Foreign Affairs Committee on March 9th, 2023

[The Chair, Liberal, Ali Ehsassi]

Mr. Genuis, you're out of time.

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

Okay, thank you.

[The Chair, Liberal, Ali Ehsassi]

Thank you.

Next we go to MP Bendayan.

You have six minutes.

[Rachel Bendayan, Liberal, Outremont, QC]

Thank you, Mr. Chair.

Thank you all, respected witnesses. As it was mentioned earlier in this meeting, this is the day after International Women's Day. We want to tell you how grateful we are for the work you are doing on the ground to support women.

Dr. Francoeur, I am very interested in the recommendations you will have for the federal government. We all know that health care falls under provincial jurisdiction, but I would like to hear your comments on improving access, which you mentioned, as well as on the importance of communicating the right information to the public in the right language.

Are you suggesting that more information be published in multiple languages to address different communities in Canada? Can you elaborate on what should be communicated to women here in Canada?

[Dr. Diane Francoeur]

Thank you for your question.

Let me clarify that I am not just a chief executive officer. I am also an obstetrician-gynecologist and I work in your constituency at the Sainte-Justine university hospital centre, the mother and child university hospital centre.

In the past year, a very large number of immigrant women who do not speak English or French have arrived in Canada. When we see those women in the hospital, we have access to interpretation services, but when we see them in a clinic or in an office, it's sometimes impossible to get those services. It's really problematic.

Pregnancy is not an illness, but when pregnant women are sick, it is important that they be able to understand in their native tongue the issues that we are trying to explain to them.

The Sainte-Justine mother and child university hospital centre is a hospital that deals with high-risk pregnancies. During the past year, we have seen very sick women, many of whom are from Haiti. These women may have transited through Chile or Brazil and had a caesarean section. They don't have a record, they don't understand what happened, and they arrive in a country where they suddenly have to make choices without really understanding that they now have rights that will be respected. In this kind of clinical situation, newcomers are still not able to make those decisions.

It is very difficult when there is a language barrier, in addition to a cultural barrier. Newcomers have often crossed the entire the United States and don't have a record. We try to help them see the real risks, but a pregnancy has a time limit: after 40 weeks, the baby has to come out. So sometimes we don't have a lot of time to help these women navigate all of this.

[Rachel Bendayan, Liberal, Outremont, QC]

You also talked about the importance of collecting reliable data. Right now, if I understand your testimony correctly, we don't have data on vulnerable women who have health problems during pregnancy.

[Dr. Diane Francoeur]

I will ask Dr. Cook, who is in charge of our wonderful maternal mortality reduction project, to tell you about the data, because it's a real problem.

[Dr. Jocelynn Cook, Chief Scientific Officer, Society of Obstetricians and Gynaecologists of Canada]

Thank you. I will speak in English, because that will be much better for all of you.

I think that's a really key point. Right now we're at a real turning point where the federal, provincial and territorial governments are working together to talk about data. We learned things from COVID. We had to learn. We were in a situation where we were forced to do new things that from a scientific point of view we don't really have good evaluation data on, but intuitively we know that they worked and they helped.

Now what we're trying to do in our field, I think, is take a breath, take a step back and really be thoughtful about what the outcomes are, what the trends are and where we need to be on top of things, for lack of a better word, so that we can understand what's happening. If we understand what's happening from a true evidence and data perspective, then we can start to plan and anticipate and identify where we need more education for the public—in what languages, for example—and more education for health care providers who are dealing with very different circumstances and contexts and even patient populations. Then we can work together and see where we can have points of intervention and prevention.

As an organization and nationally and provincially, we are working together to try to do this around severe maternal morbidity and maternal mortality, which we've already spoken about and you've spoken about at previous meetings, and also some of those really critical factors that will emerge soon in Canadian data, because some of the provinces have the data around mental health and the consequences in terms of outcomes.

Thank you for that. I love data, so I get really excited.

[Rachel Bendayan, Liberal, Outremont, QC]

I do, too.

Thank you very much, Dr. Cook. I think it speaks to the importance of the work that we're doing now in partnership with the provinces to ensure better data collection.

[The Chair, Liberal, Ali Ehsassi]

MP Bendayan, you're out of time. Thank you.

We'll next go to MP Larouche. You have six minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Mr. Chair.

I thank the witnesses for being with us today for this important study on the sexual and reproductive health and rights of women around the world.

Yesterday, March 8, we had the opportunity to reflect on how far we have come, but also on the setbacks that many women's rights have suffered in recent years, including sexual and reproductive rights. One only has to think about what is happening south of the border, in particular, where the setbacks that have occurred in recent months are really concerning.

Ms. Kanem, in 2019, the Government of Canada committed to provide an average of $1.4 billion per year over 10 years, starting in 2023, to support the health of women, children and adolescents around the world. Of this amount, $700 million is to be spent on sexual and reproductive health and rights. This is a worthwhile commitment, but it should not obscure the fact that, in 2021, Canada spent only 0.32% of its gross national income on official development assistance.

Can you remind us what target countries should aim for in providing development assistance as a percentage of their gross national income?

[Dr. Natalia Kanem]

Thank you very much for the question. It underscores the importance of being able to plan predictably for the needs of women, who are the most vulnerable in so many circumstances around the world, including in humanitarian circumstances.

I will note that last year, in 2022, Canada, indeed, was the 10th-largest donor to UNFPA core resources and our fourth-largest donor to non-core resources. This allowed us to accelerate implementation in development and humanitarian contexts, especially post-COVID, when we're trying to regain ground and, as you have already expressed, when there seems to be a retrenchment in upholding the minimum floor of overseas development assistance, which is so invaluable in terms of capacity to deliver on the ground. I'm speaking of places that may be hard to reach because of geography—small island nations or a place like Afghanistan, because of the terrain—but also because of the political landscapes.

The fixed and predictable core funding from member states is what equips UNFPA to get in there, in the over 120 countries where we're located, to address a growing number of crises in the lives of women and girls.

Thank you.

[Andréanne Larouche, Bloc, Shefford, QC]

That's interesting. Are you having any discussions with Canada to see if the country could invest even more in development?

[Dr. Natalia Kanem]

Canada has been an extremely close partner. As mentioned, back on our executive board, we've taken a lot of guidance in terms of the strategic planning, which I've insisted should be finite. We work on three transformative results: contraception, because it's empowering for women; ending maternal mortality, which is so symbolic of a health system that doesn't work; and, lastly, ending the scourge of gender-based violence, which is erupting in greater numbers, including online violence.

We consistently make the case to Canada, and I believe Canada has been responsive in that regard.

Thank you.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Ms. Kanem. I may come back to you if I have time.

Ms. Francoeur, in your opening remarks, you mentioned the issue of the human immunodeficiency virus, HIV. While doing my research, I saw a piece of information that really shocked me: worldwide, HIV is still the leading cause of death among women of reproductive age in 2023. In recent years, have these poor outcomes been getting worse or, on the contrary, improving?

[Dr. Diane Francoeur]

First of all, it is important to remember that we are privileged in Canada and that free medication is available to women. That being said, we still need to see those women.

I work at the Sainte-Justine university hospital centre, the main mother-child AIDS centre in Quebec. For years, the transmission rate was zero. However, during the pandemic, delays surrounding immigration documents caused delays in specialty clinic consultations, which require proper documentation because HIV medication is so expensive.

As a result, we unfortunately started seeing newborns being born with HIV again. This is a disaster in a country like Canada, as these infections are preventable. For those women who come to Canada and find out they are HIV positive after being tested, it is catastrophic. We have often had to perform caesarean sections when we were too late, to try to protect the little baby.

All of these problems are problems that we got rid of in the years before the pandemic. So we need to quickly get the early care of all immigrant women back on track so that the existence and results of these tests, which are often ignored for months, would be known.

[The Chair, Liberal, Ali Ehsassi]

Thank you very much.

We next go to MP McPherson.

You have six minutes.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you very much, Mr. Chair.

Thank you to all the witnesses for being here today and sharing their expertise with us.

This is a very important study. I'm hearing about the importance of data and how important it is for us to have access to it. I'm also hearing about the importance of long-term, predictable and flexible funding.

I will start with you, Ms. Kanem, if I could.

According to the United Nations Population Fund, access to family planning is a human right. It is “central to gender equality and women's empowerment, and it is a key factor in reducing poverty.”

Could you spend some time telling us why there are still an estimated 257 million women around the world who have unmet needs for family planning, please?

[Dr. Natalia Kanem]

It's true that we know that nearly one-third of women in low- and middle-income countries begin child-bearing in their adolescence, age 19 and younger. This has implications in terms of consent and in terms of how a girl navigates her adolescence safely, often in the absence of comprehensive sexuality education that would be protective to her. Every year, there are an estimated 21 million pregnancies among girls aged 15 to 19 in low- and middle-income countries, nearly half of these being unintended. A significant number end up in abortion, and the majority of those abortions are in unsafe conditions.

The correlation with the difficulty of providing modern contraception to meet the unmet need is partly an adolescent issue. It's also an issue of prioritization, because studies have repeatedly shown the value of women who understand very well the costs of raising children and who want to space their children appropriately. Still, the ability to provide contraception in a regular way means that, in a biological process, you have to have a guarantee that logistics systems will be there to support the women, as well as cost and affordability.

I'm not sure if I'm out of time, but I just want to quickly add that the other issue is that the budgeting domestically for contraception is an area that UNFPA works avidly on, because this is of import in a place like Niger, for example, with an average fertility rate of seven children per woman. There is political will there in that government, and there is also strong leadership by traditional systems, including the religious chiefs, to feature family planning as a life-saving manoeuver because of the prevalence of death during childbirth in the least developed countries.

Thank you.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you very much for that.

We've seen in British Columbia, in Canada, just this week, in fact, that free contraceptives have become law. There is a push for that to happen in Alberta, too, so I'm very excited about that for women across this country, certainly in British Columbia and Alberta.

I think it's useful to hear. We've heard this multiple times during this study, but it's useful to repeat that the failure to provide services does not result in fewer abortions. It does not result in fewer pregnancies. In fact, it results in less safe pregnancy and causes incredible damage to individuals.

Can you talk a little bit about the damage to individuals and perhaps bring in some data for those of us in the room who are data hounds?

[Dr. Natalia Kanem]

In fact, the latest “State of World Population” report by UNFPA dealt with the issue of unintended pregnancy and covered the circumstances under which lack of access can be lethal, literally, in the sense that women lose their lives. We also featured, as I mentioned earlier, that the woman who dies during many of these occurrences is not a woman at all. She is an adolescent girl who, whether through ignorance or through lack of access, or sometimes through coercion, became pregnant and there was no support.

I also believe in the link in terms of the empowerment of women to be able to fulfill their aspirations, whether that is through employment or entrepreneurship, or through motherhood. The intention makes a lot of difference, and the ability to plan your life is going to be more and more acutely necessary in a rapidly evolving technological world.

The fact is that contraception has been proven to be not only life-saving but also very cost-effective in terms of the value returned in community productivity and economic productivity. For me, the real value is that an educated girl has an unlimited wealth of opportunities in front of her, and a girl who lacks an education is not only condemned to poverty herself, but the next generations also have been shown, by data, to fare worse.

The empowerment terminology mustn't disguise that we are actually talking about individuals who would like to conduct their lives in ways that make things better for themselves, for their communities and additively for countries and the planet.

[Heather McPherson, NDP, Edmonton Strathcona, AB]

Thank you for that compelling testimony.

[The Chair, Liberal, Ali Ehsassi]

Thank you.

We now move to the second round.

For the second round, we have very little time remaining. Each member will be provided two minutes.

We start off with Mr. Genuis. You have two minutes.

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

Thank you, Chair.

I was struck by your testimony in the previous round, Dr. Kanem. You said that determining whether China's one-child policy was a violation of human rights was not a competency of UNFPA. It would seem that determining that these kinds of policies are a violation of fundamental human rights is in the competency of all human beings.

We're living through a time when this Parliament has recognized the Uighur genocide, a genocide that involves forced abortion, forced sterilization and systemic sexual violence against women, so we need to talk about issues of coercive population control and we need to talk about ending complicity—complicity by corporations that may have investments that are enabling the Uighur genocide, and complicity by organizations that are failing to call out coercive population policies and the targeting of women associated with it.

We ran out of time in my last round, but I raised a number of issues at the time, concerns raised by the National Human Rights Commission in Mexico around UNFPA's complicity in coercive population policies, and a BBC article containing certain allegations involving UNFPA's activity in India, as well as some further information about UNFPA's activity in China. If it's your position that it's not your role to make human rights determinations, certainly you have to make a determination as it relates to your own participation and complicity in that.

I would welcome your response. Thank you.

[Dr. Natalia Kanem]

Thank you very much, indeed, Mr. Vice-Chair.

I would like to emphasize that UNFPA is against any form of coercion. When it comes to reproductive health and rights, we are foremost in upholding the rights and choices of women everywhere.