Thank you for inviting me to appear before this committee on this critical issue of forced or coerced sterilization.
I'd like to begin by acknowledging that today we're meeting on the unceded traditional territory of the Algonquin people.
We are here today because we are all disturbed by reports of forced and coerced sterilization of indigenous women in this country. I want to acknowledge these women and recognize their bravery. I speak as a first nations woman, member of the Mik'maq Nation of Gespegagiag in the Quebec region, a mother of two young girls, and as someone who has dedicated her entire career to advocating for the health of indigenous peoples, both outside and inside the public service.
Forced or coerced sterilization is a serious violation of human rights and medical ethics. It is a form of gender-based violence. It is evidence of a broader need to eliminate racism and discriminatory practices, ensure cultural safety and humility, improve culturally competent informed consent, and remove barriers that indigenous women face when accessing health services in this country.
This issue is an indication of racism in the health care system, and addressing it is a matter of reconciliation, as cited by the Truth and Reconciliation Commission. All Canadians have a responsibility to ensure that these practices never happen again.
In the motion passed to request this appearance, the government's commitment to the United Nations Declaration on the Rights of Indigenous Peoples was raised. As you may know, in May 2016 the Minister of Indigenous and Northern Affairs announced that Canada is a full supporter, without qualification, of the declaration.
The declaration is a statement of the collective and individual rights that are necessary for the survival, dignity and well-being of indigenous peoples around the world. The government must take an active role in enabling these rights to be exercised. It will fulfill a commitment to implementing the declaration through the review of laws and policies, as well as other collaborative initiatives and actions, some of which I will outline today.
This committee has specifically raised article 7.2 of the declaration, which states that:
Indigenous peoples have the collective right to live in freedom, peace and security as distinct peoples and shall not be subjected to any act of genocide or any other act of violence, including forcibly removing children of the group to another group.
I would also like to point out that the principle of free, prior and informed consent is central to the declaration. In its July 2018 resolution on forced sterilization, the Assembly of First Nations stated that “the forced sterilization of indigenous women by medical professionals breaches the free, prior and informed consent standards contained in the UN declaration”.
Forced or coerced sterilization is not something that any one profession or order of government can address alone. Federal, provincial, territorial and indigenous governments and organizations all have a role to play. At the same time, coerced sterilization is a matter of the practice of medicine. Only surgical practitioners, such as obstetricians and gynecologists, can perform surgical procedures such as tubal ligation, so doctors and those who regulate the profession must be involved. Informed consent policies are administered at the local level, which means that hospital administrators and the health authorities they work within must also be part of measures to ensure free, prior and informed consent, and culturally informed and safe practices.
In keeping with its commitment to the recognition of rights, respect, co-operation and partnership, the federal government can play a leadership role in convening these bodies to facilitate dialogue and action in the spirit of the UN declaration and the principle of free, prior and informed consent.
The government will play this leadership role by reaching out to provincial and territorial ministers of Health, as well as medical associations, to seek ways to work collaboratively to ensure safety and respect for indigenous women in Canada's health care systems.
We will work with our Health Canada colleagues to bring together federal, provincial, and territorial officials to engage with indigenous groups and national provider organizations on measures to ensure cultural safety and humility in health systems.
Within Indigenous Services Canada, the department that I represent here today, we have been acting on this issue for several months. For the sake of time, I will outline some of our more recent actions.
Last week, we held a teleconference with indigenous organizations and national health organizations to discuss ways to advance collaboration and identify actions that will ensure free, prior and informed consent and culturally informed and safe services for indigenous women across Canada. The teleconference was part of our efforts towards a forum in early 2019. This is a milestone event that we had decided to undertake in June 2018 at our senior management committee, where the Assembly of First Nations and Inuit Tapiriit Kanatami are full members, and where we had invited the Native Women's Association of Canada and Pauktuutit, the national Inuit women's association, to attend as special invitees.
The forum will be an opportunity to convene indigenous and professional associations, to mobilize actions for indigenous women's reproductive health, and to discuss a recommendation received at the Inter-American Commission on Human Rights in Bogotá, Colombia to issue guidance regarding sterilization procedures.
Another recommendation made in Bogota was to produce an information brochure for health care providers and patients on proper and informed consent in the context of women's health services. We have been in discussions with national indigenous women's organizations to make this happen.
We are also establishing a new Advisory Committee on Indigenous Women's Wellbeing to inform the department on current and emerging issues, including sexual and reproductive health. The inaugural meeting will be held in January 2019, and we are pleased to have several indigenous women's organizations already confirmed to participate as full members.
In addition to responding to recommendations made at the Inter-American Commission on Human Rights, Indigenous Services Canada endeavours to support indigenous women's reproductive health more broadly through its programs and policies. The maternal and child health program, which was introduced in 2005, offers community-based home visiting services by nurses and family visitors to over 8,100 pregnant women and families with young children in over 300 first nations communities. Through the program, expectant mothers receive case management, screening, assessment and referral services, as well as health promotion strategies to identify risks and improve maternal and child health.
Budget 2017 increased the existing program funding of approximately $25 million annually by $21.1 million over five years, which represents a 30% increase. With $7.5 million ongoing from year five, the total investment by 2022 will be $32.5 million annually.
In addition, budget 2017 invested $6 million over five years for indigenous midwifery—the first ever federal investment into this area. Midwifery care to indigenous communities has been identified as a pathway that improves health and well-being of women, their children and the entire community, and it signals a repatriation of birthing into communities, a longstanding traditional practice. Furthermore, informed choice is recognized as a central tenet of midwifery care in Canada.
While the budget 2017 investment in midwifery is historic for the federal government, it represents just a first step. Most indigenous families in Canada are still with very little or no access to midwifery care. There is some evidence that midwives not only support women in their reproductive health planning, which may prevent further cases of forced or coerced sterilization, but also provide support to women in preventing custodial loss of their children.
Senator Yvonne Boyer and Dr. Judith Bartlett have found that past custodial loss or the threat of custodial loss played a role in coerced sterilization in Saskatchewan. Further work is required in this area, and we are looking to indigenous midwives' leadership to better understand. We are very pleased that the National Aboriginal Council of Midwives has agreed to sit on the indigenous women's well-being advisory committee.
The presence of a support person in labour offers many benefits to a labouring woman, including assisting her with decision making and advocating for her wishes. Budget 2017 also included new investments to strengthen maternal supports by ensuring that all first nations and Inuit women are entitled to an escort when they leave their community for childbirth.
Indigenous Services Canada's Non-Insured Health Benefits Program now provides coverage of an escort to accompany expecting mothers regardless of their age or medical condition, recognizing that no woman should have to give birth alone.
The Government of Canada has committed to implementing the Truth and Reconciliation Commission's calls to action, including calls 22, 23 and 24, which pertain to using and recognizing the value of aboriginal healing practices, retaining and increasing the number of aboriginal health care professionals and providing cultural competency training, and providing anti-racism and cultural competency training for all medical and nursing students.
With the Royal College of Physicians and Surgeons of Canada and indigenous organizations, our department has been exploring project ideas for an online repository of cultural competency learning tools. Last year, the Royal College approved indigenous health and cultural safety as a mandatory component of post-graduate medical education and certification.
In 2013, all Indigenous Services Canada's health-related operations were transferred to the control of B.C. first nations under a newly established First Nations Health Authority, which we refer to as FNHA. The FNHA has done remarkable work with the province and its regional health authorities in finalizing a declaration on cultural safety and humility, and informing cultural safety and humility training across the provincial health system.
The FNHA is presently developing the first-ever cultural safety and humility standard, in partnership with the Health Standards Organization, which is affiliated with Accreditation Canada. We are funding this work.
We are hopeful that other provinces and territories will look to this work as a promising practice. It is a key item that we will bring forward to the newly formed federal-provincial-territorial working group I referenced earlier.
The Native Women's Association of Canada and Pauktuutit have been providing leadership on indigenous women's health, and as our relationship with these women's organizations grows and expands to include Les Femmes Michif Otipemsiwak, Women of the Métis Nation, we are encouraged by their good work and guidance. Their collaboration in addressing the issue is essential to getting this right.
It will take the efforts of many to ensure that structural racism and the effects of colonization do not interfere with the health of indigenous women. I want to assure you that we are taking this matter very seriously and working in the spirit of collaboration and partnership towards culturally informed and safe health services for indigenous women throughout Canada.
I will be pleased to answer any questions that you have.
