Status of Women Committee on May 12th, 2010

[The Chair, Liberal, Hedy Fry]

I'm going to call the meeting to order.

Pursuant to Standing Order 108(2), this committee is studying 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. The motion reads:

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 would be hosting, as long as this is done before the end of May.

We are doing four hearings, and you are our third set of hearings.

Today we have four sets of witnesses. I will begin with the video conference witness, Pamela Fuselli from Safe Kids Canada, and then I will move on to the others in order.

Let me tell you that each group has 10 minutes to present. I will give you a warning when you have two minutes left. You don't have to take 10 minutes, by the way. Then we will have a question and answer set of rounds.

I'm going to begin with Pamela Fuselli, executive director for Safe Kids Canada.

Ms. Fuselli, your 10 minutes begins.

[Pamela Fuselli, Executive Director, Safe Kids Canada]

Thank you very much.

Good afternoon, and thank you for the invitation to speak to the House of Commons Standing Committee on the Status of Women. The focus on maternal and children's health is an important issue, and the discussions about children's health would not be complete without the inclusion of preventable injuries, an indicator of health and the leading cause of death for children in Canada and around the world.

Let me first tell you a little bit about Safe Kids Canada, the national injury prevention program of the Hospital for Sick Children. Our organization was founded in 1992 by Dr. David Wesson, a trauma surgeon at SickKids who saw the results of injuries and looked for a way to address the fact that they were largely predictable and therefore preventable. Safe Kids Canada is a leader in Canada, acting as a knowledge broker, bridging research to inform action through evidence-based strategies, information, and resources.

Through a stakeholder network across Canada, we have partners at the federal, provincial, territorial, and local levels. With industry, corporations, and community organizations, we are endeavouring to achieve our vision: fewer injuries, healthier children, a safer Canada.

Safe Kids Canada is encouraged to see the Canadian government's commitment to championing a major initiative to improve the health of women and children in the world's poorest regions. We congratulate the government for striving to make a tangible difference in maternal and child health by making this the top priority in June. As well, we were pleased to see that the government is looking to mobilize governments, non-governmental organizations, and private foundations alike.

In the recent Speech from the Throne, it was announced that:

To prevent accidents that harm our children and youth, our Government will also work in partnership with non-governmental organizations to launch a national strategy on childhood injury prevention.

Safe Kids Canada agrees with Canada's G8 agenda to focus on human welfare:

It is incumbent upon the leaders of the world’s most developed economies to assist those in the most vulnerable positions.

In his statement laying out the G8 agenda focusing on human welfare, Prime Minister Harper pointed out that “an astonishing 9 million children die before their 5th birthday”. This number is too high, and unacceptable. Equally so is the number of children's lives lost to injuries around the world. As a national injury prevention program, we understand the high value and strong effects that prevention can have on the health and welfare of children.

Also in his statement outlining Canada's G8 agenda, Prime Minister Harper pointed out that the vast majority, as much as 80% of deaths during pregnancy, are easily preventable. Furthermore, the Prime Minister expressed that far too many lives and unexplored futures have already been lost for want of relatively simple and inexpensive health care solutions.

Injuries are preventable. Prevention is a relatively simple and inexpensive solution to the loss of too many lives and the detrimental effects that injuries can have on a child's quality of life, as well as the lives of their families and communities.

According to the 2008 World Health Organization and UNICEF's World report on child injury prevention, 60% of all child deaths were the result of road traffic collisions, drowning, fire-related burns, falls, and poisoning. Other unintentional deaths accounted for 30%, including smothering, asphyxiation, choking, etc. In comparison, war accounted for 2.4% of deaths, and homicide for 5.7%. This is not unlike the picture we see in Canada.

Injuries are the leading cause of death and disability in the world, responsible for more than five million deaths each year. Approximately 830,000 children under 18 years of age die every year as a result of an unintentional injury. More than 95% of all injury deaths in children around the world occur in low-income and middle-income countries, although child injuries remain a problem in high-income countries, accounting for 40% of all child deaths.

It's essential that injuries are seen as an indicator of overall child health, as the WHO and UNICEF report points out:

...preventing child injury is closely connected to other issues related to children’s health. Tackling child injury must be a central part of all initiatives to improve the situation of child mortality and morbidity and the general well-being of children.

So how does Canada compare to the rest of the world? Canada ranks 18th out of 26 OECD nations for deaths from unintentional injuries. Had we enjoyed the rate achieved by Sweden, 2,665 more children would be alive today. Many experts believe that 90% of childhood injuries are preventable and that there are best-practice strategies, such as the use of bike helmets and car seats, that could be implemented immediately and make an impact on children's lives.

The annual burden that injury places on Canadians overall, our health care system and Canadian society, looks like this: over 13,000 deaths, 300 of which are children under the age of 14; over 211,000 Canadians who are hospitalized, 21,000 of them being children under 14; over three million emergency room visits; and over 67,000 Canadians permanently disabled.

We're looking at over $10 billion in health care costs and $19.8 billion in total economic costs, which is the same as the amount spent annually on pharmaceuticals across Canada. An estimated $4 billion is the economic burden of injury among children in Canada.

So why are these injuries the leading causes of death in Canada for children between one and 14 years of age? The vast majority of health care dollars are focused on treating disease, not prevention.

Given that preventable injuries are the leading cause of death to Canadian children, the amount of dollars spent are inverse to the scope of the problem. There's a misperception or misunderstanding that injuries are accidents that can neither be anticipated nor prevented. In reality, most injuries follow a distinct pattern and are therefore predictable and preventable.

Children live in a world built for adults and they have developing cognitive and physical abilities that put them at risk for injuries. The WHO and UNICEF report states that:

Over fifty years ago, one child injury expert declared that: “it is now generally recognized that accidents constitute a major problem in public health”.

Unfortunately, this statement remains true today.

As a part of a global movement of Safe Kids countries around the world, Safe Kids Canada supports the conclusion of the WHO and UNICEF report, which states:

Evidence demonstrates the dramatic successes in child injury prevention in countries which have made a concerted effort. These results make a case for increasing investments in human resources and institutional capacities. This would permit the development, implementation and evaluation of programmes to stem the tide of child injury and enhance the health and well-being of children and their families the world over. Implementing proven interventions could save more than a thousand children’s lives a day.

We think it's indisputable that injuries need to be a part of the overall child health strategy, both in Canada and worldwide. Currently Canada has the opportunity to be a leader in maternal and children's health by adopting certain strategies. In the area of injury prevention, this can begin by instituting the national injury prevention strategy, as outlined in the Speech from the Throne, and by adopting consumer products safety legislation that will allow mothers to know that the toys their children play with are safe.

Thank you for allowing me to speak with you today about the importance of injury prevention related to maternal and child health.

[The Chair, Liberal, Hedy Fry]

Thank you very much, Ms. Fuselli.

Now we'll go to Anne Snowdon, researcher, AUTO21.

[Dr. Anne Snowdon, Researcher, AUTO21]

Thank you so much for the opportunity to speak with you today. I represent AUTO21, Canada's network of centres of excellence team of researchers that focus on the automotive sector.

I am a nurse by training. I bring today to my comments background as a pediatric critical care nurse. I spent a number of years looking after critically ill children, 50% of whom are admitted to our ICUs--only very few of those actually survive--as a result of severe road crashes.

I currently lead a national team of researchers that includes not only academia--members from computer science, business, engineering, nursing and medicine--but also engages private sector partners and public sector partners to leverage both their experience and technologies in this area of injury prevention.

As you've just heard from Pam Fuselli, road crashes are the leading cause of death of children in Canada and are a substantial threat to children globally. In Canada alone we lose approximately three classrooms-full of children every year who will not see grade six because of road crashes.

As you have also just heard, we have a substantial number of very severe injuries in the neighbourhood of about 11,000 annually. Most of those injuries are lifelong, including head, neck, and spinal cord, so prevention could play a significant role if we were able to achieve that.

If today I was able to get every child in this country correctly seated in a car seat, we would be able to reduce the child deaths in our country by 74% and reduce the severe injuries by 67%. Once again, a prevention strategy has tremendous value if we're able to achieve that.

In Canada, the majority of parents I work with and have researched do attempt to keep their children safe in vehicles--about 85% of us. The sad story is that about 15% to 20% do so accurately enough so those children can benefit from protective strategies such as car seats. Some 75% of the children in the most recent Transport Canada data who died in road crashes were actually wearing seat belts.

The issue is not that we're not attempting to keep our children safe: it's the accuracy and the correct strategy for keeping them safe that is so important.

My most recent national child seat survey, which I conducted with Transport Canada, was in 2006, and I will be conducting it again this summer, in 2010. We had only 19% of children ages four to eight using booster seats in the back seats of our vehicles--the lowest and clearly the highest-risk group. We do have legislation for booster seats in five Canadian provinces at the moment. However, the impact of that legislation has not achieved the numbers of children correctly seated in that age group that we would like to see.

The question is what we can do about it? Let me share some of the lessons we have learned and the achievements I think we have been able to contribute. Education programs are--no question--important, for children particularly and the entire family. Mothers tend to be the most knowledgeable member of a family to keep children safe in vehicles, but we also engage children in our education as well, because they're a very important influence in families. We do not have a national strategy--as was already pointed out by my colleague at Safe Kids--around the education and awareness issue for these families, which I think would benefit them.

With regard to parent information, when I talk to parents in Canada, I ask them where they seek information, because it is important to try to help them find correct information. They tell me two things. They look at the pictures on the box and they go to speak with their family friends.

We've actually engaged our colleagues in computer science to use artificial intelligence technology. We've created a virtual community that is able to demonstrate the very important influence of social networks. Families tend to learn from other families, so influencing our social networks is a very important strategy that I don't believe is unique to Canada, but in fact I think perhaps could allow Canada to play an important role worldwide.

You also have to look at the impact of culture. Families do practice particular health behaviours based on cultural beliefs. We have done some studies with new Canadians in our country that suggest that there are cultural values in place. The role of the mother as protector often leads to the family's decision to actually hold their child on their knee rather than safely seat them in a vehicle in a car seat.

So again, the use of artificial intelligence has been important in helping me map and helping us conceptualize how we need to shift from just straight education materials for families, to actually social marketing, which we have done, by engaging our business school colleagues who have expertise in that.

The lessons learned, I think, can be very valuable in moving forward to a more global agenda. I won't review the number of statistics shared with you already, except to say that injury is a growing health concern, as identified by the World Health Organization. Low-income and middle-income countries particularly spend more than they receive in international aid on the outcomes of injury. So if we're able to help them prevent injury through a multi-sector and a multi-disciplined approach, we would actually be supporting them globally, I believe, in meeting some of their other needs for aid.

On networks of key stakeholders, I can't say enough about how important that lesson has been in terms of engaging key stakeholders on the ground, the people in communities who help us understand the influence of those social networks so that we can help them transmit information, knowledge, and awareness on keeping children safe in vehicles through a network approach.

National coordination, I believe, has already been identified by my colleague as a very important strategy. We have lots of data, lots of strategies, and lots of educational tools, but if we can't get them to every family in Canada, we cannot achieve the reduction in the mortality and severe injury rates that are so very high in this country, and are growing in other countries.

The rates of road crashes are expected to climb from being the ninth-leading cause of death to the fifth-leading cause of death worldwide by 2030. WHO suggests a multi-sector approach. It has also been my experience with the multi-sector approach that it is very important having families, community members, and key stakeholders from different parts of the public sector and private sector bringing technologies and different approaches to the table, in addition to researchers and academia.

I believe Canada has the ability and the capacity to achieve global leadership in the area of coordinating efforts across sectors by engaging key stakeholders; leveraging technologies like information technologies to measure and monitor our outcomes and the impacts of various initiatives worldwide; and engaging private sector, government, and academic partnerships to build the capacity we need for child health in the area of injury prevention and to start to reduce this growing challenge that we have with injury rates that have such lifelong effects for Canada's children, but also for children globally.

Thank you.

[The Chair, Liberal, Hedy Fry]

Thank you very much, Ms. Snowdon.

I'll now go to Christina Dendys, executive director of Results Canada.

[Christina Dendys, Executive Director, Results Canada]

Thank you.

Results is a national grassroots advocacy organization. We are committed to creating the political will to end poverty and needless suffering. We champion cost-effective, proven, tangible, and impactful solutions that will benefit the world's poorest and, we believe, by extension, the world as a whole. Our volunteers across the country are parents who think that no other parent's child should die for lack of immunizations that cost pennies. They're neighbours who think that nobody around the block or around the world should die for lack of drugs or access to drugs that cost dimes or dollars. They're everyday citizens, and they're your constituents.

So I'm honoured to be here today to represent their views, but also I'm honoured to present some recommendations outlined in the brief that was developed by a coalition that includes results in partnership with some of Canada's largest and most respected development organizations, including Unicef Canada, World Vision Canada, Care Canada, Plan Canada, and Save the Children, whom you'll hear from as well.

About a year ago, our organizations came together to push for child, newborn, and maternal health to be the signature development theme at the G8 initiative. We certainly weren't alone in that effort. Many partners in the room are part of that and very focused on that. So we were all very glad in January when that came to fruition.

In terms of the numbers, in the world's poorest regions, close to nine million women watch their children succumb to painful yet mostly preventable disease and illness, illnesses that, as I said, cost dimes—not dollars—to treat, illnesses like diarrheal disease, malaria, pneumonia, measles, and malnutrition. At the same time, at least 350,000 mothers die annually in childbirth due to complications during delivery.

I'm not going to run through all the statistics at this point, because I think you're very well versed in those at this point, after hearing from a number of very informed witnesses. Perhaps just to paint a picture, I'll tell this very brief story.

Last year I had the opportunity to go to Bangladesh to lead a parliamentary delegation there. We were looking at the challenges associated with global poverty but also very much focused on the hope and solutions. One day we went to a hospital called the ICDDR,B hospital in Dhaka. We were there in March, and it was just before rainy season. At that point, waters are stagnant, and babies get sick primarily of diarrheal disease and other diseases as well.

We went to that hospital that receives about 700 to 800 patients a day, children with diarrheal disease, moms and babies coming in for treatment. It's such a busy time of year that they don't have enough wards or beds, so they construct giant white tents outside, next to the hospital. I think there were two or three of them, and row upon row of kids getting oral rehydration therapies and intravenous therapies. While they're there being treated for other leading causes of death, kids who are malnourished are getting therapeutic feeding and other access to treatments that are again very inexpensive.

That scenario was poignant for a mom like me, but it's played out throughout the world. Diarrheal disease alone kills about 1.5 million children every single year. Most of those children who made it to that hospital will survive, actually, and that was the story of hope, because they had access to health services. However, many more in the most impoverished pockets of the world unfortunately will not, because they do not have access to dependable health care close to home.

This brings me to our brief. What we've focused on in our brief—I think you have it in your packages—is very much not about the global initiative as a whole, although we have some thoughts on that, but very much about where Canada's value-added contribution can be. So we've been focusing on where Canada's contribution to the G8 initiative should go.

What we're calling on is for Canadian investments in a cadre of front line health workers who have the support and training necessary to deliver an integrated bundle of high-impact interventions targeted at the poorest people, where they live, and all of that with the commitment to monitor results and measure impact.

I'm going to go over those four core elements very quickly here.

Number one, as I said: ramp up the number of front line health workers who are supported, trained, equipped, and motivated to deliver essential services to mothers and children at the community level close to home. As I'm sure you've heard, skilled and motivated health workers in the right place at the right time with the necessary infrastructure, drugs, and equipment are an essential part of the solution. That's from the Partnership for Maternal, Newborn and Child Health. There's a consensus around that. It's important because evidence shows that up to 80% of deaths of children under five years of age around the world may occur at home with little or no contact with health providers and that one in four women experience childbirth without skilled assistance.

Two, provide those front line workers with the capacity to deliver an integrated package or a bundle of interventions to get at the leading causes of death. Kids don't just die of one thing. They're susceptible to a whole gamut of illness and disease.

Among children, just four diseases--pneumonia, diarrhea, malaria, and measles--account for close to half of all under-five deaths in the developing world. The majority of these lives, experts say, could be saved by increasing the use of low-cost, effective prevention and treatment measures.

This is a UNICEF pack of oral rehydration salts, which many of you who have travelled have seen. This is what could save the life one of those children who ended up at ICDDR,B hospital. It costs, we've determined, something like 20¢ to 40¢ a package.

For mothers, there is clear evidence to show that the availability of skilled attendants at birth and immediately after, with the capacity for timely referral to access to other care facilities, is the critical factor in addressing the major causes of maternal mortality such as hemorrhage, infections, and hypertensive disorders. But also, these front line health workers have a very important role to play in addressing maternal health, which is also absolutely integral to healthy pregnancies and deliveries.

Number three, focus on the poorest people, again where they live, close to home, in rural areas or urban slums. The poorest people actually live, get sick, and die alone, far away from the nearest hospital. So focusing on the poorest people in terms of what kills them or what makes them sick will help us go a long way.

Number four, commit to accountability and tracking results, which allows for appropriate mid-course correction and measurable results on mortality impact, coverage of services, etc. In other words, any effective aid program should have a commitment to ensuring that we're getting it right and then having the capacity to improve practice along the way.

Those are the four legs of the table, as I call them, that we have been advocating for. You can read more in the brief.

Again, just to tell the story of how that plays out on the ground, this year I had the opportunity to lead another parliamentary delegation, this time to Ethiopia. We did a real focus on child and maternal health.

In Ethiopia, with the commitment of the ministry of health there and with partners like CIDA, UNICEF and NGOs, and the Global Fund, they've created a system that's very focused on community care front line workers. They've trained 30,000 young women who have about a grade 10 education. They have given them a year of training in the leading causes of death and illness and intervention—training on malaria diagnostic tests or how to deliver ACTs, which costs about a buck. A baby or a child who gets malaria can die within 24 hours. If you're far away from a hospital setting, you need to have people close by who can diagnose and treat that quickly, or that child is gone. There are 30,000 of them. They made a conscious decision that they would all be women, too. Talk about empowering women within communities; it was very powerful.

They've also created 15,000 health posts in rural areas in Ethiopia, health posts about the size of your living room, that have the equipment to address all these leading causes of death. They call them the “16 packages”. They get at malaria, therapeutic feeding, ORTs for diarrheal disease, but also immunizations. We saw babies getting measles vaccinations and polio vaccines.

So with 15,000 health posts and 30,000 health workers, that is about health system strengthening and transformative change in that country. That is the model we're talking about that could be a solution for the challenges that we face globally.

I want to talk about the money thing before we get through the two minutes.

The G8 acknowledges that the international financing gap to save 10 million women's and children's lives, between now and 2015, is estimated at approximately $30 billion globally. We feel that Canada's fair share contribution should be $1.4 billion in new—and I'll repeat, “new”, not reassigned, not repackaged, not reallocated—money. Over the next five years, that could have tremendous impact.

Thank you for this. I think it's time to focus on hope and opportunity, and we welcome the fact that you're studying this issue and helping us do that.

[The Chair, Liberal, Hedy Fry]

Thank you very much, Ms. Dendys.

Finally, we have Ms. Cicely McWilliam, coordinator for the Every One campaign, Save the Children Canada.

[Cicely McWilliam, Coordinator, Every One Campaign, Save the Children Canada]

Thank you, Chair.

Thank you, committee members, for giving Save the Children the opportunity to present today.

Save the Children works in Canada and 120 countries overseas to bring immediate and lasting improvements to children's lives. Save the Children focuses on the issues of health and nutrition, education, HIV/AIDS, child protection, emergency relief, and child rights. My specific focus, as the chair mentioned, is the Every One campaign, which is our newborn and child survival initiative.

My colleague Chris has spoken of the shocking number of children and mothers who are dying annually of preventable and treatable causes, and she has outlined the brief presented to the Canadian government by our group of six, a coalition of international aid agencies and advocates working on this issue. Like our coalition partners, Save the Children believes there should be a real drive to expand the coverage of proven integrated interventions that reduce maternal, newborn, and child mortality. These include: skilled personnel available during pregnancy, childbirth, and after delivery; preventive and curative treatment of pneumonia, malaria, and diarrhea; and support for nutrition, including breastfeeding, complementary feeding, cash transfers, and wider social protection programs.

Given the recent global economic crisis, it would be easy to be pessimistic about the prospects of achieving MDGs 4 and 5; yet we know that a really dramatic reduction in the number of child deaths is achievable. We know it because many low- and middle-income countries have cut mortality significantly over the last few decades. Many have done so more rapidly than today's developed nations have managed to do in the last century. Although further progress is of course needed, since 1990 more than 60 countries have reduced their child mortality rate by 50%.

One of Save the Children's programmatic approaches to reduce maternal child mortality is the household-to-hospital continuum of care, which strengthens the capacity of caregivers. Whether in the household, the community, health facility, or hospital, this approach helps to address major causes of death before, during, and after childbirth for the mother, as well as the causes of newborn mortality. The approach is outlined on the slide that was presented and that is in your package. You can certainly ask any questions on it during the Q and A afterwards.

Building health workforce care capacity should be a priority, particularly the recruitment and training of front line female health care providers to serve in their communities or in clinics close to their homes. Save the Children has also prioritized community case management as a global child health initiative to address the health needs of children under five. CCM is a strategy in which trained community health workers deliver curative interventions for potential life-threatening childhood infections in remote communities that lack access to health facilities, similar to what Chris outlined in Ethiopia.

For 11 years, Save the Children has reported on the state of the world's mothers. Pregnancy and childbirth is a very risky time, as we know, for mothers in the developing world. Approximately 50 million women give birth each year at home with no professional help whatsoever. This year's report examines how investments in training and deploying female health workers have paid off in terms of lives saved and illnesses averted. It points to low-cost, low-tech solutions that could save millions more lives if only they were more widely available and used.

If we want to solve the interconnected problems of maternal and newborn mortality, we must do a better job of reaching these mothers and babies. Studies show that women prefer female health workers, particularly for uniquely female health issues such as pregnancy and family planning. In some countries, women choose not to vaccinate themselves or their children when the vaccine is administered by a male health worker because they fear the perception of sexual infidelity, or, in the case of some Muslim countries, when modesty precludes women, for example, from lifting up their garments for the vaccine itself.

The report, which is an international report by Save the Children international, dovetails nicely with the Canadian recommendations. We call for training and deploying more health care workers. The number we've put on it internationally at Save the Children is 4.3 million health workers, if we are to meet the millennium development goals by the target date. We also recommend providing better incentive to attract and retain female workers, particularly those working in remote or under-served areas, and that would certainly include better pay and training, support and protection, and opportunities for career growth and professional recognition.

We also believe, of course, that an increased investment in girls' education is essential. If we are to enlarge the pool of young women who are qualified to be health care workers, we must invest in education, obviously. But also, by investing in education we empower future mothers to be stronger and wiser advocates, not only for their own health, but for the health of their children.

Finally, we recommend strengthening basic health systems and designing health care programs to better target the poorest and most marginalized women and children. As we all know, health systems in many developing countries are grossly underfunded and cannot meet the needs of their communities. More funding is needed for staffing, transport, equipment, medicine, health worker training, and supportive supervision, not to mention the day-to-day costs of operating these systems.

Today's developed countries have already cut their mortality rates dramatically over the course of the last century. Many developing countries have made huge strides, often in difficult circumstances. We do not need a major technological breakthrough to dramatically reduce newborn and child mortality; we only need to learn from other countries' successes. We don't need innovation, per se; we simply need the dedication of the adults of the world.

It must become intolerable to all of us here in this room and outside it that a child could die of a preventable or treatable cause, or indeed that a woman should die simply because she's too far away from a hospital or can't afford to have access to health care before, during, or after birth.

The deaths of millions of young children and mothers every year is a moral outrage and comparable to the worst abuses and social evils of the past. Every one of us has a role to play in tackling this problem. Further delay or inaction is simply inexcusable.

Thank you.

[The Chair, Liberal, Hedy Fry]

Thank you.

Now we're going to move to the first round of questions. These rounds are of seven minutes each, but that includes both questions and answers, so I would really like everyone to be as crisp and succinct as possible in both asking questions and answering them.

We will begin with the Liberals, with Ms. Neville.

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

Thank you, Madam Chair.

I thank all of you for being here, in person and by video.

We've certainly heard diverse presentations today. You've all offered very helpful testimony, certainly concerning the child component of the maternal and health initiative. I know that as we get into developing the report, all of your presentations will be considered.

But if you've been following the committee reports, I think you will note that we have been focusing fairly substantially on the maternal health component of the initiative. The testimony of the witnesses of the previous committees talked about the need to reconcile the current proposals by the government with Canada's international commitments and obligations on maternal and child health.

I'm going to put my questions out and then let the time run away with them.

For all of the witnesses, I would ask, given that the G8 has previously committed to a comprehensive approach to maternal and child health in Italy in 2009, and secondly, that the Secretary-General of the UN just today here in Ottawa called on the G8 leaders to honour their previous commitments and promises, would you be supportive of a comprehensive Canadian foreign policy on maternal and child health?

I'll hear your responses, and then I have individual questions for each of the groups.

[The Chair, Liberal, Hedy Fry]

We'll begin with Ms. Snowdon.

[Dr. Anne Snowdon]

Would I be supportive of a comprehensive strategy for maternal and child health? Of course I would be supportive of that. I would encourage a focus on collaboration with the various target countries. One size does not fit all, in my experience, so the population and the specific community needs have to be addressed at every system level in a very collaborative approach.

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

Thank you.

[Christina Dendys]

Yes, of course I'm supportive of a comprehensive approach for the G8 initiative, and a value-added approach for Canada where we can have the most impact as part of that comprehensive approach.

[The Chair, Liberal, Hedy Fry]

Ms. McWilliam.

[Cicely McWilliam]

I feel like I should essentially just say “ditto”. Of course we support a comprehensive approach. We have been a participant in the creation of the brief, which talks about what we feel is Canada's value added.

I think the brief speaks for itself in that regard.

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

We haven't had a chance to look at it. We just got it, so I haven't read your brief yet.

[The Chair, Liberal, Hedy Fry]

Ms. Fuselli.

[Pamela Fuselli]

I would echo the opinions that have been expressed and add my support to Dr. Snowdon's comments about involving those who are going to be impacted by any of the policy outcomes.

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

I'm assuming, then, from your remarks, that you would believe that full access to all reproductive services would be included as a basic human right; correct me if I'm wrong.

I have some other questions as well.

For Results Canada, from your perspective, what are the top three evidence-based interventions for women's reproductive health and for maternal health and for child survival?

For Save the Children, you referenced substantially the training of health care professionals. I would be interested to know how your organization trains and works with other countries to train and build capacity of health care professionals.

For Ms. Snowdon and for Ms. Fuselli, is it your understanding that injury prevention is part of the G8 commitment to maternal and child health that was made in Italy last year?

[Christina Dendys]

In terms of where we are, in our brief, I think we've identified that we think the top intervention in terms of addressing maternal and child health both—this, I think, is echoed in the brief of the Partnership for Maternal, Newborn and Child Health—is access to health services and skilled health attendants along the continuum of care, including front line health workers, but all along the continuum of care.

We've highlighted front line health workers as an entry point for Canada, and that certainly is highlighted within the partnership's manifesto as well. In fact, I think they call for a million skilled and trained front line health workers as an actual numeric target.

In terms of the interventions that address child survival and child mortality, the four leading killers of children are pneumonia, malaria, diarrhea, and an underlying cause in malnutrition. What we're suggesting is that you can't really isolate what the interventions are. We've been advocating for an integrated bundle of interventions that would be delivered to treat the whole patient.

[The Chair, Liberal, Hedy Fry]

Thank you.

Ms. McWilliam.

[Cicely McWilliam]

Save The Children obviously works predominantly with children. When we do work on maternal health issues, it is often through the work we do with children. For example, we do a great deal of work around breastfeeding and we do a great deal of work around prenatal support and vitamins and postnatal care. That is our focus. Save The Children as an organization does not perform abortion services, just to be clear.

In terms of what we believe is the focus—I'm sorry, I thought you might have had the brief earlier, but I can clarify—as Chris was saying, we do believe that the focus for the Canadian value-add is front line workers. As I said, at Save the Children we actually call for a greater number of front line workers than the partnership does. We call for 4.3 million health care workers in general, but a lion's share of those in the field.

As for the training we provide, for example with the community health workers in the CCM project, we ensure that they can diagnose malnutrition, can diagnose pneumonia, diagnose malaria; that they can provide treatments for those illnesses. We do kangaroo care, which is essentially teaching women—

[The Chair, Liberal, Hedy Fry]

Could you please finish?

[Cicely McWilliam]

Wrap it up? Okay.

So that is the kind of work we do when we work with community health workers, and that's who we train.