National Defence Committee on May 12th, 2023

[Dr. Karen Breeck]

I'll speak faster.

Absolutely, we know there's a bias across the board, on the civilian side. If I can.... To me, it's different buckets again. We already know there's a bias in primary health care. That, of course, comes over into military health care, but now we have a bias in occupational medicine as well.

Most of the original occupational hygiene rules and regulations were done in the 1970s, mostly in the U.S., which is why it's almost all male data. We need an entire revisal of all those occupational health hazards, one that now includes women. It just hasn't been done. That is a government...because it's a government-specific issue for employment.

I'll add onto that one more layer, and that's the operational level. For women doing military flying, diving and these kinds of very unique-to-the-military occupations.... Again, it is a government responsibility to do research at that level, because it's not the primary care.

When we talk about industry, there's no question. We can always learn from other areas—mining and non-traditional areas. Again, I'll highlight that all of them, though, when we start talking chemical exposure, vibration, sound and these physical things.... The last major updates were in 1970. We need a country to step forward to do an across-the-board major review—now that women are coming into these environments—of what is and isn't dangerous.

We may find a lot of the issues are not dangerous and that it is safe, but right now we don't know. It's that initial research, by the federal government, hopefully, and across departments.

[The Chair, Liberal, John McKay]

Ms. Normandin, you have one minute.

[Christine Normandin, Bloc, Saint-Jean, QC]

Are services for sexual misconduct survivors located in the right geographic areas? Are they too present in big cities, rather than being close to military bases, where the victims are?

[Rebecca Patterson]

I can give you a direction on where to go for that information. It has been part of the overall work on sexual misconduct since 2018. It's about the concentration of serving members. That's where the services are concentrated. It's especially support through family resources centres, which were mentioned previously, as well as within health centres.

I'm going to stop there. More information can come from the Sexual Misconduct.... It has a new name.

[Dr. Karen Breeck]

It's the Sexual Misconduct Support and Resource Centre. It used to be called SMRC. Yesterday's announcement officially announced the new name of SMSRC.

If I can add to that, again, I find it really important that we define our words. A lot of people interchange sexual misconduct with sexual assault, yet the vast majority of sexual misconduct is not sexual assault. It is not always sexual assault resources that are required. There are often much more complicated and alternative resources for the other things that still come under sexual misconduct as well.

[The Chair, Liberal, John McKay]

We're going to have to leave Madam Normandin's minute behind, here.

Ms. Blaney, you have one minute, please.

[Rachel Blaney, NDP, North Island—Powell River, BC]

Dr. Breeck, what work needs to be done, and what gaps are there around women's reproductive health and reproductive rights in the military?

[Dr. Karen Breeck]

In one minute...?

I'm about finding the root cause. Anything that helps is great, but on the root cause, we won't know what we won't know until we do something at a very broad, strategic level that should be helping all of the women.

Again, I think of it as a quiltmaker. We have all of these different departments making quilt pieces, but we don't have a quiltmaker yet to make sure all women benefit from knowledge on, whether we're menopausal, pregnant or breastfeeding, how and when it is safe or not safe in our newer work environments.

Within the CAF specifically one area we often talk about is medical. Medical still looks at the primary care as equivalent, but there's another layer that's government. What are the employer job benefits? Other militaries offer egg and sperm banking. You can choose to delay a pregnancy because you want to go on a deployment, say I'm going to Sudan for two years and I want my eggs already banked now before I get exposed to whatever I get exposed to. Those are employer job benefits.

Obviously, they're not going to be provincial equivalent. That would be an easy, simple thing that would help support women to have choices to be able to have eggs banked.

[The Chair, Liberal, John McKay]

Thank you, Ms. Blaney.

Mrs. Gallant, you have three minutes.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Dr. Breeck, with respect to the army, navy and air force, is there one branch where reproductive loss is higher? If so, which one?

[Dr. Karen Breeck]

I look forward to when this committee puts forward a recommendation that we study these questions.

In fairness and in follow-up, right now women's health is especially hurt by our electronic patient record. It was, again, ahead of its time in its time, but it does not include easy ways to put down our grava or para. It doesn't have easy ways to incorporate pregnancy-related information. It's not set up in a way for us to capture the data easily to do the research on, whereas a newer electronic patient record would actually help address and capture that. We're over 30 years now for women doing this. We should have data and we don't.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

At what point, generally, are pregnant members shifted over to civilian doctors for prenatal care?

Once a member with a young child is posted elsewhere, or a newborn comes along the way, how is that child cared for? In places like Renfrew county, we have tens of thousands of people on wait-lists. Often, military families go their whole posting time without ever being assigned a doctor.

[Dr. Karen Breeck]

Prenatally, when I joined we were expected to do all of our own prenatal care and work directly with an OB/GYN, who often actually invited us to be part of the actual delivery.

However, as time has progressed, anything to do with women's health issues tended to be outsourced. It's now considered pretty standard that we outsource almost immediately upon pregnancy. It actually causes a number of issues and problems when you are still actively doing unusual work that needs that occupational medicine oversight. That isn't the job and responsibility of the civilian sector. This is where one of our gaps happens. I think we lose a lot of our women unintentionally because we're not always overseeing that occupational level while they're pregnant. When they're pregnant they're over there.

I'll allow my colleague to talk about child care.

[Rebecca Patterson]

There are two things. There is a project under way within health services now, which is the women's health strategy. We need support to continue to develop that strategy, which includes bringing OB/GYNs on board. That will help with some of this oversight and trying to reduce that gap. Continued support of the programs already under way is going to be essential, and funding.

Secondly, when it comes to child care, we get stopped every time. I had my children in Petawawa, by the way, and it is a showstopper. It impacts operational readiness of jets and planes and tanks. We need to look at some way of navigating around provincial jurisdictions. It's definitely worth a project at a federal level—controlling our own health care systems and funding them.

[The Chair, Liberal, John McKay]

Thank you, Mrs. Gallant.

Ms. O'Connell, you have the final three minutes.

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

Thank you.

Senator Patterson, you touched on the health care increases compared with the CAF health care increases. I wrote down 0.7% increase, in comparison to the provincial and territorial health care agreement. Do we have the data? We might assume that the investments would be parallel to the civilian public system, but there may be a higher need in certain parts of the health care spending for CAF.

Do we have the data to break that down, in terms of how much we should be increasing year over year and in what particular priority areas?

[Rebecca Patterson]

That is a wonderfully complex question, and not my current work.

There are two things. Health care inflation is a Canada-based thing. Because we purchase civilian products—we train from there—even if we deliver the care, we purchase it. It's based on those inflation rates. That is data that needs to come from elsewhere.

When you look at how much we actually pay, that data base is building within the Canadian Armed Forces. When you ask whether there are going to be specific areas, health care that is delivered to CAF members is always going to be funded.

My reinforcement piece is controlling how much we spend in comparison to a civilian receiving the exact same service. It's what we're being charged for. I have to go back—it's a bucket with water in the bottom. Every time you slosh it one way, there's a space. The Canadian Armed Forces and the Department of National Defence make no money. They spend. That's what they do.

You need to indirectly hit it by looking at what we're being charged and where we're being overcharged. “Overcharged” is my opinion; that doesn't reflect the department. However, the data is a baseline there and building.

[Jennifer O'Connell, Liberal, Pickering—Uxbridge, ON]

If I can quickly get a question in on the day care piece, how would that look? Would we work with provinces and territories to reserve certain spaces, or would it need to be a completely stand-alone system?

[Rebecca Patterson]

I'm going to tell you what we have experienced.

Again, doing health and being a champion for women seeking child care, the challenge is that day cares are provincially regulated, as well as child care providers. Because it's not a core service delivered by the federal government, retaining spaces is not possible because it has some provincial funding in there. It is a model, but we haven't been able to overcome it.

What happens with a highly mobile community such as the Canadian Armed Forces is that we tend to be in remote areas where populations don't move. If it has to be open to provinces, as soon as a military member leaves, it's filled by a civilian. That is wonderful, but it means there's no access. We have to think differently.

[The Chair, Liberal, John McKay]

Thank you, Ms. O'Connell.

Unfortunately, I have to bring the gavel down on this meeting.

All three of you have been very helpful in our deliberations. Thank you, again.

With that, the meeting is adjourned.