Evidence of meeting #53 for Foreign Affairs and International Development in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was unfpa.
A video is available from Parliament.
11:50 a.m.
Liberal
11:50 a.m.
Liberal
Randeep Sarai Liberal Surrey Centre, BC
Thank you, Chair.
I saw you paying attention to this, Ms. Ravon. Maybe you want to comment on that study that's being done. Do agencies, like Oxfam or others, go in and try to influence culture, or do they focus on the rights of women and the availability of those services? Can you enlighten us really quickly?
11:50 a.m.
Executive Director, Oxfam Canada
Sure. Maybe I can respond in two points.
One is that an organization like Oxfam does not make decisions here in Ottawa and then tell local communities what to do. All of our work is with local partners and communities. We work with women's rights organizations in countries like Mexico and around the world. They are the ones leading the agenda. We have the privilege of being a conduit between the Canadian government and public funding and their work to support their communities, so we're not leading the agenda. That being said, there are strong women's rights organizations in every single country we work with. There's no lack of community organizations to work with on the ground.
On the previous question, if I may, I won't comment on UNFPA in particular, but what we do know is that, if you look at Mexico—I'll comment on this personally because my family lives in southern Mexico—indigenous women led the charge for abortion to be legalized in the poorest provinces of Mexico, with Oaxaca being first. Indigenous women led the green wave around abortion, because they know that they are suffering the consequences of unsafe abortion and lack of public services.
This is certainly not something that has been imposed by any foreign agent or the UN. This is very grassroots mobilizing and really impressive mobilizing that has led a country with very restrictive abortion laws to change because of grassroots, rural, indigenous women's movements, so I think we look to them as the leaders we can support. It's not driven from the outside.
11:50 a.m.
Liberal
Randeep Sarai Liberal Surrey Centre, BC
My second question into that is this: How do you deal with cultural norms in a society? How does Oxfam or similar organizations, when they go to South America, Latin America, India, the Middle East, etc., work with those? Are you there to work with the culture norms? What's a general practice, just in 60 seconds or so, as to how Oxfam works in that kind of environment?
11:50 a.m.
Executive Director, Oxfam Canada
A lot of our work is precisely on behaviour, norm, attitude and belief change with local organizations. I can give you an example of Bangladesh, where the partners we work with have developed a very popular television series that talks about women's role in the household, gender dynamics and gender norms around decisions, around sexuality decisions and around who has household chores. They're trying to shake things up.
Our partners in Bangladesh have decided that using these kinds of very popular TV stations—the word that comes to mind is “telenovela”—is the best way to access people and start raising different ways of thinking about gender norms in their countries. In other contexts, we support groups that do public radio stations in rural communities. In others, we support street theatre and community theatre.
It's very much context-specific how you shift attitudes and norms, but the best way is to be closest to the communities you're working with. It's never from the capital down.
11:55 a.m.
Liberal
Randeep Sarai Liberal Surrey Centre, BC
Just switching back to North America and the reversal of Roe v. Wade, have you seen the impact in states that do not allow access to abortion or have very restrictive access to abortions? What is the effect on women getting illegal abortions, or is it generally still accessible because neighbouring states usually have access to it?
Can you enlighten us? Even though it has been a short window, what has been the effect of Roe v. Wade on women and women's reproductive rights and the dangers to women in the United States?
11:55 a.m.
Executive Director, Oxfam Canada
Oxfam America works very closely with organizations across the country in the United States. They have seen that the biggest impact has been on marginalized communities. Black women in particular have seen a harder access to abortion. There's a direct correlation between poverty and being able to fly, take a train or take a car to get to safe abortion.
Communities that are in poverty have less access to take the three days off work. That would mean getting into the car, driving across the border to another state and having access to health care to begin with. Poverty is really the intersecting factor here, so it's not only a crackdown on women; it's a crackdown on poor people.
11:55 a.m.
Bloc
Andréanne Larouche Bloc Shefford, QC
Thank you very much, Mr. Chair.
Ms. Ravon and Ms. Vaugrante, thank you for joining us today on this day after March 8, International Women's Day, when we talked about the important need to stand up, again and again, for women's rights. What stands out for me this year is that, according to UN Women, it would take another 300 years at the current rate to achieve equality between men and women. It's a number that sets off alarm bells for me and reminds me that the fight must continue.
Ms. Vaugrante, in your presentation, you spoke about the issue of sexual violence against women. Could you tell us more about the link between, on the one hand, that gender-based violence and, on the other hand, all the health issues such as abortion and unwanted pregnancies?
In international cooperation, it is important to improve health systems, but could you talk about the work that needs to be done to decrease gender-based violence and violence against women in particular?
11:55 a.m.
Executive Director, Oxfam-Québec, Oxfam Canada
I will begin to answer your question, and I will let Ms. Ravon continue.
We have talked about this in answering different questions. Our interventions are never technical. The primary goal is to support groups that are already on the ground. When it comes to training on sexual and reproductive health, we talk about comprehensive training. So our approach is never just about the technical part of health. It's comprehensive, and it's about the full range of women's sexual and reproductive rights and ways to combat the violence they experience.
Contexts are increasingly made fragile by conflict and natural disasters, which are increasing the danger of violence against women and girls. There is evidence that contexts where democratic spaces are increasingly constrained and conflict is on the rise can lead to sexual violence.
So we work with community leaders and we also talk about the benefits of having women who are not experiencing sexual violence and are enjoying their rights, and are therefore able to participate in the community economy and contribute to solutions. That's important.
I will yield the floor to Ms. Ravon.
11:55 a.m.
Liberal
11:55 a.m.
NDP
Heather McPherson NDP Edmonton Strathcona, AB
Thank you very much, Chair.
Thank you very much for your testimony, again. You spoke about how you work with women partners. I was in Nicaragua and met with Oxfam there and with the partners on the ground.
I want to give you an opportunity to talk about two things very quickly. First is the fact that you work so closely with partners and that you are in fact enabling the people on the ground, the women on the ground, to do what they need. You're providing that support to them. One thing that was brought up was the ability of the Canadian aid sector to switch its focus. Obviously, the horrendous earthquake in Syria and Turkey and the horrible war that's happening in Ukraine have diverted a lot of our attention. Obviously, Canada needs to do absolutely everything it can for the people of Turkey, Syria and Ukraine—the women of Ukraine, who we know have suffered quite a bit of sexual violence.
Could you talk a little bit about how that support needs to be in addition to the development dollars, not in exchange for them?
11:55 a.m.
Executive Director, Oxfam Canada
If it is not, ultimately we're going to see a backslide. If we invest only in repeated humanitarian crises, we're not investing in long-term resilience building, whether it's health systems, women's education, movement building or civil society. We're going to be in a yo-yo effect where you invest one moment, and then the investment leaves because the humanitarian community looks elsewhere. That's not how we're going to build long-term resilience. While this is not specific to sexual and reproductive health and rights, in a world where climate change is going to disrupt pretty much everything and we know there are going to be increased flows of migration and conflict related to climate, we need to be building that long-term capacity for communities to be resilient, to adapt and to build up their national infrastructure, in particular their national safety nets, because we know crises are coming.
Noon
NDP
Heather McPherson NDP Edmonton Strathcona, AB
We need real solutions instead of just band-aid solutions.
Noon
Executive Director, Oxfam-Québec, Oxfam Canada
It even makes humanitarian aid more effective. I see our partners from Oxfam KEDV, in Turkey, who have been working for decades with women's cooperatives. They are close to those women; they are there. So working in international development for a long time makes humanitarian aid and response much more effective.
Noon
Liberal
The Chair Liberal Ali Ehsassi
Thank you very much, MP McPherson.
That concludes this first panel for us. I'm incredibly grateful to Ms. Vaugrante, Ms. Ravon and Ms. Garcia. I'm very grateful to you for sharing your perspectives with us.
On that point—
Noon
Conservative
Garnett Genuis Conservative Sherwood Park—Fort Saskatchewan, AB
Chair, can I raise a brief point of order?
I think one of our witnesses had her hand up for a while. I think witnesses are able to submit follow-up information in writing to the committee, and that is considered as part of the evidence.
I don't know if you want to allow an opportunity for her to speak further or not, but I would encourage people who have further comments to submit them in writing.
Noon
Liberal
The Chair Liberal Ali Ehsassi
Thank you, Mr. Genuis.
Ms. Garcia, at this point, a witness can't make any further submissions, but if there is anything further that you would like us to consider, please feel free to send us any written submissions that you think would assist our members in coming up with their recommendations.
Thank you for that.
On that point, let me thank you all for your time and for your perspectives.
We will need a few minutes to get to the second panel. For those on Zoom, you don't have to do anything. We will reconvene in two minutes.
Thank you.
12:10 p.m.
Liberal
The Chair Liberal Ali Ehsassi
Welcome back, everyone.
Pursuant to Standing Order 108(2) and the motion adopted by the committee on Monday, June 20, 2022, the committee resumes its study of the sexual and reproductive health and rights of women globally.
It is now my great pleasure to welcome, from the United Nations Population Fund, Dr. Natalia Kanem, the executive director and under-secretary-general of the United Nations.
We also have equally distinguished witnesses from the Society of Obstetricians and Gynaecologists of Canada. We welcome Dr. Diane Francoeur and Dr. Jocelynn Cook.
For the benefit of the witnesses and the members, please ensure that you're recognized by me before you speak. For each of the witnesses, we are providing five minutes of opening remarks before we open it up to questions from the members. When you're getting towards the end and you have only 30 seconds remaining, I will give you a sign. I would be grateful if you could wrap up your comments. This goes for both your opening statements and the questions posed by the members.
That having been explained, allow me to welcome Dr. Kanem.
Dr. Kanem, you have five minutes.
12:10 p.m.
Dr. Natalia Kanem Under-Secretary-General of the United Nations and Executive Director, United Nations Population Fund
Thank you, Mr. Chair, vice-chairs and honourable committee members.
Thank you for inviting UNFPA, the United Nations sexual and reproductive health agency, to address you today, and thank you for Canada's continued, generous support to UNFPA. We are delighted to have Canada back as a member of the UNFPA executive board through the year 2024, and we look forward to your guidance during this period. It's the support of partners that spells the difference between life and death for millions of women and girls around the world each year.
There can be moments of great joy amidst tremendous suffering, as we saw in the wake of last month’s devastating earthquake, when Khawla Hassan Al-Ali was able to give birth safely to four healthy babies, quadruplets, delivered by Caesarean section at a UNFPA-supported clinic in northwest Syria.
Nasreen Faroug Balla, a young Sudanese woman, was in critical condition when she finally reached a UNFPA field hospital in a settlement for Ethiopian refugees, after being carried three kilometres through rain and mud and suffering from pre-eclampsia. Nasreen's blood pressure spiked dramatically and she lost consciousness. Fortunately, the doctors were able to perform an emergency Caesarean section, and both she and her baby boy survived and received the care they needed to recover.
Of course, not every story has such a happy ending. Every two minutes, a woman dies during pregnancy and childbirth—an estimated 287,000 women in 2020, according to a new report by UNFPA and our United Nations partners. Very often, this woman is an underage girl.
Most of these deaths are preventable. One of the most cost-effective ways to prevent maternal deaths is to educate and deploy midwives. Midwives can deliver 90% of all essential sexual, reproductive, maternal and newborn health services. However, currently the world faces a global shortage of 900,000 midwives. With support from Canada and other partners, UNFPA works to close the gap and to create a well-trained midwifery workforce.
Also very critical is reducing unintended pregnancy that so often ends in unsafe abortion, which is among the leading causes of maternal death. UNFPA research shows that nearly half of all pregnancies are unintended. Our research also shows what works to address this: increasing access to a range of quality contraceptives, improving comprehensive sexuality education for young people, and protecting a woman’s right to decide whether, when and with whom she wishes to have children.
We will also need to tackle harmful norms and practices that undermine women and girls’ human rights, their bodily autonomy and their access to life-giving health care. Why? The figures speak for themselves. One in three women experiences physical or sexual violence in her lifetime. One in five girls is married or in a union before the age of 18. More than four million girls are at risk of female genital mutilation this year. Just 56% of partnered women are able to make their own decisions about whether to have sex, use contraception or seek health care.
We know that changing this will require partnerships, first and foremost with communities, with civil society organizations, with traditional and religious leaders and, critically, with men and boys.
The benefits for both individuals and their societies are enormous. According to UNFPA research, every dollar invested in ending preventable maternal deaths and unmet family planning needs by the year 2030 would yield $8.4 back in economic benefits by 2050.
UNFPA certainly welcomes Canada's feminist approach to international assistance. Your leadership is a beacon of hope at a time when push-back on gender equality and women and girls’ rights is intensifying.
UNFPA looks to Canada as a strong ally in advancing gender-transformative change, rooting out disparities, discrimination and inequalities, and defending the rights and choices of all people in all their diversities.
I'll end by saying that we look forward to continuing our work together toward a world where every pregnancy is intended, every childbirth will be safe and every woman and every young person can choose the direction their life will take, transform their community and help build a more equitable, prosperous and sustainable future.
Thank you very much.
12:20 p.m.
Liberal
The Chair Liberal Ali Ehsassi
Thank you very much, Madam Under-Secretary.
Next, we will go to the Society of Obstetricians and Gynaecologists of Canada.
Ms. Francoeur, you have five minutes.
12:20 p.m.
Dr. Diane Francoeur Chief Executive Officer, Society of Obstetricians and Gynaecologists of Canada
Ladies and gentlemen, good afternoon.
My name is Diane Francoeur and I am the chief executive officer of the Society of Obstetricians and Gynaecologists of Canada, or SOGC. With me today is Dr. Jocelynn Cook, who is our chief scientific officer.
We thank you for this opportunity today to speak with you about sexual and reproductive health and rights of women globally. The SOGC has over 4,000 members, including obstetricians, gynaecologists, family physicians, nurses, midwives, researchers and other health care professionals working in our field. Our mission is to lead the advancement of women’s health through excellence and collaborative professional practice. Our vision is: healthy women, healthy professionals and excellent care.
Our organization and our members are very committed to the sexual and reproductive health and rights of women, both in Canada and around the world. The SOGC has distinguished itself for many years as the go‑to organization for health care professionals and women when it comes to quickly finding the latest evidence-based recommendations. Our members, who are involved in the development of guidelines, are among the best experts in Canada and, unusually for a country with 17 medical schools, are able to speak with one voice when it comes to changing our practices to improve care for women.
Today, we will share our recommendations, as well as some thoughts on science-based solutions to meet the current needs of women and those who care for them, as they too deserve our support and attention to do a better job.
The pandemic has left us with a shortage of human resources that is undermining our health care system. It is clear that this shortage has had a direct impact on women's health by creating a bottleneck, especially for under-served populations. New immigrant women, indigenous women and people of diverse gender identities are finding it harder than ever to navigate our overburdened system. Because it is difficult to get access to the specialty clinics and health services they need in a timely manner, the consequences and impact of delayed care on their medical condition will be even more significant and sometimes, unfortunately, irreversible.
One example is the appearance of HIV-positive newborns when medication was started late for the mother. No one can ignore all the pregnant women who are crossing the United States and arriving via Roxham Road in Canada as refugees. Even if they have medical coverage through the interim federal health program, they do not know how to navigate our system and often have to rely on their children or friends to translate their medical problems when interpreters are not available. How do we explain to them that their sexual rights will be respected when we are unable to have a private conversation free from influence?
Overcrowded clinics are not the best place to welcome immigrants and assess their medical and social risks. As health care professionals, we need time to be able to build a trusting relationship to help those women make the best possible decisions about their medical and social issues. Unfortunately, their complicated medical condition often dictates the speed of necessary interventions before these women even have time to realize that they now live in a country where they will have the right to choose.
Issues of access to safe or illegal abortion, access to contraception without financial constraint and special care for the LGBTQ+ community, including the multicultural aspects of health and managing the trauma experienced by each woman, are even more complex issues and problems in situations of conflict, pandemic and war for these under-served populations. Women around the world experience the consequences of those problems, and we need to be able to understand the trends, gaps and opportunities to improve their lives when they arrive here.
Sexual and reproductive health and rights must be a priority for all women and their unborn children. In this regard, Canada must stand out for its commitment to all its women, whether they were born here or are newcomers.
This way, we will be able to back up every dollar invested internationally with our credibility in our actions, and not the other way around.
Canada lacks reliable and accurate data on the health of its women when it comes to monitoring indicators and producing reports to guide investments and decision-making. We see some aberrations on the ground, such as the fact that women of colour, indigenous women and new Canadians appear to be more likely to die during childbirth in Canada. However, we have no data to support these observations, as these data are not measured or reported.
However, the SOGC is confident in developing training tools to prevent these deaths. Mental health and opioids are issues seen in rich countries, but unfortunately they are also very closely linked to limited access to available services.
For more than 80 years, the SOGC has been advocating for improvements to women’s health, providing training and education, leading research and producing evidence-based guidelines. We have worked in partnership with countries around the world to develop training programs on sexual health and reproductive rights for their professionals, with their learned societies and governments. We have trained over 10,000 health care professionals in low-resource countries to optimize emergency obstetric care based on the philosophy of and respect for everyone's rights.
We would like to leave you with a few recommendations.
We have to support our health care teams with innovative models of care and think outside the box to improve access, decrease stigma and improve patients' experiences and health indicators. The shortage of human resources is unfortunately here to stay. Therefore, we must find solutions that are not based solely on the magical thinking of seeking professional resources from other countries, especially those in the developing world.
We have to reach the public and our patients with the right information, in the right language, to help them make decisions about their health. We have to share the same science and recommendations with women and physicians, so that they can speak the same language.
Finally, we have to continue to work with federal, provincial and territorial data to ensure that we can identify issues and trends, so as to be able to measure the impact before it's too late to act.
Thank you again for your invitation today—