Health Committee on April 11th, 2024

[Leah Gazan, NDP, Winnipeg Centre, MB]

Thank you very much.

I want to go back to training. I know that you're both researchers, but you're also scholars at universities. Would you say that training needs to be changed, medical training specifically, because we're talking about postpartum, to include a focus on training around postpartum for women? Part of the reason I'm asking is because you've been very clear that we become a vessel for babies, and then we become a separate physical entity once we give birth. I wanted to hear your thoughts about that.

[Dr. Liisa Galea]

Sure, I'll start.

Yes, we need more training, but again, to be able to train people, we need to know what to train them and what the evidence-based information is that we can tell our health care practitioners.

I also want to underscore that postpartum is really important, but I don't want the women's health committee to only focus on the postpartum, because it's the whole lifespan. I know you're not.

We've talked about perimenopause, menopause and puberty. All of these time periods are really important and are so understudied in girls, women and gender-diverse individuals.

[Leah Gazan, NDP, Winnipeg Centre, MB]

Do you think it would be helpful to have programs specifically geared to women and gender-diverse folks to enter the field? I know that this field is still predominantly populated by males. Do you think that it would be helpful in changing some of these systemic barriers?

[Dr. Nichole Fairbrother]

Yes, I do think that it would be helpful to have increased representation within health care for women's health, absolutely.

[Dr. Liisa Galea]

Also, empower women. If we tell people that women's health is valued information to have, then more people will do it. Right now it's so undervalued, and I think that's part of the problem.

[Leah Gazan, NDP, Winnipeg Centre, MB]

I share that. With all due respect, I'm glad there are women around the table, but the health committee currently, in terms of regular members, outside of one woman, is all men. I think that's demonstrative of the lack of focus on women's health issues in the system.

There are two now. There you go.

[A voice]

That's a 100% increase.

[A voice]

The problem is that we're only 30% in the House of Commons.

[The Chair, Liberal, Sean Casey]

Thank you.

Mrs. Roberts, you have five minutes, please.

[Anna Roberts, Conservative, King—Vaughan, ON]

Thank you very much, Mr. Chair.

I'm going to ask my questions to both Jeanne and Linda. I need to know, from your explanations, the difference between state and non-state torture, because Canada does not recognize non-state torture. I'm sure everybody has heard about the young girl, who was raped and tortured at 11 years of age, Kerri Kehoe; and nobody believed that she was tortured. Nobody believed that she was raped. The rapist finally got arrested and was let out on parole. Kerri Kehoe is reliving her experiences all over again. How do we change the justice system in this country to realize that that is torture? It's not abuse; it's torture. If we can make it torture, we can increase the sentences so that these guys don't have an opportunity to get out of jail and revictimize the victims.

[Jeanne Sarson]

That is an excellent question, because it's one Linda and I were shocked about in 1993 when Sara came to us and said she was tortured. We looked around and were shocked to find out that Canada does not recognize torture by non-state actors. Then we went global to try to understand the discrimination that occurs in the law. We found out that, in Canada, section 269.1 of the Criminal Code says very clearly that a torturer can only be a public officer, a police officer or a military officer, because it was not thought that women and girls, or children, were ever tortured in the private domain. Back in the eighties when the convention against torture was created, violence against women and children in the family was a family matter. Everybody knew about it, but nobody paid any attention to it.

What has happened, in our opinion, is that when the convention was rolled out—and it had discrimination in it, that it only happened really to men in war, or men in terrorism—countries all over this planet decided to make a law that mimicked the convention, which said that it could only be a public official. Nobody every thought of women.

Linda and I work with a group in Vienna. We asked one the experts about when they were creating the convention, if they ever thought of women and children; and he just said no, that it wasn't even a thought in their minds.

That created the discrimination, and it has rolled out across this planet. We think it's really important that the UN has been trying to change that attitude. For example, the committee against torture in 2008 in paragraph 18 said very clearly that non-state actors commit torture and the countries should look at that and change their law.

Women and men in this country might be surprised that it was only in 1993 that the abuse and torture of women was acknowledged. They were talking about women at the convention on human rights in 1993 in Vienna. That was the first time, really, in human rights history around the conventions that the issue of abuse and torture of women came up. We're very new at the issues that we're all talking about here. That's not a very long time.

Also, the CEDAW committee, which is to remove discrimination...and Canada has ratified both of these conventions. They too are trying to catch up with modern times. In their recommendation 35, they also brought in that non-state actors can commit torture.

[Anna Roberts, Conservative, King—Vaughan, ON]

I want to just read from page 45 of your book. It says: “This is what torture is—it is the destruction of a human being—it is the actions of a torturer that dehumanize and attempt to destroy another human being—it is a bone chilling reality.”

I believe from reading your book that this is what Sara and some of the women you've helped have experienced. We need to, at the federal level, ensure that we bring a law forward to change it, to let people know that what these victims are going through is not abuse—it's torture. I had tears in my eyes just reading some of the descriptions in the book, because this is what they're doing to our children. We as women have to stand up for them, because our justice system has failed us.

[Jeanne Sarson]

I would like to add a little bit about babies for the discussion that we've had.

The one issue that hasn't come up is that this can be intergenerational. The women have told us that if that's not talked about in prenatal care and if it's not talked about in labour and delivery, these families get missed.

For the women we've supported, all they ever wanted was to be taken out of their families.

[The Chair, Liberal, Sean Casey]

Thank you.

[Jeanne Sarson]

If we don't name that torture can be happening in families, we have blank spots in our knowledge. There's sufficient knowledge out there now that we can do better than we're doing.

[The Chair, Liberal, Sean Casey]

Thank you.

Our final questioner will be Ms. Brière for five minutes.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you, Mr. Chair.

I want to thank you all for making a difference in the lives of women, mothers and mothers-to-be.

Going back to the previous discussion, I would first like to point out that, in 2016, the Standing Committee on Justice and Human Rights looked at the definitions of such offences as assault, torture and aggravated assault. It concluded that the existing provisions of the Criminal Code already included these definitions.

My questions are for Ms. Galea and Ms. Fairbrother.

You have developed a series of online interventions for perinatal anxiety disorders. Could you tell us more about that?

[Dr. Nichole Fairbrother]

I have not developed online interventions.

[Dr. Liisa Galea]

I haven't either.

[Dr. Nichole Fairbrother]

What I could say is that, maybe in large measure as a consequence of COVID, I think there's been a realization that we can broaden access to mental health treatment by having Internet-based e-health interventions. This is particularly important for people who live in rural and remote communities, who historically would have to travel long distances to access specialized care.

In addition, it is possible—although I think we are still in need of additional data and research on this—that some combination of self-help by the patients themselves mixed with therapist support may be able to produce similar outcomes to face-to-face treatment at a much reduced cost. I wish I knew a little bit more about how well that works.

I know that if you remove the therapist support piece from Internet-delivered therapies, the effectiveness of the therapies drops through the floor. You have to have the therapist support. At exactly what dose in order to bring it up to the same level of expertise, I'm less confident of.

[Dr. Liisa Galea]

Yes, I think maybe what you are remembering is the Summit trial by Daisy Singla, Simone Vigod and others.

I'm not super familiar with it, but they were training non-professionals to be sort of like therapists in certain situations in the postpartum and it worked very well. The trial results are released already. There will be more big announcements about it, but it does seem to be a low-cost, effective tool that can be used.

[Élisabeth Brière, Liberal, Sherbrooke, QC]

Thank you.

Earlier, you said that the focus was often on the baby to the detriment of the mother's needs, particularly in terms of mental health, and that this could pose a risk after childbirth.

Can you tell us a little more about that?

[Dr. Nichole Fairbrother]

I'm trying to think of how we can have healthy babies with unhealthy mothers. I'm not really seeing how that can be. I think we need mentally healthy mothers to have healthy babies.

This hasn't really come up today, but I think it's worth nothing that if you look at the data on unpaid domestic labour in Canada and who is doing this unpaid labour, it is still largely women. As women, we are doing much more of the child care typically, compared with men.

Therefore, there's this additional burden, which can also impact mental health. Having that weight of responsibility is also significant for women's mental health, so I think we have to be paying attention to that.

[Dr. Liisa Galea]

Just speaking outside of the postpartum, women are also more likely to be significant caregivers to their elderly parents as well. That also creates a big burden.

I just want to say something about the women's health committee and the percentage of men on the committee. We also need male allies. It can't just be about women helping women. It also has to be about men and gender-diverse.... We're stronger together. I applaud the men who are on the committee.

Thank you.

[The Chair, Liberal, Sean Casey]

What an excellent note to finish on.

Thank you, all, for your very powerful presentations.

Ms. Roberts.