Status of Women Committee on May 10th, 2010

[The Vice-Chair, Conservative, Cathy McLeod]

It's 3:30 and I'd like to call the committee to order.

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 G8 in June that Canada will be hosting, as long as this is done before the end of May.

The committee will hold four meetings on this question. The first two meetings brought together non-governmental organizations and coalitions specializing in development issues as well as maternal and child health. Witnesses specializing in maternal and sexual health are appearing at today's meeting.

We are very pleased to have here with us today Jolanta Scott-Parker from the Canadian Federation for Sexual Health. We also have Ainsley Jenicek from the Fédération du Québec pour le planning des naissances; and Bridget Lynch from the International Confederation of Midwives. Joining the Canadian Federation for Sexual Health, just to provide support here, is Pierre La Ramée. Finally, we have Regroupement Naissance-Renaissance.

We will start, and each witness will have 10 minutes. We are pleased to start now with Jolanta Scott-Parker.

[Jolanta Scott-Parker, Executive Director, Canadian Federation for Sexual Health]

Thank you.

I'd first like to thank the committee for the opportunity to appear here today as a witness to address the important topic of maternal and child health. We're certainly very humbled to appear alongside the variety of esteemed organizations that have appeared both today and on the other two days of hearings dedicated to this topic.

The Canadian Federation of Sexual Health, formerly Planned Parenthood Federation of Canada, is a national network dedicated to supporting access to comprehensive sexual health information, education, and services in every community. We have member organizations in a variety of communities across Canada, and these members range from full-service primary health care providers to small information- and education-based organizations. Together they work with dedication to provide quality sexual and reproductive health information and services to the members of their community.

In addition to being a network of Canadian organizations, the Canadian Federation for Sexual Health is very proud to be the Canadian member organization of the International Planned Parenthood Federation. In fact, as Madam Chair pointed out, I'm joined here today by my colleague, Pierre La Ramée, from the IPPF's western hemisphere region office in New York—although, I might add, he's actually a Canadian. He'll be pleased to participate in the question and answer period along with me.

IPPF is the world's leading organization in sexual and reproductive health, with an unparalleled network of health providers in 171 countries. IPPF and its member organizations implement grassroots service delivery programs that meet the reproductive health needs of the poor, marginalized, socially excluded, and underserved.

All of those in the IPPF network welcomed the Canadian government's announcement that it would focus on maternal, newborn, and child health as part of its G8 legacy initiative. We believe this plan must be an integrated approach to saving women's lives that includes comprehensive sexual and reproductive health services, including access to modern contraception and safe abortion where abortion is legal.

There is strong evidence to show that family planning saves lives. The World Bank estimates that 40% of maternal deaths could be prevented by a wider uptake of reliable contraceptive methods.

For too long there has been little progress on maternal and child health, and yet we have a strong international consensus about the actions required to make change. We also have a strong international commitment, at least in principle. We have simply lacked the political will and the financial investment. With unprecedented attention to this issue in the last 12 months, we have a tremendous opportunity to move forward with new momentum.

To review quickly some of the facts that you've been presented with in recent days, there are an estimated 215 million women worldwide who want to plan their families and cannot access family planning services. A dramatic improvement in access to contraception would dramatically reduce the number of unintended pregnancies, which would mean fewer pregnancy-related deaths and complications.

I know that Sharon Camp was here last week to speak to the new research from the Guttmacher Institute, which suggests that if we met both the unmet need for contraception and the unmet need for maternal and newborn care services—instead of the latter alone—pregnancy-related deaths could be reduced by 70%. In this case, it is also estimated that unsafe abortions would decrease from 20 million to 5.5 million.

So the study suggests that meeting the combined need would actually be less expensive than meeting the need for maternal and newborn care alone. This cost saving would be a result of the dramatic reduction in the need for pregnancy-related care due to unintended pregnancies.

Somewhere between 330,000 women and 530,000 women die every year of complications related to pregnancy and childbirth—and this range refers to the recent research suggesting that some change may have occurred, which is very positive. It is estimated that 13% of these deaths are due to unsafe abortions, which represents as many as 70,000 deaths a year.

Contraception and safe abortion services must go hand in hand. In some instances, access to contraception is not enough to ensure that women are exercising their right to control the timing and spacing of their children. This is true in cases of contraceptive failure or in cases of rape or sexual coercion, as well as a variety of other factors. In cases where abortion is legal, women must be offered access to this procedure safely.

At the 2009 G8 summit, Canada committed to “accelerating progress on maternal health, through sexual and reproductive health care and services and voluntary family planning”. Furthermore, all of the G8 leaders signed on to the consensus for maternal and child health, which agreed that the actions needed to address maternal and child health include a quality package of evidence-based interventions delivered through effective health systems. These include: comprehensive family planning advice, service, and supplies; skilled care for women and newborns during and after their pregnancy as well as during childbirth, which must also include emergency obstetrical care; safe abortion services where abortions are legal; and improved child nutrition and prevention and treatment of major childhood diseases.

The upcoming G8 meetings come at a critical time, as world leaders also prepare to gather in September of this year to review the world's progress on the millennium development goals. MDG 5 and MDG 5.B are the goals toward which the least progress has been made, and this G8 meeting provides a tremendous opportunity to change that. Strong and effective civil society organizations are critical to ensuring the effective implementation of the government's maternal and newborn health strategy. Civil society and governments must work together to ensure that we meet the MDGs and to ensure progress in sexual reproductive health and rights. Civil society organizations are often in a unique position to deliver specialized sexual and reproductive health services, especially to the poorest and most marginalized populations.

IPPF and its member organizations are a critical component of the maternal health architecture, working in the world's least developed countries to build capacity to deliver high-quality services from a rights-based perspective. The evidence is overwhelming, and the global consensus is clear with respect to what action is required.

In just over one month, I expect to give birth to my second child. I will do so within the Canadian health care system, in the capable care of a midwife. If I am in the unfortunate position of experiencing a postpartum hemorrhage, as I did three years ago with the birth of my first child, I will seek emergency obstetrical care and be transferred to the care of an obstetrician/gynecologist. I have a guaranteed form of transportation to the hospital and I can be assured that the roads will be passable when I need them. I can be assured that the tertiary hospital I will go to has blood products available and a specialist on call 24 hours a day.

A pregnancy-related complication for me will be an unfortunate reality, but it will not threaten my life or the long-term well-being of my family. I am choosing to have my second child almost exactly three years after my first and I have had the privilege of a variety of forms of modern contraception to assist me in making this choice. I also have fairly readily available access to abortion services, had this not been a pregnancy that I was able to continue, for whatever reason.

All of the women of the world have the right to the same opportunities to control their fertility and to safe pregnancy and childbirth. Canada has an opportunity to demonstrate tremendous leadership on the world stage. Let us lead by example by investing in an integrated maternal, newborn, and child health strategy that is built on evidence and that maximizes its investment by providing comprehensive sexual and reproductive health services.

Thank you very much.

[The Vice-Chair, Conservative, Cathy McLeod]

Thank you very much.

Next we will hear from the Fédération du Québec pour le planning des naissances.

[Ainsley Jenicek, Project Manager, Fédération du Québec pour le planning des naissances]

Thank you very much. I too am very humbled by the co-presenters I have the honour to present alongside.

Thank you very much for inviting our federation to make a presentation today. We really appreciate the opportunity to deliver our point of view. In my presentation, I will address the topic of abortion in the context of the recent confirmation of the fact that the Government of Canada will not be financing such services as part of its maternal and child health initiative at the G8 Summit.

I will first explain why abortion services are inseparable from maternal and child health in general. I will close by explaining why the strategy of refusing funding for abortion services is ineffective.

First, abortion is a fundamental component of maternal health. A false distinction is often made between abortion and maternal health. It is as if the women who chose abortion and mothers were different women. But we forget that mothers are often the ones who need abortion services. There is also a lack of understanding of the link between abortion and child health. In reality, more than 220,000 children lose their mothers each year due to unsafe abortions. So it is a lot more likely that, without their mothers, those children will die.

In addition to children who suffer as a result of losing their mothers, it would be inhuman to deny women in poorer countries those essential services. The majority of the 42 million abortions performed around the world annually take place in developing countries. Approximately 70,000 women die each year due to unsafe abortions.

That means seven women die per hour every year from unsafe abortions.

Five million women are hospitalized because of complications resulting from unsafe abortion and this number does not even include the other three million women who do not have access to a hospital. The complications those women are experiencing can have short-term and long-term consequences that would cost their governments more money than funding safe abortion services.

In Canada, and in most developed or rich countries, we have access to safe abortion services. These services, in addition to being essential health care services, meet women's need to be in control of their bodies and, therefore, of their lives. Refusing to recognize that fundamental need perpetuates not only a flagrant injustice between women from the south and women from the north, but also denies women their universal rights.

Canadian and Quebec women have fought for these rights. We must not allow our government to dictate to women from poorer countries what they can and cannot do with their own bodies.

I'll move on to my second point, which is simply that refusing to finance abortions abroad does not actually reduce the rate of abortions.

We can learn a number of key lessons from former President George Bush's reinstatement of the Mexico City policy, also commonly called the “global gag rule”, the policy that denied U.S. aid funding to NGOs that performed abortions, provided counsel and references related to such services, or lobbied for the legalization of abortion in their country. U.S. aid was even cut off from organizations that used non-U.S. funding for these activities.

Its main lesson is, to repeat, that refusing to finance abortion services abroad does not actually reduce their frequency. When legal and safe abortion services become less available, the only thing that changes is that women seek out unsafe procedures or try to self-abort, and these procedures often occur under unsanitary and dangerous conditions. Refusing to fund safe abortion procedures therefore bolsters the rate of maternal death, infection, and long-term consequences, such as infertility. Let us remember that 13% of maternal deaths across the world are due to unsafe abortions. The most effective way to reduce abortions is to reduce the number of unintended pregnancies. The way to achieve this is to increase the availability of family planning initiatives that include abortion services.

Why include these services?

It's because contraception alone is not enough. It often takes decades for contraception to be broadly introduced and accepted, meaning that abortion continue to be an important recourse. Reliable access to contraception is also nearly impossible for some of the world's poorest women, including adolescents, refugees, victims of sexual coercion or violence, or those suffering from chronic illnesses, such as HIV/AIDS. Even where contraception is broadly available, abortion services continue to be needed, because no contraceptive method is 100% effective.

The global gag rule also teaches us that refusing to finance NGOs that provide abortion-related services only interrupts, complicates, or even shuts down family planning programs. In other words, cutting off funding from abortion-related services weakens maternal health initiatives. Faced with restrictions placed on funding during the global gag rule, numerous NGOs concluded that it would be unethical for them to cut any mention of abortion out of their family planning programs. They were therefore cut off from U.S. aid, causing many to reduce their staff power and their services and to even close clinics.

We should note that the global gag rule even applied in countries where abortion was legal, meaning that the global gag represented an affront on poorer countries' sovereignty. It also undermined the promotion of democracy abroad, notably the fundamental democratic principle of free speech and open public debate.

Finally, while the global gag rule affected women on the international stage, it was part of a broader strategy to diminish the rights of women domestically and abroad, sometimes called “Bush's other war”, the war on women's reproductive and sexual rights.

In conclusion, a maternal heath initiative that includes contraception but not abortion will be insufficient in helping women.

We must remember that the principles of free choice and self-determination are shared by most Canadians. In April 2010, an EKOS poll showed that the majority of Canadians are pro-choice. They know that, even if we do not want to use abortion services ourselves, these services must be available to women who need them.

I urge you to use your privileged status and influence to encourage the Conservative government to change its position on funding for abortion services abroad.

Thank you very much.

[The Vice-Chair, Conservative, Cathy McLeod]

Thank you very much.

We will now move on to the International Confederation of Midwives and Bridget Lynch, who is the president.

You have 10 minutes.

[Bridget Lynch, President, International Confederation of Midwives]

Thank you, Cathy.

It's a pleasure and a privilege for me to be here to speak on behalf of midwifery and the role that midwifery has to play in the reduction of maternal and newborn morbidity and mortality globally.

I want to start off by talking about this at an international level. Then I'd like to come back to look at what we're doing here in Canada as well, in terms of the potential recommendations coming out of your committee.

In The Lancet , in 2005, midwives were identified as the key health care providers for reducing maternal and infant morbidity and mortality globally. In 2008, the World Health Organization identified that among the 1.2 million health care workers needed to improve health systems globally, we needed 350,000 more midwives to attend to the issue of the high levels of morbidity and mortality.

When we look at the role of midwives in sub-Saharan Africa and in South Asia, where they have the highest incidence of maternal and newborn morbidity and mortality, we see a virtual invisibility of midwives in those countries. Midwives are often lost, in terms of their identity, within the ranks of those covered by the overarching term “health care workers”.

One of the issues that's really being highlighted this year is the issue of the female health care workforce and the low level of support and recruitment into the female health care workforce, especially in the low-resource countries where women and their infants are dying.

One issue that has been identified, and this is extremely important when we're looking at addressing maternal and infant mortality and morbidity, is the role of midwives in normal newborn and normal birth care. The facts are that 85% of all births in healthy women are normal. In most of our countries, in our own reference points, we have become very used to physicians and obstetricians taking on the greater part of care for maternal and newborn care.

In looking at the best health care providers for the continuum of care that has been identified, it is really important, in addressing human as well as economic resources, that if a mother survives, then, as you've said, her newborn and her older children have a much higher rate of survival as well. The continuum of care is basic to midwife care. Our scope of practice covers antenatal care through childbirth care, through looking after the mother in the postpartum as well as looking after her newborn.

In terms of the best use of resources, we should be working with countries and encouraging the G8 to identify the specific role of the midwife. Currently, and in most of the literature that's out there, we're still talking in vague, overarching terms and addressing this as a health care workforce issue. The problem is, unless we start to identify midwives and the need to develop a midwifery workforce, we will not accomplish the education, the regulation, and the professional development that midwives need at a global level.

The International Confederation of Midwives represents 250,000 midwives in 95 countries globally. One of the biggest issues that has been identified in the low-resource countries is the lack of good education for midwives, lack of standards of education, lack of regulation, lack of full integration into multidisciplinary teams of health care workers, lack of recognition by pediatricians, lack of recognition by obstetricians, and lack of recognition by governments of the important role that midwives can play in determining maternal and newborn health policy.

Midwives provide family planning, and in some countries are attending at first trimester abortions. We provide sexual and reproductive health care. We prevent mother-to-child transmission of HIV. We provide treatment for malaria. We provide bed nets. Most importantly, we provide women-centred care. Finally, coming onto the international agenda has been very important. It's not just important that a mother and her newborn survive, but that a mother survives with dignity and is treated with dignity.

It's very important in Canada that we recognize the role of midwives here in this country; we have developed one of the strongest models of midwifery care in the world.

The three pillars of any strong health care profession are a good education system, a strong regulatory system, and a strong professional association that can contribute to policy development and can work as colleagues and in conjunction with our other health care professionals.

Canada has developed a profession of midwifery that recognizes and respects the right of a woman to choose her place of care. This is the only jurisdiction in the world where women are supported in choosing their place of birth. We are required to provide women with informed choice in all decision-making, putting them at the centre of their care, and we are required to provide a continuity of care provider for women so that they are not seeing multiple health care providers during the course of their pregnancies and their childbirths.

Quebec has the only four-year undergraduate degree program in French for midwives in the world. The Maison de naissance is located in Quebec, the only jurisdiction in the world where midwife-led, out-of-hospital maternity facilities have existed for 10 years. It's a tremendous model that is being talked about globally. Nobody knows, not even here in Canada, if we really recognize this particular model and its success and the fact that many women in Quebec have chosen this model.

In fact, when they did a survey of women in the 1990s as to their preferred place of birth, the women of Canada chose an out-of-hospital birthing facility.

I want to come back to Canada before I end. The unanimous all-party resolution that went through our Parliament last June 5 called for the Canadian government to renew its commitment to reducing maternal and infant mortality and morbidity globally and to improve maternal and newborn health here in Canada.

I do want to make a plea that Canada join the ranks of Holland and Great Britain and develop a national strategy for maternal, newborn, and child health. It's so important to take this opportunity not only to look outside our country but also to look at the ways we can improve what's taking place here in Canada.

We need to improve our perinatal surveillance system. We still don't have all provinces on board with a cohesive national perinatal surveillance system. We don't really even know what's taking place at many demographic levels here in our own country. In strengthening the demographic components of the perinatal surveillance system, we need to look at health indicators, including diabetes, tuberculosis, and hypertensive disorders. We need to look at proximity to care. We need to address the social determinants of health and access to fresh food in our inner cities and in our remote communities. We need to address clean water and sanitation as we look at improving maternal, newborn, and child health in our own country. We need to address issues of safety and security at the personal and community levels.

We need to strengthen the continuum of care approach to maternal, newborn, and child health in our own country. We need to encourage our professional associations, pediatrics, obstetricians, nurses, and midwives to work together. They need to be invited to the table by the federal government to also identify maternal, newborn, and child health areas of research.

We need to have coordinated research efforts in this country to look at improving maternal, newborn, and child health--

[The Vice-Chair, Conservative, Cathy McLeod]

Could you quickly wrap it up? You're over time.

[Bridget Lynch]

The last piece I want to identify--and this is extremely important--is adolescent health. It's not thought of when we look at maternal and child health. The largest reason for death among adolescent females globally is pregnancy and childbirth. We need to identify this as an at-risk population. We need to look at the influence of drugs and alcohol. We need to pay specific attention to our inner-city, native, and immigrant adolescent populations.

[The Vice-Chair, Conservative, Cathy McLeod]

Thank you so much.

We'll now move on to Lorraine Fontaine. She's with the Regroupement Naissance-Renaissance.

Welcome.

[Lorraine Fontaine, Coordinator, Political Issues, Regroupement Naissance-Renaissance]

Good afternoon. As a mother, grandmother and childbirth advocate, I am honoured to have been invited to speak to you on behalf of my organization, Regroupement Naissance-Renaissance, which has been a part of the movement for the humanization of childbirth and the perinatal period—pregnancy to one year after birth—for the past 30 years in Quebec.

This afternoon, I would like to present a woman's perspective on maternal and infant health and bring to your attention an innovative initiative that addresses our concerns about women's autonomy in decision-making regarding childbirth, and focuses on the importance of treating women with respect and dignity. All local and international policies, programs and initiatives must respect the fundamental rights of women to self-determination regarding their own and their children's health.

You have been passed a copy of this document. I'd ask you to read it when I'm done. There are many details, but I want to draw your attention to four of the details in it.

The International mother-baby child birth initiative, or IMBCI, as I will call it, has already garnered widespread support and is modelled after the World Health Organization/UNICEF baby-friendly hospital initiative, with its 10 steps to successful breastfeeding. I quote:

The purpose of the IMBC...is to improve care throughout the childbearing continuum...in order to save lives, prevent illness and harm from the overuse of obstetric technologies, and promote health for mothers and babies around the world.

It includes and builds upon an already widely accepted and implemented program that has saved millions of lives.

So these four steps that I'd like to draw your attention to are steps that we have identified in our organization, but they are also steps that the most active nations that are in support of IMBCI have chosen.

The first reads:

Treat every woman with respect and dignity, fully informing and involving her in decision-making about care for herself and her baby in language that she understands, and providing her the right to informed consent and refusal.

The most important principle that we must hold to, all of us, in our work is that women must be treated with respect and dignity regardless of their economic status, country or culture of origin, physical abilities or disabilities, and any other recognized rights status. Women must be at the heart of all decisions regarding their reproductive health. The women who choose motherhood must be the ones to decide where, how, and with whom they give birth.

Step six reads, “Avoid potentially harmful procedures and practices that have no scientific support for routine or frequent use in normal labour and birth.” Caesareans are a good example of an intervention that has the potential to help, but also to harm. According to the World Health Organization, optimum Caesarian rates should be within 5% to 15%. This means in countries where the rate is 2%, women are dying from lack of obstetrical care. Conversely, in countries where the rates exceed 15%, we begin to see what borders on dangerous overuse of obstetrical intervention, manifested by increasing maternal mortality rates. Examples of C-section rates... Canada goes up to 26%; in the U.S.A., 30% to 40%; in Puerto Rico, 60%. We're beginning to see third-generation women who are having Caesareans. In Brazil, the rates are even higher.

We cannot just export the model we have put in place in North America and think we will save lives. According to the national birthing initiative for Canada in 2008, data released by the OECD in June 2006 indicates that we have slipped in rank from sixth to 21st regarding infant mortality, from 12th to 14th with regard to maternal perinatal mortality, and from second to 11th in maternal morbidity rates. I quote: “When it comes to maternity care in Canada, we must not assume that everything is OK.”

The third step I would like to point out to you is this:

Possess and routinely apply midwifery knowledge and skills that enhance and optimize the normal physiology of pregnancy, labour, birth, breastfeeding, and the postpartum period.

You said it all, my dear. Thank you very much. But I would add that a very recent survey that was published on May 5, on international midwifery day, states that in Quebec, 26% of women of childbearing age would prefer to give birth with a midwife, but only 2% have access. So midwifery is a practice rooted, according to us, in the respect of women and their capacity to give birth, and it promotes a physiological birth and well-being in a culturally appropriate manner. We see all over the world midwifery practices and more traditional practices of midwifery disappearing. We need to do something about that as well.

The tenth step is the baby-friendly hospital initiative. It is part of the mother-friendly or the mother-baby initiative. They are connected. I particularly want to point out something about breastfeeding that all of you would know. The commercialization of breast milk substitutes in the seventies and eighties wreaked havoc on the lives of mothers and newborns in developing nations. Likewise, in the 21st century we must be vigilant so that childbirth does not become the stage for similar misplaced interests and consequent mistreatment.

The BFHI, or baby-friendly hospital initiative, is reinstating breast feeding to its proper place, not only as a life-saving and low-cost form of nourishment, but also--and this is also important--as a means of strengthening psychological and emotional mother-child bonds, notably through skin-to-skin contact immediately after birth.

A requisite for becoming a baby-friendly maternity service is adhering to the code of commercialization of breast milk substitutes. The IMBCI, the initiative that I proposed to you, is taking this a step further in filling an important gap by ensuring that childbirth and the mother's experience be included and seen as essential.

All of what I am saying to you today is also backed up by the UN Human Rights Council's resolution of November 2008, entitled “Preventable maternal mortality and morbidity and human rights”, which reaffirms the links between maternity and human rights.

When you separate women from their support networks and you separate mothers from their newborns, you break bonds that save lives. Like the baby-friendly hospital initiative, the international mother-baby childbirth initiative, when adhered to, will ensure maternal and infant health, reduce mortality and morbidity, and bring health to many babies and mothers.

However--and I conclude with this--we must not delude ourselves that these issues are problems only in developing nations. There is ample evidence of failures in our own system towards mothers and infants. From immigrant and northern communities to disabled and handicapped populations to young mothers, we are too often usurping women's individual and collective rights.

Health is more than the absence of death and disease. With respect to maternal and infant health, we must have a holistic vision that includes the social and economic environment in which mother and infant live. You all wished a happy Mother's Day to your own mothers yesterday, so you know well that motherhood is a long-term commitment. If we are not going to follow up on the BFHI and the IMBCI and all the other good initiatives out there with a commitment to continued improvement of the socio-economic well-being of women, children, and families throughout their lives, then we're creating a false hope and a potentially disastrous disservice to those whose lives would be saved.

Whatever actions we take to reduce maternal and infant mortality and morbidity must be done by and for women and with the support of a variety of organizations, including community-based ones. Funding for these community-based organizations needs to be strong and sustained, because we cannot improve maternal health without women and without those who are listening closely to women and working side by side with them.

So we recommend that the Government of Canada through its representatives, present the IMBCI to the participants of the upcoming G8 Summit as a means of both improving women and children’s health and promoting practices that will ensure their well being. Thank you very much.

[The Vice-Chair, Conservative, Cathy McLeod]

Thank you very much to everyone for sharing their perspectives on this very important initiative.

We're going to go into our rounds. The first round is seven minutes for both questions and answers. As we get towards the end, I usually cut in to make sure everyone has a fair opportunity both for questions and for answers.

To begin, we have Ms. Neville for the Liberals.

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

Thank you, Madam Chair.

Thank you all for being here.

This is our third panel, and there's again a great diversity of opinion.

My colleague asked whether Pierre would get a chance to speak. I assume he'll have the opportunity during the questions.

I have three thrusts to my questions. They all relate to the upcoming G8. I'm going to put all three out there and then ask you to respond.

First, Ainsley, I think you referred to this in your presentation. During question period in the House on Friday, the minister responsible for the status of women referenced at least four times the fact that, as we sit here, 24,000 children under the age of five die in the developing world every day. I think we all know that.

My concern or my question is to those of you who are actively engaged internationally. I would like to know about the mothers who die from abortions. Can you tell us about that? I've heard various statistics. Can you tell us about the impact it has on children, both in terms of their own mortality and their long-term well-being should they survive? That's question number one.

My second question is this. My colleague from Toronto Centre, Bob Rae, asked a question in the House last week in terms of abortion as it relates to rape. He particularly used the Congo as a reference because of what's going on there.

I was astounded by statistics that my office and my staff provided me with today. The information is from an organization called Solidarity Helping Hand. It says that one child is raped every three minutes in South Africa and 45% of rape victims in South Africa are children. I would ask for comments from those of you who do international work. What are the impacts on those children, and what is Canada's role?

My third question relates to the Canadian government and The Lancet editorial that we heard about last week. They said the Canadian government does not deprive women living in Canada. I don't want to read it all. It said that “bans on the procedure, which are detrimental to public health, should be challenged by the G8, not tacitly supported.” Further:

Canada and the other G8 nations could show real leadership with a final maternal health plan that is based on sound scientific evidence and not prejudice.

Again, my question to all of you is this. How do you see Canada's role in providing leadership to the G8, given their limited response to women's productive rights?

Those are my three thrusts, to whoever wants to go first.

[The Vice-Chair, Conservative, Cathy McLeod]

We have about three and a half minutes left to try to tackle a number of issues. Who would like to try to tackle any one of the three questions that have been put forward?

[Jolanta Scott-Parker]

I can start with the last one.

In response to the question on the G8, I think the important thing is that we move forward with an integrated and comprehensive approach. I think it's perhaps what The Lancet article suggested in terms of not leaving out pieces of it. The evidence shows that a comprehensive strategy that addresses sexual and reproductive health and rights as part of a strategy for maternal and child health is critical. All the evidence supports that.

We also know that a menu-based approach to funding, where we have different countries picking different pieces of it, doesn't provide the type of cohesive joint strategy that is called for under these circumstances.

I guess that would be my response to the third question.

Do you want to try answering one of the other ones?

[Pierre La Ramée, Director, Development and Public Affairs, Western Hemisphere Region, International Planned Parenthood Federation]

Picking up also on the third question, as a Canadian living in the United States for quite a number of years I have often found myself feeling rather smug vis-à-vis my American colleagues, given many of the issues and conflicts around sexual and reproductive health in that country, issues like the global gag rule that has already been mentioned, for example. I find myself now in the very peculiar position of having to defend my own country when people approach me with some of the same questions about what's happening with Canadian policy: “Why are these positions being taken by your country?”

My personal embarrassment at this is very small in comparison with the potential consequences of this backsliding in Canada's vaunted and well-deserved leadership role on all of these issues for quite a number of years, and I think Canada should regain a leadership role in the G8, along with the rest of our G8 colleagues, and basically show the wider community of nations the direction in which we should be going on maternal mortality.

[The Vice-Chair, Conservative, Cathy McLeod]

We have a minute left. Does anyone want to tackle that?

Ms. Fontaine.

[Lorraine Fontaine]

Regarding reproductive rights and the backsliding and what not, I'm thinking of two changes that were recently made, which I read about. I think you would probably know better than I would. In the charter of rights in Iran, they decided to change the word “rights” to “protecting women”. What did that represent? I was reading an article about that. When we see women as victims--victims of violence, victims of disease, victims of poverty, and all of that--then we want to go in with compassion, and that's a good reason to want to go in, but my main point is that women are not just victims. They are actors within their situation. They are the principal actors within their situation, and they have to be involved in the decision-making.

So when there is talk in Canada about being afraid of the words “rights” and “defending our rights”, we shouldn't be afraid of those, because empowering women is part of democracy.

[The Vice-Chair, Conservative, Cathy McLeod]

Thank you.

We now move to Madame Deschamps.

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

Thank you, Madam Chair. I will try to be quick, but this is an important issue. I am surprised to see that we are still discussing the right to abortion in 2010. Thank you for your testimonies. They were very stunning.

Mr. La Ramée, the Secretary of State, Hillary Clinton, recently paid us a visit. She made a rather sensational statement. We can assume that the U.S. is now showing a degree of openness to abortion and contraception.

[Pierre La Ramée]

I will answer in English since that will be a lot faster. It is a lot easier for me.

There already has been a substantial reopening of discussion on both abortion and of course sexual and reproductive health in general in the United States under the Obama administration. Certainly, as Secretary of State, Hillary Clinton plays a very important leadership role in that respect, but we can see in the appropriations for foreign assistance, for example, that the largest amount ever appropriated in U.S. history for reproductive health--or family planning, as they tend to call it--was passed.

In terms of the issue of abortion, there are a number of issues that will, I think, restrain progress. First of all, there's the difficulty of dealing with the Congress, where in spite of having a large majority, as we saw in the debate on health care, there are a number of Democrats who have anti-choice views, so that puts certain limits on the administration's ability to move forward.

Nevertheless, one of the first things President Obama did was to rescind the global gag rule, and there are currently some very strong initiatives to try to get a permanent rescinding of the global gag rule so that no future administration can re-implement it.

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

It is said that we are furthest behind on goal 5, which deals with maternal health but also with child health. Last year, countries agreed to make it a priority and move forward with it. In June 2009, Canada co-sponsored a resolution of the United Nations Human Rights Council that recognizes maternal mortality and morbidity as a pressing human rights issue.

This year, we are celebrating the 15th anniversary of the Beijing Platform for Action, in the context of which governments from around the world, including Canada, reaffirmed that reproductive rights are based on the recognition of the fundamental right of all couples and individuals to freely and responsibly decide the number, the spacing and the moment of births, the right to have access to information and means to decide, and the right to receive the highest level of sexual and reproductive health.

We earned that fundamental right here in Canada. We fought and now it is written: women have a right to abortion. How is it that having control over our own bodies is part of our fundamental right but we do not promote it abroad although we want to move ahead with the goal we are furthest behind with? How is it that we do not promote this right in the poorest countries where women have no choice and where, often, their husbands dictate their choices? I do not understand, and if there is no global consensus on all services, including abortion and contraception, we will completely miss the target. I think we will have to forget about achieving the goal for the year 2015.

[Ainsley Jenicek]

It is precisely why we cannot say that we do not want to address divisive topics for the Canadian population, since the majority of Canadians are pro-choice. Also, maternal health is not a neutral subject. It is impossible to be neutral on this topic; it is always a very politicized topic because we are talking about women's bodies and lives. So I am pleased we agree.

[The Vice-Chair, Conservative, Cathy McLeod]

Ms. Fontaine.

[Lorraine Fontaine]

I have made a point about the marketing of breast milk substitutes and its corollary to birth. What also worries me is what is going on with women's bodies. This attack on abortion is an attack on women's reproductive health; I get the impression that a woman's body is a territory occupied by pharmaceutical companies, corporations and economic interests. I am very concerned about the fact that abortion is being proposed as a topic for a great dialogue and a source of conflicts and obstacles, and I suspect that we are going to have to “slip one by” because there are other interests. I hope not.

I hope we are not trying to make money at the expense of women, as is the case in the south, in the US where 66% of hospital revenue comes from mothers and newborns.These questions must be asked.

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

Ms. Lynch?