Foreign Affairs Committee on March 7th, 2023

[Dr. Elizabeth Sully]

Yes. Often they are forced to leave school. When they become pregnant, they can't remain in school. Often, adolescents may not have control over if and when they have sex. I think that's just a reality. Also, contraceptive methods fail. They work great—a lot of them work very well—but they all fail at some point or another. Therefore, we need a second line of defence, and that's safe abortion.

We did a study in Uganda among adolescent girls, and we found that sexually active adolescent girls had the highest rate of abortion, as well as abortion complications. They're showing up in health facilities, and this is impacting their long-term health.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you very much for that testimony.

[The Chair, Liberal, Ali Ehsassi]

Thank you, Ms. Sully.

We now move to the second round, and the first question goes to Mr. Genuis.

Mr. Genuis, you have three minutes.

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

Thank you, Mr. Chair.

I'll come back to Mrs. Akello.

I do wish the committee had given you more time in general, but I'm grateful again for your being here.

I want to follow up on the issue of sovereignty and ask you about the violation of local laws. My view is that if the Government of Canada is involved in supporting activities that are illegal in the country where they're happening, it should at least be transparent about that fact. Then we can have the conversation, as a country, about whether that's something that we want to do.

In African countries, are you seeing abortions being performed that violate local laws with the facilitation of international NGOs or foreign governments? Could you share information you have about that, please?

[Lucy Akello]

Thank you.

The fact that we haven't legalized abortion in Uganda doesn't mean it's not going on. It's going on, even under the watch of most of these big organizations.

I want to give an example. We have a facility called Marie Stopes. It hides in the name of doing family planning, but at the end of the day, it actually is doing what it calls safe abortions.

We have Reproductive Health Uganda, which is directly linked to International Planned Parenthood, and it's actually doing a lot of these. I remember last year I raised a question in Parliament regarding the involvement of Reproductive Health Uganda in teaching our children—as young as nine and 10—that it is actually okay to do abortions as a way of family planning. Secondly, a family planning method like tubal ligation.... Why would a child as young as 10 years be learning about, knowing or appreciating using tubal ligation for family planning?

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

Yes.

Just because of the time constraints, I want to make sure that the committee has heard what you said precisely. Are you saying that Marie Stopes and the International Planned Parenthood Federation are, in your view, involved in performing abortions that are violating local laws in Uganda?

[Lucy Akello]

Yes. Marie Stopes, yes, and Reproductive Health Uganda, which works directly with this organization.

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

Thank you.

Is that sort of widely known? Is that widely discussed? What is the local government's response to that? What should our response be, given that Canada's government has funded both of these organizations?

[Lucy Akello]

Actually, it's widely known. Everybody knows this fact, but what they cannot come out to do.... They hide behind the name of providing family planning services to the people. That's why in countries like Kenya there was actually a demonstration for Marie Stopes to be closed down because of that.

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

Am I...?

[The Chair, Liberal, Ali Ehsassi]

You're over time.

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

Yes. I'll happily take more if it's available.

[The Chair, Liberal, Ali Ehsassi]

No, that's fine. We'll move on.

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

Thank you.

[The Chair, Liberal, Ali Ehsassi]

Next we go to Dr. Fry.

Dr. Fry, you have three minutes.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much, Chair.

I just want to thank everyone.

I'm so sorry, Mr. Bermejo, that we couldn't hear you, because I think this is such an important issue. Rob Oliphant earlier on pointed out that you cannot pick and choose what are human rights. Some human beings are not more important than others. No human beings are more equal than others, so human rights are a universal issue. I just wanted to say that because I feel strongly about that.

I have a question for Dr. Sully from the Guttmacher Institute. Can you tell me what happens? Do you have data that tells us what happens when a young person in a conflict situation is raped—because rape is now a tactic of war—and they cannot have access to abortion? What happens to that young person? What do they do? How can they cope with that and is there any way...? We see it happening in Ukraine right now, and when someone goes into Poland or into Hungary, they don't have access to abortion. That's the first question I have.

Second, if you don't have access to legal abortion, you're going to have to go and get an illegal abortion. That has been done since the dawn of history, and we know that causes extreme illness. The reproductive organs of many young people are harmed because they have unsafe abortions, and many young people around the world die from having unsafe abortions.

My question to you is this: It seems that everyone wants to focus on abortion. I would like to make sure that's not all we are focused on. The point is what happens to people when they're stuck in a conflict situation or in areas where they're pregnant and don't want to be and they're very young? What happens to them if they have no access to legal abortion?

[Dr. Elizabeth Sully]

Thank you for those questions. I have to admit that our data is not great on fragile contexts to begin with, let alone on adolescent girls in those settings, and that's something in which we need to invest more funding to generate evidence to really understand those needs.

What we do know is that, when adolescents and all women in these contexts have unintended pregnancies and they are unable to access safe abortion services and they go and have unsafe abortions, they are having the least-safe abortions. Unsafe abortion is a very broad category, but there are extremely dangerous unsafe abortions that are part of that category. When we've done research in refugee camps and in humanitarian settings, we've seen that those in those camps have worse and more severe complications from unsafe abortions compared to people in the surrounding communities. They aren't even able to access the same services as those in the same geographic area.

They're having more severe complications from unsafe abortions, and that's impacting their long-term health.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you. One quick question I want to ask is about access to contraception. We know that about 400,000 women in Uganda between 15 and 49 do not have access to contraception. We heard that it's because there are side effects. Women in other parts of the world take birth control pills. They have other forms of contraception. We know the IUDs can be unsafe and can cause problems, but why is it that there is no access to safe abortion in some of these countries? What is the problem here, and what can we do to fix it?

[The Chair, Liberal, Ali Ehsassi]

You're out of time, so we will allow a 20-second response.

[Dr. Elizabeth Sully]

I would say side effects are a very small piece and are not the most common thing for adolescents. For adolescents, it's often a question of access. It's providers who are biased and unwilling to provide those services, to give them the full range of options that are available. It's discrimination. It's stigma. There is a range of factors that adolescents in particular face when trying to access services for contraception in particular.

[The Chair, Liberal, Ali Ehsassi]

Thank you very much, Ms. Sully.

We now go to MP Larouche.

You have a minute and a half.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Mr. Chair.

I'd like to remind everyone that today is March 7 and March 8 is International Women's Day. Despite the fact that women have a right to sexual and reproductive health, we must keep up the fight to protect that right.

Dr. Bermejo, knowing that the number of conflicts in the world will only continue to rise, and that sexual and gender-based violence is pervasive and gets worse in humanitarian emergencies, why do you think that addressing sexual and gender-based violence is not considered a priority when crises occur?

[Dr. Alvaro Bermejo]

Thank you.

I hope you can hear me now.

[The Chair, Liberal, Ali Ehsassi]

We sure can.

[Dr. Alvaro Bermejo]

Okay.

Thank you for that question. I'll speak not just as IPPF but also as having spent 10 years as part of the humanitarian system and for the last five as the health director of the International Federation of Red Cross and Red Crescent Societies.

I would argue that the main reason this happens is that our feminist foreign policy and approach do not cover humanitarian assistance and our humanitarian response. The humanitarian response remains, probably after the oil industry, the most macho industry that I've ever worked in. People come back from missions in Yemen or in Afghanistan or in Iran or wherever and say that women didn't come to them to talk about their reproductive health needs. I always say, “No, women didn't come to you, full stop, and certainly, if they did come, they wouldn't have talked to you about their reproductive health needs.”

I think it has something do to with how the system works. I think we saw in Ukraine very clearly, for everybody who wanted to see it, the massive impact of the conflict on women's rights and their bodily autonomy. It wasn't just about the use of rape as a form of war, which of course is there. It was also about women who were pregnant, whose husbands were going to war, and who now didn't want to continue with their pregnancies. It was also about many other things. People continue to have sex during wars as well.

There is no doubt in our minds, and there shouldn't be doubt in anybody's mind, that sexual and reproductive health services are life-saving services that need to be provided in conflict situations.

I say this also, in responding to another question, as an organization that has 40,000 clinics and service delivery points, including on the Sudan-Ethiopia border. I was there in the refugee camps just a week before the peace settlement was signed. You saw an incredible amount of sexual and reproductive health violence there. You saw it there, and at the same time—