Status of Women Committee on May 3rd, 2010

[Jill Wilkinson Sheffield]

I'd like to start.

You are absolutely right. The statistical information is pretty dreadful. I'm sure you all know that the number of women dying is an approximation. It's not an exact number because in many places women's lives don't count and they aren't counted when they die, nor are many of the newborn deaths counted. So one of the things this new study that has come from Washington State tells us is that we see a downward trend, but the statistics are still unacceptably poor. We hope that one of the outcomes is going to be that this gets a major polish-up in doing that.

I want to make one observation. I don't have my number exactly right, but it's relatively exactly right, which is if women had the same access to agricultural education and agricultural extension services as men in Africa, production would be up 20%. They don't have access to that, and 20% is a lot.

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

It strikes me that Canada in particular could have a positive role in that.

I don't know if you have any comments.

[Dr. Dorothy Shaw]

Unfortunately, my partner in crime, so to speak, the coordinator for the partnership in Canada, is not here today, and she has quite a bit of experience in terms of the agricultural area. She is an economist. We'll be pleased to provide you with that information if that would be helpful.

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

Thank you.

[Janet Hatcher Roberts]

There is quite a bit of evidence in terms of the impact of microenterprise with women, that by giving them the power and giving them the opportunity, they are able to improve their lot, and therefore improve their access to other services, and therefore improve their health. You can look at it in different ways.

In the health area we say all these things determine whether you get up in the morning and go to work. If you are healthy, if you're not sick and you have food in your belly, you can learn, and you can get up and go to work. You become a productive person. If you're not having babies every 14 months, then you have energy and you can get up and work and be productive.

Looking at that whole infrastructure is really important. Just as roads are important for transporting agricultural goods, they're also important for transporting a woman from A to B. But they're also vectors too. As the trucking routes increased in Africa, they became the routes for the spread of HIV/AIDS; so it's not always good and it's not always bad. We have to look at it in a very broad and very intersectoral way.

On the lack of statistics, you're correct, but in terms of health, the health statistics are probably better than many of the other statistics because we're really good at doing that. If you die or if you live, it's pretty easy—although not always are you counted—and those statistics are gathered up at the smallest little health centres on little scraps of paper and put into a binder and sent up to the minister of health. What is done with them is the issue. They are not analyzed well, they are not interpreted well, and they're not fed back down to the district level where the planning takes place, and that's a huge issue. So the health information piece is huge.

I think CIDA has only funded four health information systems projects in the last 10 or 15 years, and that kind of shows where you need to be integrating it within all of the health projects.

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

How much time is left?

[The Chair, Liberal, Hedy Fry]

Thank you, Mr. Calandra. Your five minutes are up.

I am going to go now to Madame Demers, from the Bloc.

[Nicole Demers, Bloc, Laval, QC]

Thank you, Madam Chair.

Thank you for being here, ladies.

I agree with my colleague. This morning, Ms. Ravololonarisoa told us that the G8 members, including Canada, were serious about women's health and their willingness to help them get out of the prevailing poverty of Africa. African women should be supported as agents of change and transformation, and not just as child bearers.

Ms. Sheffield, you were talking about $12 billion per year to support all areas of women's health. Are the $12 billion intended for all 68 countries under the initiative? That is not a lot of money per country. I have a hard time understanding how we can put so much money towards war and so little into an initiative that could save lives and really allow women to get back on their feet and take control of the destiny of their loved ones and of their families.

Last week, a representative from World Vision said that half a loaf is better than no bread. That was insulting to me because that meant that women are not worth more than half a loaf.

How can we really change things in African countries? How can we make better use of the funding available for that program?

[Dr. Dorothy Shaw]

I think the very first thing we need, and we already have it in several African countries--in fact in most African countries, but not all--is a real political willingness in the country to engage, to make commitments, including commitments to their own health budgets so this can materialize.

Then after that it's a question of what support they need. With the limited information we have.... It's actually quite good information in terms of quantity; its quality may be questioned, but we do have quite a lot of information on the health of children and even on mothers. We could do with more. What can we do with that at the country level that will help inform the priorities for that country, and how will that then be responded to in terms of international aid? It has to start with the country. You can't have an initiative that wants to go somewhere where there's still conflict, for instance. You can't build a public health system in a country where there is still significant conflict.

When you have no health system to speak of except in a major city, such as perhaps Ethiopia at the moment, your approach would be very different from what it would be in a situation where you might well have some distribution of health facilities, weak though they might be. I think it isn't a question that you answer with any one approach.

[Jill Wilkinson Sheffield]

The fact is exactly that. Some ingredients in this stew are similar, but the specifics are very local and they need to be. On the other hand, what we now know and what the Women Deliver conference in five weeks is going to talk about in great detail is the variety of solutions that have worked in comparable areas, whether they're urban or rural, with or without manpower or womanpower.

If we truly strengthened health systems that benefited women, guess what that would also be. The best indicator of an overall health system is to deal with the population at large. So the basic health system needs to be one of our overall investments. I'm not talking fancy; I'm talking basic, practical, needs-based health systems.

[Nicole Demers, Bloc, Laval, QC]

If—

[The Chair, Liberal, Hedy Fry]

Sorry, that's it, Madame Demers.

Ms. Mathyssen, for the NDP.

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

Thank you, Madam Chair.

I'd like to get back to something that Dr. Roberts said with regard to the global gag rule. Of course we know Obama revoked that, but Bush put that in place in 2000 in the first week he was in office. It barred any foreign organization from receiving U.S. funds if they provided or advocated or informed or counselled women with regard to abortion.

Based on your experience, what effect did that have? What happened as a result of that withholding of funds?

[Jill Wilkinson Sheffield]

Disaster--really bad. The International Planned Parenthood Federation has a report that itemizes the people who didn't get services. It wasn't just contraceptive services. It included contraceptive services, but it was prenatal care and emergency obstetric care. It really is a hard statement to make. It's itemized by country, by the lack of money, and it is incredibly unfortunate that this happened.

It was also a difficulty when PEPFAR, the president's emergency plan for AIDS relief, began spending, because a number of difficulties became very obvious. People tried to use PEPFAR money in place of. That was absolutely not acceptable and couldn't work.

PEPFAR paid salaries that were way out of range of local hires, local employees. They offered services that couldn't be continued with local sustainability.

I think we have learned really sad lessons writ large because of a withdrawal of that support and the misuse of some of those other moneys. It's just really too bad.

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

It's interesting that those agencies, the organizations that advocated, were basically, I would say, held at ransom. We are perhaps seeing some of that. Women's organizations here in Canada have been warned, “If you keep pushing this abortion question, you're going to lose your funding”. In fact, we heard that as early as this morning. It's out there, that the Canadian government is borrowing a page from George Bush's gag rule.

Ms. Sheffield, you also said that if the G-8 focused only on family planning, we could reduce maternal mortality by 70%, and that's significant. Can that reduction be achieved without access to safe abortion?

[Jill Wilkinson Sheffield]

I'm sorry, what...?

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

Can that 70% reduction be achieved without access to safe abortion?

[Jill Wilkinson Sheffield]

Let's hear the doctor.

[Dr. Dorothy Shaw]

That figure actually comes from the Guttmacher “Adding It Up” report, which is about a combination of family planning and maternal health care. That 70% is from that combination. It doesn't include access to abortion. You can save even more lives if you add in access to safe abortion.

[Jill Wilkinson Sheffield]

In fact the Guttmacher report--which I'm happy to leave a copy of, if you'd like it--basically says that if you made that investment in family planning, for every $1 you invest, $1.40 is returned to you in terms of health services that are unused because they're unnecessary. It says: “Seventy percent of maternal deaths would be averted”, “Forty-four percent of newborn deaths would be averted”, and “Unsafe abortions would decline by 73%”.

This is dramatic.

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

Ms. Sheffield, you said that Canada has not yet erred from its commitments, the ones that it made decades ago. What's your concern? Why did you raise that? Are you afraid that we may be...?

[Jill Wilkinson Sheffield]

Quite the contrary. I am so thrilled that the G-8 and G-20 are going to be here, our neighbour, and it's going to be two weeks after the Women Deliver conference. There's a continuum of effort that is happening. It starts with you folks right here, right now. Women Deliver, and then it's the G-8 and G-20, where we can really make good on the agenda on which the G-8 and G-20 agreed. Then it's the African heads of state meeting at the end of July. And then in September, starting on the 20th, it is the special session of the General Assembly focusing exactly on the millennium development goals. The Secretary General has said that his energy is going into MDG 5, so we need Canada to help this momentum build and become as important as I believe it needs to be. It's an opportunity.

[The Chair, Liberal, Hedy Fry]

Thank you.

We now move on to the final person in this round, Lois Brown for the Conservatives.

[Lois Brown, Conservative, Newmarket—Aurora, ON]

Thank you, Madam Chair.

Thank you, ladies, very much for being here. I found your presentations very enlightening and very educational.

I want to pick up in just a minute on an issue you spoke about, Ms. Sheffield.

But Dr. Shaw, you spoke specifically about countries being willing countries, saying that we need to work with countries that are prepared to make changes and work with us on issues to build the capacity they need to build health systems.

I was very privileged last year, Ms. Sheffield, to visit Bangladesh. This year I happened to be in Zambia and Botswana and had some observations there too. Bangladesh is a very needy country, but one that has recognized some of the problems it faces and is prepared to work on them.

My comment is that what I also observed was that the day that a girl starts her period, the day she begins menstruation, is the day she becomes, in their culture, of marriageable age. We are dealing with culture shift in many ways and we know that culture shift changes at glacial speed. So we have issues there that we need to work with.

What I saw in Bangladesh was the introduction of what they call a Shasthya Shebika in the villages, whereby they have a woman who is trained in basic health initiatives to be the first responder, as it were. She is given some very elementary training in midwifery. What she is really trained for, though, is tuberculosis identification and giving access to medications, which the state is working on providing. That was very helpful.

I also had the opportunity to visit a maternal health centre, if I may call it that, in the slums of Dhaka, where birthing units are available. They are elementary, by all means.

If girls are leaving school at the age of 13 because they are now of marriageable age or eligibility, how do we go about changing the attitude to keep girls in school? We know that education is what's going to change. I watched them having to teach women over and over again how to wash their hands, because they don't know to wash their hands after they have been to the sanitation facilities, or lack thereof. And clean water is absolutely non-existent there. We know this is transferring disease to young children.

When we say that we're prepared to work with the vertical issues, how do we change this and help create educational opportunities for girls, because we know they're going to be the ones who take this forward?

Could either of you comment on that?

[Dr. Dorothy Shaw]

I'll start briefly.

I think you've hit on something that is definitely important. It underpins all of these efforts in several countries. Bangladesh is one of them, Ethiopia is another, and Mali is another where child marriage in particular, regardless of laws that may have been implemented, is still very common. The last time I looked at the statistics, I believe that Ethiopia and Mali actually have the highest overall rates for child marriage.

But there are changes that can be made. India has used an incentive program in a number of ways. They've used different incentivizations. It depends what resources are available. Sometimes showing the way from a donor country can help with incentivized programs, but then, is that a sustainable effort?

It's complex to get that cultural shift. All I can say is that there are examples of it happening, but in a big picture sense, for any given country it's going to take time.