Good afternoon. Thank you for inviting me to also appear before this committee on the critical issue of forced or coerced sterilization.
I would also like to begin by acknowledging that we are on the unceded traditional territory of the Algonquin people this afternoon.
We're here today because we're all disturbed by reports of forced and coerced sterilization of indigenous women in Canada. I want to acknowledge these women and recognize their bravery. I speak as a First Nation woman, member of the Mik'maq Nation of Gesgapegiag in Quebec, and mother of two young indigenous girls, and as someone who has dedicated her entire career to advocating for the health of indigenous peoples, both outside and inside the public service.
Forced or coerced sterilization is a serious violation of human rights and medical ethics. All Canadians have a responsibility to ensure that these practices never happen again. As noted by my colleague, Abby Hoffman, there is evidence of the broader need to eliminate racism and discriminatory practices and to eliminate forced or coerced sterilization as a form of gender-based violence. Its practice, among others, compels us to seek to ensure there is cultural safety and humility in health systems across Canada, to improve culturally competent informed consent, and to remove barriers facing indigenous women when accessing health services. As cited by the Truth and Reconciliation Commission, addressing racism in health systems is a matter of reconciliation.
ln addition to the progress that Abby noted to advance cultural safety and humility within health systems, I would also like to highlight the work that Indigenous Services Canada has been undertaking on this issue. For the sake of time, I will outline some of the more recent actions.
ln early December of 2018, we held a teleconference with indigenous partners and national health organizations. We discussed ways to advance collaboration and to identify actions that would ensure free, prior and informed consent, along with culturally informed and safe services for indigenous women across Canada.
The Inter-American Commission on Human Rights recommended that Canada produce an information brochure for health care providers and patients on free, prior and informed consent in the context of indigenous women's health services. To make this happen, we've been in discussions with national indigenous women's organizations on how to proceed.
We're also establishing a new advisory committee on indigenous women's well-being made up of representatives from national indigenous organizations, national indigenous women’s organizations, the National Aboriginal Council of Midwives, the National Aboriginal Circle Against Family Violence, and the Society of Obstetricians and Gynaecologists of Canada. This committee will inform the department on current and emerging issues, including sexual and reproductive health. The inaugural meeting will be held on February 14, 2019.
In addition, we'll be hosting a national forum in the spring to mobilize indigenous and professional organizations to take collaborative actions on indigenous women's reproductive health, and to develop guidance on free, prior and informed consent regarding sterilization procedures.
ln addition to responding to recommendations made at the lnter-American Commission on Human Rights, lndigenous Services Canada endeavours to more broadly support indigenous women's reproductive health through its programs and policies. The first nations and Inuit health branch's maternal and child health program offers community-based home visiting services by nurses and family visitors to over 8,100 pregnant women and families with young children in over 309 first nations communities. This is not counting British Columbia, which is under the direct control of the First Nations Health Authority mentioned by Abby. Through the program, expectant mothers receive case management, screening, assessment and referral services as well as health promotion strategies to identify risks and improve maternal and child health. Budget 2017 increased the existing program funding of approximately $25 million annually by $21.1 million over five years.
ln addition, budget 2017 invested $6 million over five years for indigenous midwifery, the first-ever federal investment in this area. Midwifery care to indigenous communities has been identified as a pathway to helping improve the health and well-being of women, their children and the entire community. lndigenous midwifery is a way to bring birthing back to communities where it had previously been a longstanding traditional practice embedded with ceremony as well as traditional medical practices. Furthermore, informed choice is recognized as a central tenet of midwifery care in Canada. It could help ensure that indigenous women play a central role in their own health care and in their experience of giving birth.
Senator Yvonne Boyer and Dr. Judith Bartlett, who conducted an external review into reports of forced and coerced sterilizations in Saskatoon, found that previous custodial loss, or the threat of custodial loss, has played a role in the forced and coerced sterilization of indigenous women in Saskatchewan.
There's some evidence that midwives not only support women in their reproductive health planning, which may prevent further cases of forced or coerced sterilization, but that they also provide support to women in preventing custodial loss of their children. Further work is required in this area, and we're looking to indigenous midwives' leadership to better understand the issues. To that end, we're pleased that the National Aboriginal Council of Midwives has agreed to sit on the indigenous women's well-being advisory committee.
Budget 2017 also included new investments that will strengthen maternal supports by ensuring that all first nations and Inuit women are entitled to an escort when they have to leave their community for childbirth. We know that the presence of a support person offers many benefits to a labouring woman, including assisting her with making decisions and advocating for her wishes. lndigenous Services Canada's non-insured health benefits program now provides coverage for an escort for expecting mothers, regardless of their age or medical condition. This recognizes that no woman should have to birth alone.
The Government of Canada has committed to implementing the Truth and Reconciliation Commission's calls to action, including calls 22, 23 and 24, which were mentioned by my colleague. These calls pertain to using and recognizing the value of Aboriginal healing practices, retaining and increasing the number of Aboriginal health care professionals, and providing anti-racism and cultural competency training for all medical and nursing students.
Our department has been exploring, with the Royal College of Physicians and Surgeons of Canada and indigenous organizations, project ideas for an online knowledge hub of cultural competency learning tools. Last year, the Royal College embarked on making indigenous health and cultural safety a mandatory component of postgraduate medical education and certification.
As also mentioned by Abby, the B.C. First Nations Health Authority has done remarkable work with the province and its regional health authorities in finalizing a declaration on cultural safety and humility, as well as informing cultural safety and humility training across the provincial health system. It is presently developing the first-ever cultural safety and humility standard in partnership with the Health Standards Organization, which is affiliated with Accreditation Canada. We're hopeful that other provinces and territories will look to this work as a promising practice.
We can't undertake this work unilaterally. The Native Women’s Association of Canada and Pauktuutit Inuit Women of Canada have been providing leadership on indigenous women's health. As our relationship with these women's organizations grows and expands to include Les Femmes Michif Otipemisiwak, or Women of the Métis Nation, we're encouraged by their good work and guidance. Their collaboration is essential to getting this right.
It will take the efforts of many to ensure that structural racism and the effects of colonization do not interfere with the health of indigenous women. I want to assure you that we are taking this matter very seriously and will continue to work in the spirit of collaboration and partnership towards culturally informed and safe health services for indigenous women throughout Canada.
I would now be pleased to take your questions.