that there has been an increase or a decrease in our financing in particular. Around the world, I think we have seen a reduction in spending around SRHR programming writ large. For example, there have been reductions in the U.K.'s ODA spending. They cut a significant amount of SRHR programming over the past year, a big portion of which was to contraceptives, and we've seen reductions from other donors.

While this was already a small field of investment, there is a growing need and a decreasing amount of investments from other donors, which is why Canada's leadership in this space is so critical right now.

[Stéphane Bergeron, Bloc, Montarville, QC]

I would like to go back to one of the questions I asked you earlier.

Do you feel that since your call in 2019 there has been an increased access to contraception around the world, or has there been, again, setbacks?

[Kelly Bowden]

Overall, we have seen growing access to contraception. Canada has a number of partnerships, like the Ouagadougou partnership, which is a connection among a number of west African countries that are investing to ensure the provision of contraceptive services there. There are things like the Family Planning 2020 platform—now Family Planning 2030—which is another forum where countries are working together to ensure a coordinated scale-up of both supply provision and demand generation for contraceptives in countries.

Broadly, we have seen an increased provision of these services. The piece that continues to need further attention is on the demand side, ensuring that people have an understanding of what these supplies are and how access can be met.

[Stéphane Bergeron, Bloc, Montarville, QC]

Thank you.

Your website also says this:

Engaging with the international human rights system involves gathering and submitting evidence to the UN that shows where Canada is failing to meet its human rights obligations.

Very specifically, in relation to this goal that you describe very clearly on your website, what are the gaps in Canada's human rights record in terms of women's reproductive health?

[Kelly Bowden]

Through both the financial commitment that Canada has made in our international development assistance and the way we are showing up at international forums like the Human Rights Council, the Commission on the Status of Women and the Commission on Population and Development, Canada has been largely clear that we are standing in support of these rights. I think it's about doubling down on that advocacy so that it is clear and so that we can push other countries to do the same.

[Stéphane Bergeron, Bloc, Montarville, QC]

Thank you.

[The Chair, Liberal, Ali Ehsassi]

We next go to MP McPherson.

You have six minutes.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you very much, Mr. Chair.

It's delightful to have you here with us today, Ms. Bowden. Thank you so much for being here. It's nice to see you again. I wish I could be there in person.

Your testimony is not new to many of us. However, I can't help but be shocked by these numbers. We all know them, but they are shocking nonetheless: the 219 million women who have unmet needs with regard to reproductive rights and health, and the loss of life that is happening because of unsafe abortions.

I think your testimony makes it very clear that limiting women's access to health care does not stop abortions from happening; it simply stops safe abortions from happening. The number that you gave us for the cost to the health care system of $553 million per year because of unsafe abortions is another indication of how we are failing women around the world.

I know that you are such an expert in this field, so I just want to give you some time to expand on your recommendations on how or where Canada could specifically scale up funding for SRHR in neglected areas.

[Kelly Bowden]

Yes, thank you.

As I mentioned, there are the neglected areas of abortion, contraception access, CSE and advocacy for SRHR. There is the neglected among the neglected of investment in abortion and comprehensive sexual health education. It's under $2 million in 2020-21 that Canada invested in access to safe abortion services. Look at the scale of the need and the financial implication of not providing these services. While we're naming this as a part of the comprehensive package of care, we are not putting the money in this area just yet.

I think that aggressively scaling up in all four of those areas, in particular the ones that remain underfunded by this government and governments around the world, is a key step for Canada to be taking if we are going to use this 10-year commitment as a way to catalyze global investment and backing for the advancement of these rights. I would say that two of those four require further attention.

I also think that global advocacy on behalf of the country has an important role here. We cannot go this challenge alone. The amount of money that Canada is putting into this work is significant. Its long-term nature is significant. What is unique about it is the potential for us to demonstrate investment in these neglected areas and catalyze other countries to do the same. We need to be organizing with other allies and donors, making clear the impact of these investments and that there is a rationale and a need for them to further invest themselves.

There is a lot of good work being done by Canada already, but there are things like the global SheDecides partnership on abortion that I think we could really lean further into, working with those allied countries to make investment in this area grow.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you very much.

You speak about the need for Canada to be a leader in advocacy work. I'm conscious that I will be in Sweden later on—in just a few days, in fact—and they have recently announced that they will no longer have a feminist international assistance policy. You spoke about Canada not yet having a feminist foreign policy. My colleagues have spoken about the backsliding in the United States. You mentioned the U.K. and the reductions that are happening there.

Are you concerned that Canada is going to take some of the lessons from these allies? How do you feel about Canada's perspective now? I'm concerned about the direction that some of our allies are going in. I'm wondering if you could provide your perspective on that.

[Kelly Bowden]

As has been mentioned, we've seen backsliding on these rights in many different settings and many different places of the world. I think Canada has a huge platform to stand on with the investment that we've made. There is an opportunity that needs to be leveraged in order to take global leadership and work with others to continue to ensure that we make progress on these rights.

I want to be clear that I feel it's really important to expand that beyond development assistance and development minister conversations. There's a role for us to play in World Health Organization conversations and international affairs. It was last year at the assembly of ministers for religious freedoms that took place in the U.K. that we had the situation where introduction on SRHR language was there and then disappeared in further versions of the negotiating documents.

It is across many different forums that we see the risk of backsliding on a consensus that these are rights that require investment and progress. I think there is an opportunity for us, and I think it spans far beyond the development arena, which is why looking at how this integrates into a more fulsome foreign policy approach is required.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

You spoke about the SheDecides campaign. If you would send us some information on that, I think it would be great for the analysts to have some of that.

My very last question in this round is that we look at ODA—

[The Chair, Liberal, Ali Ehsassi]

You have 12 seconds remaining.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

I will save that for my next round.

Thank you, Mr. Chair.