Status of Women Committee on May 3rd, 2010

[The Chair, Liberal, Hedy Fry]

I call the meeting to order.

Pursuant to Standing Order 108(2), we are doing a study on maternal and child health. On April 12, 2010, the Standing Committee on the Status of Women unanimously adopted the following motion to study maternal and child health:

That the committee study maternal and child health following the government's announcement to make maternal and child health a priority at the G-8 in June that Canada will be hosting, as long as this is done before the end of May.

That is why the study is being done now: so that we can complete it before the end of May and have our report ready before the end of May.

We are holding four meetings on this question. The first two meetings will bring together non-governmental organizations and coalitions specializing in developmental issues as well as in maternal and child health.

Today we have three sets of witnesses. We have Dr. Dorothy Shaw, the Canadian spokesperson for Partnership for Maternal, Newborn and Child Health; Janet Hatcher Roberts, executive director of the Canadian Society for International Health; and Jill Wilkinson Sheffield, president of Women Deliver.

I want to welcome you and thank you for taking your time to come and present to this committee and answer some of the questions that everyone is obviously going to be asking you.

Each one of your groups has ten minutes to present. I will give you a two-minute warning so that you will know when you have two minutes left. Then we will have question-and-answer rounds. I think we may be able to do two rounds in this one, but we'll see.

Presentations will be in the same order as you are listed on the agenda. We will begin with Dr. Dorothy Shaw from the Partnership for Maternal, Newborn and Child Health.

[Dr. Dorothy Shaw, Canada Spokesperson, Partnership for Maternal, Newborn and Child Health (PMNCH)]

Good afternoon everyone, Madam Chair, Dr. Fry and members of the committee. Thank you for giving me the opportunity to meet with you.

I will speak in English because it will be easier for me to explain these very important things.

The Partnership for Maternal, Newborn and Child Health is based in Geneva and is a partnership of 300 organizations, including the UN, H-4, non-governmental organizations, health professionals, academics, donors and funding agencies. It's hosted by WHO and its aim over the next six years is that every pregnancy is wanted, every birth safe, and every newborn and child healthy, and that we will save the lives of over ten million women and children by 2015.

The next slide you should have gives you some statistics on the global situation. I'm not going to read them all. I want to bring to your attention that figures on maternal deaths on this slide at 536 are estimated because that's the last UN figure that we have. A paper recently published in The Lancet indicated that figure might be 342,900. That actually would be welcome progress, given all of the efforts that have been done on maternal health, in particular over the last several years. We were expecting to see some progress. The bottom line is that in fact hundreds of thousands of women still die from preventable causes every year.

I hope you are familiar with the millennium development goals. I'm not going to spend time detailing them, except to say that the millennium development goals that have been most off track have been numbers 4 and 5, but particularly goal 5, to improve maternal health. Child mortality has in fact been reduced to less than ten million, which is still a huge number, and that burden is now focused in the neonatal period.

Goal 6, HIV/AIDS, malaria, and other diseases, is obviously very much integrated into what we need to be doing to save the lives of women and children globally.

There is another map, which I hope you have in colour, on the next page. You don't? Okay, I apologize. It's a little difficult to see not in colour. I think essentially what it tells you is that we do have the most recent data now for children. Those will be released further in terms of country-specific profiles at the countdown meeting. Jill Sheffield may say more about that later. We're still waiting for updated information on the maternal health situation, but what those maps show you is that progress has been little in terms of MDG-4 in Africa and insufficient in Asia; and in MDG-5, for the last year that we have data, we are still seeing maternal deaths to be a very common problem in Africa and Asia.

The other thing that is really important to remember is that while you may think those numbers of deaths are not significant in the whole scheme of things in terms of maternal deaths from a numbers perspective, for every woman who dies--and more to the point, when we start getting into what we can do for those where we are providing effective interventions--there are another approximately 20 to 30 women whose lives are seriously compromised with problems such as obstetric fistula. I'd be happy to explain that later.

The next graph, on page 6, shows you in a different way the figures for child mortality for MDG-4 and MDG-5. We know there has been significant success in under-five child mortality in all regions and in many regions by more than 50%. But in sub-Saharan Africa, southern Asia, and Oceania, the regional rates are declining much more slowly. Maternal mortality ratios, which is not the same as the number of women who die--that's deaths per 100,000 live births--are slowly declining across the regions, with few exceptions.

I think what's also important to know is that when we look at the global causes of child deaths and the 8.8 million child deaths every year, we understand why those happen. These are very dependent on the health of the mother. We're again talking about under the age of five. Of those deaths, 41% occur in the neonatal period, which is the first month of life. Of those, we know that the vast majority occur in the first week of life. So this is something that is addressed by providing emergency obstetric newborn care through skilled birth attendants. That's why the focus has been particularly important on that particular group. We know that in terms of those child deaths, 42% are accounted for by pneumonia, diarrhea, and malaria, and under-nutrition contributes to up to about a third of child deaths under five. One of the things that we have learned over time is that there are important variations between regions and countries, and once we have country profile information, that becomes even more evident. So in fact it's very important that countries have their own data, derived ideally by them in order to determine their priorities for action.

When we look at the next slide, it is again from the last countdown figures, looking at the countries with the lowest mortality rates and also at the countries with the highest mortality rates. You will note that of the ten best performers, the last time these figures were released--and we won't have the new figures until June--seven of them have maternal mortality ratios over 100. Anything over 100 is considered high and anything over 500 is considered very high, and anything over 1,000 per 100,000 is extremely high. The solutions and the actions you need to take will differ, depending on the maternal mortality ratios, what is actually responsible for killing women during pregnancy and childbirth.

On page 9, the pie chart looks at why women die during childbirth. We know that postpartum hemorrhage is still the most common killer of women, and unlikely to change based on the updated figures this year. When you look at the obstetric causes of maternal mortality, the next causes after that are hypertension problems, blood pressure problems of pregnancy, and unsafe abortion and infection. When you then look at what we call indirect causes of maternal mortality, that is when you would include problems such as HIV/AIDS, malaria, and cardiac diseases. Altogether, we know that the three leading causes of maternal death are hemorrhage, high blood pressure, and indirect causes, and they account for about 70%.

If you look at the next slide, which is number 10, the coverage failures across the continuum are really quite instructive, and you can see the wide variation in those bars from where the actual bar graph block ends. So you can see that those are opportunities that we have in terms of this Canadian-led initiative, but a G-8 initiative, on maternal and newborn child health to actually make a difference.

Contraceptive prevalence is something where a significant opportunity exists. Skilled attendants at delivery.... We know that, globally, 40% of women deliver without skilled attendants, and in Africa it is higher in many countries. In Ethiopia it is still over 90%. Post-natal exclusive breastfeeding.... You can see where we have in fact many opportunities.

On slide 11, this is a reminder that MDG 5 is also about universal access to reproductive health and that family planning is very significant in terms of meeting the causes of maternal mortality. We know, in fact, the unmet need for family planning, mostly in married women, in the world is 215 million women.

I want to highlight the role of nutrition because this has been quoted in the media as being very significant in saving the lives of women and children. In fact, it's important to recognize that the nutrition of mothers is critical for their children's health--the newborn and child health--because under-nutrition, as you have heard, is implicated in one-third of child mortalities. However, there is no evidence at this point that addressing under-nutrition in women will successfully contribute to eradicating maternal mortality. What kills women, as I said, is hemorrhage.

Interventions needed to save the lives of mothers, newborns, and children are on slide 13. I want to highlight that community engagement is essential. We're talking about a continuum of care that supports nationally led health plans. So the countries need to determine their priorities.

On slide 14 is a demonstration of the platforms, starting with family and community, that are built to deliver integrated maternal, newborn, and child health packages. Through a major funding commitment we can and will save the lives of up to a million women from pregnancy and childbirth complications. You can see the other lives that we will save: 4.5 million newborns, 6.5 million children, and 1.5 stillbirths. And there will be a significant decrease in the global number of unwanted pregnancies and unsafe abortions. We would potentially end the need for family planning. That will take an additional 50 million couples using modern methods of family planning, and 234 million births taking place in facilities.

What will it cost? For the G-8, look at doubling in total bilateral aid, and an appropriate increase in multilateral aid. The funding mechanism is not something the partnership is pronouncing on, except to say that a new funding mechanism would not be recommended.

I want to mention that we have problems at home in our fetal and infant mortality rates. In fact, the infant mortality rate in Canada in 2004 was nearly double in the first nations population, with 9.8 per thousand live births for infants under one month, versus 5.1 for the population as a whole, and over three times the national rate for infants between one month and one year. The problem with mortality and morbidity statistics for the aboriginal Indian and Inuit populations in Canada is that they are very difficult to track. I'd be pleased to explore that a little more with you.

The next slide shows that Canada did make progress when its own economic status was not rosy.

The next slide gives you more detail about the median coverage levels for countdown interventions from this year's report. It indicates that just over half of women have a skilled birth attendant.

The next slide gives you one example--there are many--of how Thailand used midwives, starting with village midwives who were certified, to reduce their maternal mortality.

Accountability is critical. There are some principles articulated on the next slide. All development commitments should be results-based, with specific and measurable objectives. They should be time bound, with clear start and end dates. They should be explicit about whether funding is additional or inclusive of previous commitments. They should also be clear about how much each donor and partner country is contributing.

Page 24 really gives the bottom line: skilled attendance at birth will save mothers and babies.

I think I'll leave it at that.

[The Chair, Liberal, Hedy Fry]

Thank you very much, Ms. Shaw.

Now we'll move to the Canadian Society for International Health and Janet Hatcher Roberts.

[Janet Hatcher Roberts, Executive Director, Canadian Society for International Health]

Thank you. It's a great opportunity for the Canadian Society for International Health to be here.

We are a non-government organization committed to the strengthening of health systems. I personally have worked and interacted with ministers of health, education, family and youth, NGOs, and researchers, in over 35 low- and middle-income countries. I've had the privilege of seeing health systems in action and the importance of interaction with other ministries.

I first want to give two points on the political context, and then move into the health systems evidence and add on a bit from Dr. Shaw's comments.

In July 2009 in Italy, as you know, the G-8 heads of government agreed that maternal and child health was one of the world's most pressing global health problems. They committed to accelerating progress on maternal health, including sexual reproduction health care and services and voluntary family planning. They also announced support, as Dr. Shaw mentioned, for building a global consensus on maternal, newborn, and child health as a way to accelerate progress on the MDGs--millennium development goals--for both maternal and child health.

In June 2009 Canada co-sponsored a landmark resolution at the UN Human Rights Council recognizing maternal mortality and morbidity as a pressing human rights concern.

I'll talk a bit more on the health systems evidence. Most maternal deaths are easily preventable, as we said. We've seen this wonderful progress in Canada, although we do have some inequities. The gap between rich and poor countries is shockingly wide. In Canada, for example, the lifetime risk of maternal death is one in 11,000. In Ethiopia, the risk is one in 27. In Angola and Liberia, the risk is one in 12; and in Niger, it's one in seven.

Of the 10 million women who have died in pregnancy and childbirth since 1990, three-quarters of the deaths were preventable, primarily where they occur in Africa and South Asia. Millions of other women have been left with crippling injuries or illnesses as a result of poor care during childbirth.

A new study released in March 2010 by the United Nations Population Fund, UNFPA, and the Guttmacher Institute estimates that 70% of the world's maternal deaths could be prevented for $13 billion. That's about $4.50 per person, per year. That's not a lot of money.

Dr. Shaw mentioned some of the care gaps. Of the 123 million women in the developing world who gave birth in a health care facility and needed care, 62 million received it. Of the 5.5 million women who needed care for hemorrhage or bleeding, 1.4 million received it. You can see these huge gaps. Of the 7.6 women who needed care for obstructed labour--that means when the baby is not coming out very well--1.8 received it. There are huge care gaps.

There are 215 million who would like to delay or avoid child bearing and do not have access to modern contraception. A dramatic improvement in access to family planning, including contraception, would sharply reduce the number of unintended and unplanned pregnancies. That in itself means fewer pregnancy-related deaths and complications. Evidence shows that access to family planning alone could prevent as many as one in every three maternal deaths by allowing women to delay motherhood.

It's not just what we need to deliver but how we need to deliver it. And how we need to deliver it is through a sustainable and well-funded health system. That's not just the care part, the services and programs you've heard about, which are very, very important, but a whole health system.

There is a picture here of what a health system is--you will all receive copies of this. The services and treatment and programs are the health care system, but a health system has many elements. One is a vision for equity and a fair distribution of resources coupled with leadership and sustainability. It also has to do with a fair access, not equal access. We'll never have equal access, but we can have a more fair distribution and availability of services for health care.

We also need health information systems. That is often forgotten about, but unless we have funding for health information systems when we also fund intervention programs for maternal health, we will never know how well we are doing. So we need to make sure that is integrated within the health system, because that gives evidence for policy, but it also gives evidence for how well we are doing in terms of quality of care.

A great gap in many low-income countries is the ability to plan, the ability to say where these resources should go. Most countries have a decentralized social system in education and health. They were decentralized almost overnight as a result of World Bank demands and their structural adjustment, and they have very little capacity for planning. Therefore, the decisions about where the money goes are left in the hands of people who don't have data, who don't have capacity, and thus the resource allocation is not evidence-based. Of course, we need well-trained professionals--nurses, doctors, midwives, community health workers--to be in the right place at the right time doing the right thing, but we also need to promote a continuum of care throughout: a primary health care system that delivers a large part of maternal and child health, well baby care, well pregnant care, and we need emergency obstetrical care. That is essential. Without a primary health care system--if that gets gutted--we don't have a continuum of care. That's the access point for mothers and for their children. It allows for anything that needs to be dealt with at a specialist level to be picked up.

Sub-Saharan Africa faces the greatest challenge. While it has 11% of the world's population and 24% of the global burden of disease, it has only 3% of health workers. In addition to the care part of the system and the health information, it's also important that there be public participation in health care decision planning, as we have here in Canada. People get involved and make their views known. Non-governmental organizations need to be funded to build that capacity for communities so they can start to understand what they need and where and how they need it.

Finally, there needs to be a transparent and accountable public system. Most countries have a publicly funded system, and they often have a privately funded system. Doctors sometimes work in the mornings in the public system, and in the afternoon they go to the private system. So if you go to a clinic in the afternoon in many of these countries, there is nobody there. That is because the doctors are off in the private system, because they have probably not been well paid in the publicly funded system. This shows the need for a well-funded public system.

There are two pillars that really support a health system. One is the determinants of health, and you have probably heard about those: poverty, education, peace, gender. These are things that make us healthy. If we have a peaceful situation, if we don't have an environmentally challenged system, if we are not poor, if we are well educated, if we have jobs, we tend to be healthier. You will get copies of these maps that show the absolute significant and critical inequities of the distribution of these determinants of health. If you look at education, if you look at poverty and wealth, the maldistribution is huge.

Finally, we have to look at the policies that have an impact on health. It's not just the ministry of health. It is the ministry of transportation. It's the ministry of environment. It's trade. It's labour. It's human rights. If we work with the transportation sector to look at where the roads would go, we could hook up with the primary care systems and the delivery of good care. If we know that the environment and environmental policy are health promoting, we have a better chance at improving our health, so we have to look at all of those policies in terms of health, but more particularly in terms of maternal and child health.

Finally, Canada has played a leadership role in promoting good governance and accountability across many sectors, including health, and we feel it could take a leadership position in supporting this as it relates to maternal and child health.

I'm sorry that you didn't get the slides, but I'm sure you will get them later, and you will be able to see them in colour as well. I'm sure that's the case for yours too, Dr. Shaw.

Thank you.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

Now we are going to go to Women Deliver and Jill Wilkinson Sheffield for ten minutes.

[Jill Wilkinson Sheffield, President, Women Deliver]

Thank you, Madam Chair and committee members, for inviting me here this afternoon to talk about the fact that women do deliver. They deliver babies, and they die in large numbers. They also deliver a lot of other things. They are major benefits to our social and economic fabric of life around the world.

I am Jill Wilkinson Sheffield and I am the president of Women Deliver. We're a global maternal health advocacy organization. We use all the data that Dr. Shaw has shared with you, and I'm so pleased to be speaking after Dr. Shaw, so I can save on the numbers.

It's a really important time for the women in the world, and frankly a momentous time for Canada. Women are the economic heart of the developing world, and they really need to know that their lives, their health, and their rights matter. Perhaps just as importantly, they need the funding committed to make that happen.

I want first to thank the Canadian government, which for decades has worked steadfastly toward improving the health of mothers and their newborns and children in developing countries. In my 30 years in the maternal health field--and in the reproductive health field, more largely--my fellow advocates and I have known Canada as a true ally and we have appreciated your strong leadership and your commitment. And we're counting on it now, as June approaches.

As you may know from the news, the most recent studies on maternal mortality demonstrate that we are making progress. This tells us that investments are paying off, and it tells us that there are solutions at hand that we can employ more broadly.

We have only five years left to achieve the millennium development goals. You know that MDG 5 is to improve maternal health. Its target is to reduce maternal mortality by three-quarters in these remaining five years. Unfortunately, so far this is the goal that has made the least progress. It has also had the least investment. And if women are the heart of our families and our economies, it's time to change that.

Canada has an unparalleled opportunity to lead the promise of progress on this issue with its legacy initiative on maternal, newborn, and child health, to be introduced at the G-8 and G-20 summits in June. And yet as Canada seeks to shape its legacy, I urge you not to forget your past legacy. It's building on great success.

In 1994 in Cairo, Canada joined 178 other countries in a global consensus on the importance of addressing the health and rights of women in a comprehensive framework. That was the United Nations International Conference on Population and Development. And since that time Canada has not erred from its commitments. Now is not the time to do it either.

In 1974, even longer ago, Canada was at the table in Bucharest when it was agreed by the nations of the world that individuals and couples had the right to plan the number and spacing of their children, and that it was the responsibility of governments to ensure this happened.

Fortunately, to address maternal mortality and to achieve MDG 5, we really don't need the discovery of a miracle drug or an expensive medical breakthrough. We have low-cost solutions now. We know what works and we know it now. You've heard it already, just before my turn.

Women need access to family planning programs and modern contraceptives. And they need access to skilled care before, during, and after childbirth, especially access to emergency obstetric care. And we don't know when these emergencies will arise; that's one of the problems. Women also need access to safe abortion services when and where they are legal.

These solutions aren't rocket science, but they do save lives and they present enormous economic, social, and health benefits. Hundreds of thousands of women die each year in pregnancy or childbirth. We now know that the world loses $15 billion in lost productivity because of these deaths. I'm not sure anyone feels that this sum can afford to be lost--lost lives or lost productivity.

So while I wouldn't claim that maternal health is a simple issue to address, if we are to advance as a global community into a millennium of stability, prosperity, and dignity, it's a very necessary issue for us to address. Global consensus has been achieved before; we can do it again. In fact, we have to do it again for the sake of the women and the girls and our futures worldwide. We know what it costs to do this. It's an additional $12 billion a year, and that's not a lot in the scheme of things.

Over the past decade, since the global efforts, there have been setbacks and stagnation. We also know that we've made enormous progress. There are low-resource countries that have made dramatic changes in the situation of health for mothers and girls. Rwanda, Bangladesh, Honduras--the mark that all of these countries have in common is political will. They simply decided it had to be done and they are doing it, just as we know that not to decide is also to decide.

There are few times in your careers as parliamentarians that a problem and terrible injustice that has brought suffering to millions of women and their families can actually be solved. This is our moment to make this happen. We can do it. We absolutely have to do it. It's over to you and up to you, and civil society is ready to help in any way we can.

Thank you again for the invitation.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

Now we are going to go to the question and answer period. The first period is a seven-minute period, and that includes questions and answers. So I would like everyone to be as succinct as they possibly can.

We begin with Anita Neville for the Liberals.

[Anita Neville, Liberal, Winnipeg South Centre, MB]

Thank you. My challenge is to be succinct as well.

Thank you very much for being here today and thank you very much for the work you're doing.

I don't know whether you were all downstairs this morning at the event on international leadership and Canada's role on the promotion of gender equality and women's rights. If you were, I'd ask you to comment on it. I would ask you to particularly comment on some of the funding challenges we heard about.

I want to just comment briefly on the fact that at the G-8 meeting last year in July, the G-8, including our government, committed to accelerating the progress on maternal health, “including sexual and reproductive health care and services and voluntary family planning”. I just wanted to get that on the record.

You referenced the economic cost of the death of so many women around the world. Last week the Minister of International Cooperation said:

It's our responsibility to our taxpayers and our peoples to ensure that we are getting the biggest bang for the buck.... We spent a lot of attention on how we are going to measure outcomes, how we are going to ensure that our investments are actually going to pay off and make a difference.

I wonder if any of you have had any experience in measuring outcomes in terms of what it means in a country when a mother of four, five, or six children dies and is no longer able to create economic viability for her family. Is there a way of measuring those kinds of outcomes?

My other question is talking about the funding of the work that needs to be done and some of what we heard this morning.

I don't know who wants to go first.

[Jill Wilkinson Sheffield]

I was not there this morning, but I really do want to comment on women being the economic heart, particularly in low-resource countries. Did you know that women drive the economic development in virtually all agricultural economies? They operate the majority of small businesses and farms. It's women who do the agricultural labour. When they die, it's their daughters who come out of school—and that's the investment in the future. That's one of the investments.

There are systems to track this. They track the level of mortality of those under the age of five. The newborn babies, if they do survive, are likely to be dead within a year. So yes, it's possible to track the investment in keeping mothers alive.

[Anita Neville, Liberal, Winnipeg South Centre, MB]

And keeping them well, presumably.

[Jill Wilkinson Sheffield]

Yes, well—you bet.

[Dr. Dorothy Shaw]

I also wasn't at the earlier session today, but I think Jill already referred to the $15 billion in potential or real productivity that's lost every year related to maternal deaths. I think I did give you some figures on what it will cost, in one of the slides in my presentation. Clearly, the overall gap is roughly $30 billion a year between 2009 and 2015.

I think the issue we're looking at here is what does this really mean for the G-8? How can they leverage funds both from the non-G-8 countries and the private sector and other donors, so that we can in fact bring this home? There certainly are a number of innovative financing mechanisms that have been suggested.

In terms of the economic cost to the family, the only other comment I would make is that not only is there a higher chance of the newborn or infant dying if the mother dies, but also the fact that for children under ten there are now data to suggest that if there is a maternal death, children under ten are also much more likely to die. If the father is killed for some reason, that isn't there.

[Anita Neville, Liberal, Winnipeg South Centre, MB]

Thank you.

Just to follow up with Ms. Hatcher Roberts, who was here this morning, I would ask the following. Given that Stephen Harper signed the G-8 agreement last year and committed to what I read—and much more—what do you see as the responsibilities, obligations, and commitments of Canada in this area?

[Janet Hatcher Roberts]

Well, we have committed to this and many other agreements that promote women's health and women's rights. Our commitment is to maintain or hold the line on what we committed to last year—at the very least. At the very most, we should be expanding that commitment and putting some money toward that commitment. I say this because last year there was just the actual commitment and no dollars were put toward it. The hope was that this year we would put some dollars toward that commitment. Our hope is that we will live up to what we agreed to last year as Canada. Mr. Harper did sign onto that and to the whole ball of wax.

Earlier today we were talking about challenges around gender and women in a broader sense, but to come back to this discussion, what are the rights-based issues here and the rights of women with regard to maternal and child health? If we keep to that line, I think we can stay true to where we should be going. It's right out there, as we have committed to this and to these kinds of agreements for many, many years. It's very clear what this means in terms of a full range of comprehensive reproductive and sexual health services. Without that comprehensive range of services, we can't promote women and children's health.

One other figure is the following: if a mother dies, I think a child has a four times greater risk of dying before the age of 12. That, clearly, is another high risk. On that, there's been a great deal of work going on in terms of the disability-adjusted life years, potential years of life lost, and the economics of that. There is very good economics that talks about what all of that means in terms of dollars, as Dr. Shaw mentioned. There's a lot of analysis there that you could be provided with, which really gives you an idea of what the economic implications are of women dying prematurely—not just for themselves and the labour market, but also the impact on their families and their children. Should you want it, I'm sure we could get hold of it for you. The World Bank has done some good analysis of this, as well as other organizations.

[Anita Neville, Liberal, Winnipeg South Centre, MB]

I would be interested in seeing that. Thank you.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

Now I will go to Madame Deschamps and the Bloc Québécois.

[Johanne Deschamps, Bloc, Laurentides—Labelle, QC]

Thank you very much. I am very happy to see you again, dear colleagues. I had left you some time ago.

Good afternoon, ladies. I will try to be brief so that you can do full justice to my question in your answers.

It is said that we have barely made any progress on goal 5, which is to improve maternal health. Actually, the goal is to reduce maternal mortality by three quarters. The deadline for achieving the goals is 2015. There is very little time left for attaining this goal, among others. That seems to me to be virtually impossible. Do you think it is a realistic goal?

To succeed, we have to have all the necessary tools. We should not give some up at the expense of others. If we accept the figures you gave us today, almost 13% of maternal mortality—the estimated number varies from 350,000 to over 500,000—are the result of unsafe abortions performed by quacks. Those women chose to do it because they had so many children that they could no longer feed them. So they reached a dead-end and had a decision to make.

How can we reach the goal of reducing the number by three quarters if we do not give them all the necessary tools?

[Dr. Dorothy Shaw]

I would say two things in answer to your question. First of all, will all target countries achieve millennium development goal 5? The answer is no. At the same time, many of them can—or at least they can come close. They can certainly make very significant progress. I think that, as in many challenges, when you are making progress and you have made the commitment to focus on maternal mortality and maternal health and you have a national plan—and most countries do have a national plan—then you are in a good position to determine the priorities that will actually help you accomplish your goals.

It really does depend on the country. It depends so much on the specific problems the country faces. Sometimes there are geographic problems, in addition to the country's other problems, and it depends on how many human health resources they have. Africa has very depleted human health resources to begin with, and the distribution of them is also a problem. So I think that each country needs specific information about its own indicators that will help inform where it needs to place its priority actions. That information is going to be available. It's partly available now, but we will have more current data coming up in June.

I think there are two key issues that we know would make a huge difference to mothers and newborns, and to the overall rate of maternal and child deaths: skilled birth attendants, and family planning.

[Jill Wilkinson Sheffield]

Some countries are making huge progress and some countries are actually moving backwards. For example, Bangladesh is now on target to meet the goals. This is a dramatic thing.

There are two ingredients required. Political will is the bedrock issue. Without the political will--the will of governments and the will of society at large--the rest of it won't happen.

The other thing is resources. We need resources of different kinds to do this, and some of it's money. I wanted to say in partial answer to the earlier question that in fact we shouldn't assume that donor countries are the only ones making these investments. In the budget and the agreement on how to meet the cost of the Cairo plan of action, developing countries said they would contribute two-thirds of the cost and donor governments said they would pick up the remaining third. Fifteen years after Cairo, who has lived up to their commitment? It's the developing countries themselves, because they saw what a difference it made.

I want to say that if you have only one short-term investment to make, it needs to be in family planning. If those 215 million women had access to modern contraceptive supplies, the Guttmacher report, which is just out, tells us that you would reduce maternal mortality by 70% because you would have removed unintended pregnancies, which are the biggest problem.

Family planning is your quick win. I have given you six wins. Some of them are quick; most of them aren't, but it's for sure that an investment in family planning, which is safe, is really one of the best investments the G-8 and G-20 can make.

[Johanne Deschamps, Bloc, Laurentides—Labelle, QC]

Do I still have time, Madam Chair?

[The Chair, Liberal, Hedy Fry]

You have ten seconds.

[Johanne Deschamps, Bloc, Laurentides—Labelle, QC]

I only have time to say this. Following the G8 meeting held in Halifax last week, we were informed about a decree under which each country would define its own policy to be implemented. Do you not think that operating that way would be a headache in terms of logistics? Also, if each one defines its own policy, how are we going to measure our progress?

[The Chair, Liberal, Hedy Fry]

You have gone over time. Perhaps I can ask the witnesses to hold the thought, and if it's pertinent when you're answering other questions, you can do it. What I may want to do in this instance is give you about a minute each to wrap up at the very end, if you feel that you weren't able to put stuff on the table. I think it's really important to have you get these unanswered questions in.

Thank you very much.

Now we will go to Ms. McLeod for the Conservatives.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

Thank you, Madam Chair.

I have a couple of quick questions. To refresh my memory, how many target countries are there?

[Dr. Dorothy Shaw]

There are 68.