Foreign Affairs Committee on March 7th, 2023

[The Chair, Liberal, Ali Ehsassi]

Welcome to meeting number 52 of the Standing Committee on Foreign Affairs and International Development.

Today's meeting is taking place in a hybrid format pursuant to the House order of June 23, 2022. Members are attending in person in the room as well as remotely using the Zoom application.

I'd like to make a few comments for the benefit of the members as well as the witnesses.

Please wait until I recognize you by name before speaking. For those participating by video conference, click on the microphone icon to activate your mike, and please mute yourselves when you are not speaking. Interpretation for those on Zoom is at the bottom of your screen and you have a choice of floor, English or French. For those in the room, you can use the earpiece and select the desired channel.

In accordance with our previous practice, I'd like to inform everyone that all witnesses have completed the required connection tests in advance of the meeting.

Pursuant to Standing Order 108(2) and the motion adopted by the committee on Monday, June 20, 2022, the committee now resumes its study of the sexual and reproductive health and rights of women globally.

It's my great pleasure to welcome to our committee, first of all, from the Guttmacher Institute, the principal research scientist, Ms. Elizabeth Sully. Also, from the International Planned Parenthood Federation, we have with us the director general, Dr. Alvaro Bermejo. Lastly, from the Parliament of the Republic of Uganda, we have with us member of Parliament the Honourable Lucy Akello.

Welcome, all of you. Thank you for being here with us today.

You will each be provided five minutes for your opening remarks, after which we will open it to the members for questions. I should say that once you have 30 seconds remaining, I will make a sign to you that you should really be in the process of wrapping up your comments. That applies not only with respect to your opening remarks but also when you're in the process of answering questions from the members.

All of that having been said, Ms. Sully, the floor is yours. You have five minutes.

[Dr. Elizabeth Sully, Principal Research Scientist, Guttmacher Institute]

Thank you, Mr. Chair, and good morning, members.

The Guttmacher Institute is a leading research and policy organization committed to advancing sexual and reproductive health and rights, or SRHR, worldwide.

We're at a critical juncture globally. We've achieved substantial progress over the last few decades. The number of women using modern contraception has risen, unintended pregnancy has been declining globally, maternal deaths are dropping and legal access to abortion is expanding. However, as of 2019 there were 218 million women in low- and middle-income countries with an unmet need for modern contraceptive methods. This resulted in 111 million unintended pregnancies annually and 35 million unsafe abortions. We're also at risk of backsliding on the progress that we've achieved, with a global opposition to SRHR that's emboldened by the recent overturning of Roe in the United States.

I want to highlight for the committee today two main areas where greater investment and leadership are needed to ensure SRHR globally. First, through our decades of conducting research with global partners, the data clearly shows that investing in a comprehensive package of sexual and reproductive health services is a smart and cost-savings investment that protects health and saves lives. Investing in a comprehensive package of services can result in substantial gains. For example, if all women in low- and middle-income countries wanting to avoid a pregnancy were to use modern contraception, and all pregnant women and their newborns were to receive care at international standards, we would see a two-thirds decline in unintended pregnancies, unsafe abortions, and maternal and newborn deaths, and an 88% drop in HIV infections among babies six weeks and younger.

When investments are made in a comprehensive package of services, there are also important cost savings to the health system. Every additional dollar that's invested in modern contraceptive services would save three dollars on pregnancy-related and newborn care through preventing unintended pregnancies. Investing in maternal and newborn health is essential and important, but it is insufficient on its own. A comprehensive investment is necessary to really make an impact in reducing preventable maternal deaths, ensuring bodily autonomy and reducing health systems costs.

The second point I want to make to the committee is that global leadership is needed now to protect and expand on the gains that we have achieved in safe abortion access. People around the world have and need abortions. That is not going to change. Globally, more than 60% of all unintended pregnancies end in abortion. That’s 73 million abortions annually. Legal restrictions do not stop abortions from happening. We find no evidence that the abortion rate differs in countries where abortion is restricted versus where it is legally allowed. Abortion restrictions instead lead to more unsafe abortions. There are an estimated 21 million abortion complications annually in low- and middle-income countries. However, if all unsafe abortions were made safe, that would drop to two million, and there would be a 45% reduction in the health system costs of providing abortion care. Providing safe abortion care saves lives, respects rights and reduces costs.

The United States has become a global outlier by eliminating the right to abortion. This is in stark contrast to decades of progress on abortion rights, with the global trend towards liberalization of abortion laws. Nearly 60 countries have expanded the legal grounds for abortion since 1994. We need global leadership to support countries in their efforts to expand safe abortion access. Supporting safe abortion means investing and filling the evidence gaps, it means strengthening advocacy and it means expanding access to abortion services.

Canada has made a historic commitment to SRHR. My team at the Guttmacher Institute has conducted two studies estimating the impact of Canada's investment in family planning over the last few years. We find that as of fiscal year 2020-21, Canada invested $63.5 million in family planning. That resulted in 2.5 million women and couples receiving contraceptive services, preventing 1.1 million unintended pregnancies and 347,000 unsafe abortions, and resulting in 1,800 lives saved.

Canada can have similar impacts on the other neglected areas of SRHR. We're facing a global backlash, but countless allied low- and middle-income country governments and civil society organizations want to secure comprehensive SRHR in their countries. To do this they need support, and they need Canada's support. They need data and evidence to support their efforts. They need funding to expand services within their health systems. They need political support and strong and vocal global leadership.

How countries respond to sexual and reproductive health and rights is really a story about how much societies do and do not value women.

Canada has made its voice clear that it values women through its feminist international assistance policy and its historic new funding commitment to SRHR.

I hope that the facts and evidence I have shared today demonstrate why it's imperative that Canada continues to put these values into action on the global stage.

Thank you very much.

[The Chair, Liberal, Ali Ehsassi]

Thank you very much, Ms. Sully.

We go next to Dr. Bermejo.

You have five minutes, sir.

[Dr. Alvaro Bermejo, Director General, International Planned Parenthood Federation]

Thank you, Mr. Chair.

Good morning, committee members and fellow panellists. The International Planned Parenthood Federation, IPPF for short, is a global service provider and a leading advocate of sexual and reproductive health and rights for all.

Today, IPPF is a worldwide federation of 119 national member associations and 29 collaborative partners working with and for communities in 149 countries. These local member associations are nationally owned and governed civil society organizations, and leading sexual and reproductive health service providers in their respective countries. This gives IPPF a global presence unparalleled among other sexual and reproductive health and rights civil society organizations.

We defend the right of all people to enjoy their sexual lives free from ill health, unintended pregnancy, violence and discrimination. We deliver comprehensive sexuality education to young people, in and out of school, to help them both understand and claim their sexual rights, and we support a woman's right to terminate her pregnancy legally and safely.

As an international federation, IPPF provides a platform for member associations and stakeholder groups from around the world to come together. Our global presence makes IPPF a powerful advocate for sexual and reproductive health and rights at all levels. We are, in a way, a living expression of the universality of sexual and reproductive health and rights and an expression of global solidarity.

I want to endorse everything that my colleague Elizabeth Sully from the Guttmacher Institute has said, and maybe just spend a couple of minutes looking at what she has called the “backlash”. From where I sit, [Technical difficulty—Editor].

[The Chair, Liberal, Ali Ehsassi]

Mr. Bermejo, we can't hear you. We're having some technical difficulties.

We'll suspend for a few minutes.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Chair, can we just go to the next witness and then go back to him?

[The Clerk of the Committee, Ms. Ariane Gagné-Frégeau]

No, we have to suspend.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Okay.

[The Chair, Liberal, Ali Ehsassi]

Thank you.

[The Chair, Liberal, Ali Ehsassi]

Dr. Bermejo, we're back. We're terribly sorry for the technical challenges we were experiencing. We will reset the clock for you, and you can commence from the very beginning, if you so wish.

Is that your intention?

[Dr. Alvaro Bermejo]

No, I will aim to be a bit shorter and not repeat everything from the beginning. Thank you, Mr. Chair.

Good morning, again, everybody. You have my apologies for the interruption.

I am speaking on behalf of the International Planned Parenthood Federation, IPPF, which is a federation of 119 member associations and national civil society organizations that provide sexual and reproductive health services. We provided 200 million services last year through our 40,000 clinics around the world—

[The Chair, Liberal, Ali Ehsassi]

Mr. Bermejo, I'm sorry. Interpretation is not working. We'll try to work on it on our end to make sure your remarks are translated properly. In the interim, I presume the best route forward would be for us to go to Ms. Akello.

Ms. Akello, if you're ready, we will hear from you for five minutes, and then circle back to Dr. Bermejo.

Welcome MP Akello, the floor is yours.

[Lucy Akello, Member of Parliament, Parliament of the Republic of Uganda]

I bring you greetings from Uganda, Mr. Chairman and your committee members.

As you rightly said, I am Lucy Akello, a member of Parliament from Uganda.

Africa has a long history of colonization—just like Canada—and of people, foreign governments and foreign-led organizations telling us what is good for us or what our priorities should be.

I will speak from the context of an African woman, a mother and a legislator. I speak not just for myself but for the constituents who have asked me to speak on their behalf about their priorities and concerns. Clear polling data shows that what I will tell you is overwhelmingly in line with public opinion throughout Africa. I pray that my submission is as candid as you would like it to be.

I'll speak first about abortion.

Our people are still loyal to religious truths and cultures. Canada, too, has its beautiful cultures. It seems that no matter how much money is spent on making abortion look good, our people still see through the money, marketing and mass education. The women I represent are able to see through this. We believe life starts from conception, and where I come from, once conception takes place, it is life. Even when you have a miscarriage, that life is given a decent burial, irrespective of the sex.

Africa generally finds abortion repugnant. A survey of 2014 by Ipsos Synovate, for example, found that 87% of Kenyans oppose the thought of killing an unborn child. This nationwide Kenyan survey echoed the findings of a 2013 global study by Pew Research Center that asked 40,117 respondents in 40 countries what they thought about various moral issues, including abortion. The overwhelming majority of Africans said that abortion was morally unacceptable, with 92% of Ghanaians, 88% of Ugandans, 82% of Kenyans, 80% of Nigerians and 77% of Tunisians saying they considered abortion to be morally wrong.

Almost 80% of African countries have some sort of law prohibiting and restricting abortion, and it is predicated on a widely held belief that unborn babies have a right to live and deserve to be protected by law. With this prevalent view of the issue of abortion, most people are satisfied with these laws. There are hardly any locally organized complaints, demonstrations or protests calling for the legalization of abortion. On the contrary, there have been many pro-life rallies, marches and conferences in various countries, expressing the people's desire for the continued protection of the unborn.

Globally, crisis pregnancy facilities are vilified as misinformation or disinformation centres. Postabortion recovery programs for women who have been wounded by abortion, or who would like to find emotional and psychological healing are not a common occurrence in Africa. The result is that the trauma they have suffered follows them because there's no one who tells them before they carry out the abortion.

On family planning, to the women I represent, the term “family planning” is synonymous with contraception. This is how it has been sold to them. When one says they are on family planning, they mean they are on contraception. However, women are hurting from the side effects of hormonal contraception, and they talk about it with each other. Contraceptive side effects are a major deterrent to the consistent use of contraception, and women who experience bleeding-specific side effects are most likely to make a choice of contraceptive discontinuation and switching.

On the issue of comprehensive sexuality education, the parents I represent see this as an assault to the health and innocence of children.

Mr. Chairman, in the interest of time, I recommend that the Canadian government and this Parliament look more at keeping the girl child at school as opposed to giving them contraceptives. Where I come from there is a push to put girls even as young as 13 or 14 onto contraception. What does this do to a young girl?

I also recommend that you respect Uganda's sovereignty.

Thank you so much.

[The Chair, Liberal, Ali Ehsassi]

Thank you very much, Ms. Akello.

Have we sorted out the technical problems? Okay, we'll call him.

Are the members okay with going to questions?

[Some hon. members]

Agreed.

[The Chair, Liberal, Ali Ehsassi]

Once the previous witness is good to go, then we'll revert back to that.

For our first round of questioning, we have Mr. Genuis.

Mr. Genuis, you have four minutes.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Thank you, Chair.

I'd like to move forward with my first question here. Before that I want to thank all of our witnesses. All of you have made an effort to be here, in particular Mrs. Akello flying all the way from Uganda to be with us in person. Sometimes we have public servants who don't want to come from their offices to be with us in person. I look forward to the continuing discussion here.

I'm the shadow minister for international development. A big concept in international development right now is the issue of localization—listening to and responding to the needs of local people and applying those without bringing in predetermined western priorities.

What are the development priorities of the local women you represent in Uganda? How can we ensure that our development assistance relates to local priorities instead of bringing in predetermined western priorities?

[Lucy Akello]

Thank you so much. I chose to fly here after two days of thinking. I've just witnessed it here—systems can actually fail. I would have failed to represent the voices that would have told me to come here. I think I made the right choice.

I will go back now to your question on development priorities.

For a long time I worked with civil society before joining politics. One thing that was so good at that time was that, when the donors would come to us, they would ask us what our values were. What does our culture say about this, this and this? They would say that they would fit into our culture.

Now things have changed. What is now happening is that you must fit in with the donors. The donors come and tell you that you must fit into their values. You must fit into their culture. This is really, for me, wrong. If you want to help me, come build what I have as opposed to making me fit into your priorities.

Right now, like I say, our priority is to keep the girl at school. Studies have shown that when a girl stays at school she will definitely stay out of unwanted pregnancy. We will not need abortion for her. We will not need contraceptives for her. That is for me the development priority that I think we need.

We need more functional health centres for our women and children as opposed to more money for contraceptives, family planning and abortion.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Thank you, Madam.

In 2018, Prime Minister Justin Trudeau met with President Museveni, the President of Uganda. He was widely criticized at the time for not raising the issue of LGBTQ rights in particular, given that your president has taken positions on that issue. Our party joined in that criticism of the Prime Minister at the time. I just raise this, because there are issues where people want to see us raise issues that reflect widely held opinions here, but those may differ from opinions or perceptions on the ground and with our partners.

On the issue of abortion, how do you suggest we navigate those areas where there are sincerely held disagreements, deeply held, among governments, among parliamentarians? How do we navigate those areas relating to abortion, family planning, in a way that is true to our convictions but also sincere and respectful?

[Lucy Akello]

Thank you.

My president has always said that Uganda is a sovereign nation, just like Canada and just like any other country. If we all respected our sovereignties, then we wouldn't have many problems. You have laws here in Canada. We also have laws in Uganda. Those are the things that should get us going.

Thank you.

[The Chair, Liberal, Ali Ehsassi]

Thank you.

We next go to Mr. Oliphant for four minutes.

[Rob Oliphant, Liberal, Don Valley West, ON]

Thank you, Mr. Chair.

I'd like to take a moment of privilege to raise one name at the committee. It's the name Bonnie Bean.

Bonnie was a friend of mine and a parishioner in the church where I was the pastor. She died on February 21 after a lifetime with Planned Parenthood in the Toronto office and after a lifetime of sexual education for young people and advocating for women's rights. She had a profound influence on me for all my life. I just want to raise her name and get it in our record today as someone who has made a difference in our country. Her death is a loss to our community.

I wanted to raise Bonnie's name and also thank Ms. Sully for her presentation and very factual understanding. I also want to thank the witness from Planned Parenthood, who raised some important issues.

I am going to address some issues with respect to Member of Parliament Akello's presentation today.

With all due respect, and fully understanding the sovereignty issue, the world community has decided that human rights are universal. They transcend political boundaries. They're indivisible and they're interdependent.

I understand that you are a co-chair of the women's caucus in your Parliament—or you have been co-chair of the women's caucus, with the Minister Sarah Opendi—and you have worked on women's issues.

I want to know how you address the human rights, the health and the well-being of lesbians in your country.

[Lucy Akello]

Thank you.

Just for the record, the Honourable Sarah Opendi is the chair of the Uganda women's parliamentarians. I am nowhere in the executive. I am actually the vice-chair of an accountability committee, PAC, and I sit on the foreign affairs committee of Parliament. I'm just a member of the Uganda women's parliamentarians. I thought I needed to set this record very clear.

[Rob Oliphant, Liberal, Don Valley West, ON]

Sometimes the Internet is wrong.

[Lucy Akello]

Now you're getting it from the right person. It's the reason why I needed to be here.

Yes, you're right. Human rights are universal, but with the UN declaration—the original one—if you look through how everything has changed, we now make definitions of what human rights are based on what we now want. Even today I can wake up and decide to define “human rights” the way I want. If you look through the definition of “human rights”, it has changed over the period from the original definition of what we knew as human rights.