Status of Women Committee on May 3rd, 2010

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

There are 68. Okay.

Dr. Shaw, in your slides you had some comments about the work done in Thailand involving skilled birth attendants. If you wouldn't mind, could you take a bit of time to describe that a little better and also tell us whether it's translating into other countries?

[Dr. Dorothy Shaw]

Thank you.

Thailand, as I said, is just one example. We could give you Sri Lanka, Malaysia, and in fact Brazil. Brazil is probably the most recent example where they have managed to reduce the under-five death rate and they've now managed to get free primary health care for everyone. All Brazilians have access to skilled attendants at birth. They now have to work on other issues, such as the quality of the care that is being delivered, but they do now have that. So that's been a huge undertaking, because we often still see inequities in poor countries between the richest and the poorest quintiles in both maternal and child health. Brazil deserves a great deal of credit for that.

So I think that Thailand's success story, mirrored by others--and Janet and Jill probably can also answer this--is interesting in many ways, because it really does involve the community. You need to involve the community. Often we have traditional birth attendants in villages who attend mothers if they don't give birth alone, and those were substituted by certified village midwives.

Now, I don't have the specifics of how long they would train for in Thailand. There are some other countries where midwives are being trained for less than the four years that we train our midwives here in Canada, and we can debate the merits of that. But six months is a bare minimum for training. They are trained close to the village and go back to the village.

What happens is as you begin the training, you scale it up over time. You can see in this graph what happens when you start training and then when you scale it up.

In fact, what's really fascinating.... I do have a slide that's not in this set that takes you back to the Taj Mahal, which is a monument to a woman who died of a postpartum hemorrhage after giving birth to her fifteenth child. At that time Sweden also had a high maternal mortality rate, and the queen of Sweden decided that she was going to start a midwifery training school. The rest is history in terms of what happened in Sweden with maternal mortality.

Yet in India until very recently--the most recent figures for India are showing progress--the most common cause of death, as with the rest of the world's women, is still postpartum hemorrhage.

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

Okay. My quick next question would be that I guess every country would be very different, but would you perceive that this really needs to be integrated into and enhancing whatever primary health care system is already in place?

[Dr. Dorothy Shaw]

Yes. I think that the whole point of any initiative--and certainly the one that's envisioned by the partnership, by the NGOs in Canada who have been working on this, and I believe by the Canadian government and the G-8--is that this has to be an initiative that begins with community engagement and that involves community health workers. They currently might be doing things at the moment like providing immunizations, family planning, well-baby, and in some cases providing HIV prevention and screening. It takes that and adds to it a trained health professional, a primary health care worker.

Generally speaking, that would be someone with midwifery skills who can then provide safe birth attendants at a clinical facility that's appropriately resourced. That's the first basic level of emergency obstetric care. The next level of emergency obstetric care would be the ability to provide blood transfusions and Caesarian section.

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

We talked earlier about family planning, contraception, and skilled help at birth being a huge need. You talk about HIV/AIDS certainly as a big issue. To what degree would impacting mother-to-child transmission support have in terms of the goals of reducing mortality?

[Dr. Dorothy Shaw]

Again, it's going to depend on the country. The last maternal mortality audit figures for South Africa made it clear that HIV/AIDS was the most common cause of death, except that it's an indirect cause of death. What that really means is that it's not a primary cause. Women might die of something else, but they were HIV positive and had AIDS. Therefore that contributed significantly to why they died. In South Africa, it's huge. In other sub-Saharan African countries, it's also very significant. But you do have to have the data for your country specifically.

What we know is that as few as 15% of pregnant women are tested for HIV, and that this is significant both for them and their newborns. At the same time, we need to be extremely careful that if we are going to introduce screening of women during pregnancy for HIV, it is done in a way that is sensitive to their needs as women in the community and not in a way that will aggravate stigma and discrimination and leave them isolated.

[Janet Hatcher Roberts]

If I could add--

[The Chair, Liberal, Hedy Fry]

One minute left.

[Janet Hatcher Roberts]

Yes.

One of the other reasons for success is when there's donor harmonization, and if we're all working to the same drummer, things work a whole lot better in the field, on the ground. If you have a sector like the health sector, all harmonized, and the donors are all thinking and working together with common goals, it works very well. That speaks to, I think, a previous comment in terms of competing priorities or competing packages. The more things are harmonized at a country level, at a national level, the more ability people have to implement programs that are comprehensive and represent a continuum of care. I think we've all worked at that field level where things aren't always working that way, so we appreciate when things are harmonized. That's part of the Paris Declaration that Canada signed on to as well. So we believe in it. We've signed on to it and it fits in with some of the issues that were raised today.

[The Chair, Liberal, Hedy Fry]

Thank you.

I will now go to the fourth person, who is Ms. Mathyssen, for the NDP.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you, Madam Chair.

Thank you very much for coming here and providing your expertise.

I had a number of questions. I'll start with Dr. Shaw, because I'm using this document, but please, I welcome input from all three, with any of these questions.

In one of the first slides it is very clear that improved maternal health has been the least addressed issue in terms of the millennium development goals, and you said the most neglected. Now, Ms. Sheffield, you suggested that it was because there hadn't been much investment here. I'm wondering if there are other reasons.

We know, for example, that in a lot of countries women have absolutely no control or say over their own reproductive health. They're living in a world where men dominate them and they have no rights in regard to their sexuality and their bodies. Is that part of it? Or is there something else at work here? Why on earth is this at the bottom in terms of progress?

[Dr. Dorothy Shaw]

Thank you. I think there are several answers to your question, and I'm sure my colleagues will be happy to contribute as well.

First of all, I think the reason there has been much more attention paid to child health is that it is actually easier to save lives quickly through immunization-type programs and treatments of diarrhea, and those kinds of vertical programs, we might call them. It's much easier to do that and to get good results quickly than it is to build a public health system. Emergency obstetric newborn care, or skilled birth attendants, primary care, all of that, but particularly the emergency obstetric newborn care, is the cornerstone of building a public health system.

So I think what you have seen is that even in fragile countries, in terms of their economic state, their health systems, or lack of them, they have been able to be supported to provide significant advantages or advances in terms of child health, and it has been more challenging to provide the advances on the maternal side.

We know that decision-making is often not with the woman and that this is a factor in terms of her being able to access care, both with respect to the decision made in the first place and the finances related to being able to fund that care once it has been sought, which is why there has been a significant push and an uptake from committed countries to either provide free access at point of care for mothers and young children, or a coupon-type system.

[Jill Wilkinson Sheffield]

I'd also like to add that until recently, I'll say three years ago, in particular, the conversation changed from a social justice issue to an economic issue in pointing out that women bring social benefits to families, communities, and economies, but they also bring major economic benefits. I think this has suddenly begun to effect a change in the way people think about the fact that women die. You may smile when I say women deliver, and more than babies, but for so many people it was simply a categorical thing. They delivered babies and were a disposable asset, shall we say, and I think that those doors are now behind us and we're moving into the mode of thinking of women as major economic benefits to the small micro-economy of their family, but also to the macro-economy of nations.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you. It's interesting that you raise that, because after the violence in the Congo, all the rapes and the degradation of women, they discovered that their agricultural production was down by 70%. They were in a terrible situation, because women were so traumatized and they'd been so brutalized that they weren't able to perform that economic aspect of what women do.

[Janet Hatcher Roberts]

Gender is a determinant of health. The socio-economic aspect of being a man or a woman or a boy or a girl is a determinant of health. Even though we're making progress and even though we're starting to talk about the economics of production and women being productive, you're still arguing with a chief in a village about whether to put a hemorrhaging woman into a truck. You're still fighting those fights, and there's still at that micro-level a huge amount of work to be done.

In many small villages and in many parts of the world, the value of women is still not where we want it to be, and that's still going to be underlying what's happening here in terms of valuing women. You could be pulling your hair out trying to argue that with a chief, and he's got the power. So until you've got the chief in the village onside, that truck's not going to move out.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

You make a salient point, and I'm assuming that's part and parcel of what you mean when you say that for every woman who's helped, there are 30 whose health is severely jeopardized and compromised.

In terms of what you just said about valuing women, countries like Canada have a role to play, do they not, in terms of making a clear statement that women matter--their equality, their equity, their ability to play a part in the economy and be leaders matter? We need to do that in order to have any substance at all, in terms of what we say at meetings, to have that kind of credibility.

[Janet Hatcher Roberts]

Countries are looking to us for that leadership, especially low-income countries.

[The Chair, Liberal, Hedy Fry]

Thank you, Madam.

I'll move on to the second round. This is a five-minute round. Again, that means five minutes for questions and answers.

We begin with Michelle Simson for the Liberals.

[Michelle Simson, Liberal, Scarborough Southwest, ON]

Thank you, Madam Chair.

I'd like to thank the witnesses for appearing here today. It has been interesting reading and getting up to speed on this particular issue.

I'd like to address this to all of you, so I'll quickly pose the two issues I'm concerned about. I'd like to pick up where my colleague, Ms. Deschamps from the Bloc, asked a question about the viability of countries that have signed on picking and choosing what they will and will not fund. I am addressing the practicality of how you see this working. It was Ms. Roberts who mentioned that harmonization is something you like to see, but if there isn't harmonization and picking and choosing goes on, how big an impediment do you think it will be to making progress in this area?

The second issue I have is with respect to our government's most recent statement with respect to funding reproductive health and in fact restricting it. How do you think this is going to be viewed by the WHO assembly in two weeks? How can we reasonably explain that?

Perhaps you would care to comment, bearing in mind I only get the five minutes.

[Dr. Dorothy Shaw]

I'll take a stab at the first question you asked, and others may wish to comment.

I think that at this point a funded mechanism for the G-8 initiative has not been determined, as I understand it. Therefore, what really needs to be determined is how the commitments that were made last year will be met, with whatever funding mechanism is put in place, given those who will be contributing to it.

I think when we look at how other funds, such as the Global Fund, work, as I understand it--and I'm an obstetrician and gynecologist and not an economist or a finance person--what happens is that this is really country-driven. In other words, a country has a plan, it establishes its priorities, and it applies for funding to a fund. That's one scenario.

Obviously, specific bilateral relationships are a little different, and it depends which one we're speaking of.

[Janet Hatcher Roberts]

It can create difficulties. When I was working in Guyana, for example, during the Bush gag order, we were working on HIV and AIDS and STD programming on behalf of the Canadian government, but we were also trying to figure out who was doing what and what were they doing, and the extent to which they were doing it, etc. It was difficult for some of the donors, like USAID and the PEPFAR groups. But then there were a lot of other bilateral organizations, mostly faith-based organizations, that were in Guyana as well doing HIV work, and it was very difficult to control the quality, the training, the protocols, the guidelines, the standards, etc., when we weren't all speaking from the same book.

With regard to WHO, you're correct, there is an agenda item on the World Health Assembly agenda with regard to the progress of the MDGs. Canada as a member country will be there, and it won't necessarily be addressing it but will be part of the commitment to the MDGs. Everybody's assumed that we have committed to those, and the assumption would be that they would be consistent with their previous commitments at the World Health Assembly with regard to the MDGs. Whether that's consistent with what happens at the G-8 is a reasonable question.

[The Chair, Liberal, Hedy Fry]

Thank you.

I think we have half a minute, Ms. Wilkinson.

[Jill Wilkinson Sheffield]

In half a minute, some of your parliamentarians were at a meeting in Addis Ababa, Ethiopia, last October. We came out with three priorities. One of them is exactly that when you make a commitment to strengthen the health system, we added a phrase that says “with a positive bias toward sexual and reproductive health for women and girls”, because what we've noticed in the past is that when it is that categorical contribution, not a penny of it goes to women and girls. So now we want governments to make a positive bias toward the health of women and girls.

[The Chair, Liberal, Hedy Fry]

Thank you.

We go to the Conservatives. Mr. Calandra.

[Paul Calandra, Conservative, Oak Ridges—Markham, ON]

Thank you.

I have a couple of questions. I was reading some of the millennium development goals, the report that was issued by the UN with respect to Africa, and one of the items they mentioned--and you mentioned it too, Ms. Sheffield--was with respect to the role that women play in agriculture. I'm going to go into a bit of a different area here. One of the things they mentioned was the need for more of a role, better sustainable agriculture, crops that for instance are more resistant, better transportation. I think somebody mentioned infrastructure modes as being one of the big issues that is stopping Africa from achieving some of its millennium development goals. I wonder if you could comment on that.

One of the other things that struck me was they mention in this report the lack of actual statistics. A lot of the member nations that the report covered actually don't have appropriate statistics. They don't maintain statistics and they don't look at things in the right way, so it's very difficult for organizations and for governments to truly understand the depth of the problem they're having.

Another area they mentioned was with respect to trade and how it's important that developed nations improve their trade with Africa so that there's more of an opportunity to trade agricultural products. I suspect that goes not just for Africa, but for other impoverished nations. The reason I bring that up is because we've been focusing a lot in Parliament with respect to opening up new trade markets for Canadian goods and there have been a lot of delays with respect to opening up trade markets in some of the poorer nations. There's also a lot of discussion right now about potentially limiting the access to modified seeds with respect to agriculture. I'm worried about that in relation to how this will impact Africa in the future.

I wonder if any of you can talk about that as well, more of a long term with respect to how we meet the nutritional needs in Africa.