Veterans Affairs Committee on Oct. 31st, 2023

[The Chair, Liberal, Emmanuel Dubourg]

Welcome to meeting number 68 of the House of Commons Standing Committee on Veterans Affairs.

For the first hour, pursuant to Standing Order 108(2) and the motion adopted on Monday, October 3, 2022, the committee is resuming its study on the experience of women veterans.

For the second hour, we will discuss the national monument to Canada’s mission in Afghanistan.

Allow me to say hello to two individuals who are here today as substitutes. Carine Grand‑Jean will be acting as clerk and Diana Ambrozas as our analyst.

In accordance with our usual procedure, before speaking, please wait until I recognize you by name. The connection tests have been completed, and everything is in order. Although the room is equipped with a sound system that performs well, it is possible that audio feedback will occur, which can be extremely harmful to interpreters and cause serious hearing injuries. The most common cause of audio feedback is an earpiece being too close to a microphone. So we ask all participants to be very careful when using their earpieces. In order to prevent incidents and to protect the interpreters' hearing health, I invite participants to ensure that they are speaking properly into the microphone and to avoid manipulating their earpiece.

Pursuant to our motion, we are resuming our study on the experience of female veterans. Having said that, before we welcome our witnesses, I would like to provide this trigger warning. We will be discussing experiences related to mental health. This may be triggering to people who are here, to viewers, members, or staff with similar experiences. If you feel distressed or need help, please advise the clerk.

Now, I would like to extend a cordial welcome to our guests.

For the first hour, as an individual, we have Chris Edwards, researcher; from the Canadian War Museum, we have Mélanie Morin-Pelletier, historian; and from Veterans Emergency Transition Services, by video conference, we have Debbie Lowther, chief executive officer and co-founder.

We're going to start with opening statements.

I'd like to invite Ms. Mélanie Morin-Pelletier to make her opening statement.

Please go ahead. You have five minutes.

[Mélanie Morin-Pelletier, Historian, Canadian War Museum]

Mr. Chair and members of the committee, thank you for inviting me to contribute to this important study.

You have been fortunate to hear testimony from dozens of women veterans, who have courageously shared parts of their experience. As a military historian, I can only offer a simple summary of more than 20 years of research on the lives and experiences of women veterans in the two world wars.

Studying the historical context of these pioneering women's military service helps us understand the rest of the story. We quickly realize that the challenges these women dealt with in that era's social and military structures persisted for a long time, as did the barriers, pre-conceived notions, discrimination and prejudice they faced.

Until 1941, the only title a woman in the Canadian army could have was “nursing sister”. A total of 2,845 nursing sisters served in France, Belgium, England, Greece and Russia during World War I, 60 of whom died as a result of injury or disease. They were given a military rank corresponding to that of lieutenant, which gave them some authority over their patients in hospitals, but not over the men outside them. As you can imagine, that caused some confusion at times. As officers, however, they were forbidden to fraternize with soldiers outside hospitals. That was one way to protect their public morality. They were also required to wear a different uniform, including a long blue dress and white veil, which very much resembled a nun's habit of that era. These women were thus portrayed in the contemporary and media as white angels and universal mothers, and their behaviour was to reflect those stereotypes.

The rules required military nurses to be single at the time they enlisted. There were a few exceptions for married women and widows, but they had to have no dependents. Until 1943, those who got married were released from their duties. Until the 1970s, the Canadian Armed Forces viewed marriage and maternity as major problems and valid reasons for relieving women of their duties.

These pioneers wanted to serve their country in both world wars. I would like to say that there were always more women volunteering than there were available positions. The main reasons they gave for enlisting were that they wanted to serve their country and help win the war. These women had to struggle through a social, political and military system that considered their presence tolerable for the duration, but mostly unwanted.

Even during World War II, when over 50,000 Canadian women wore the uniform and served mostly in Canada, the army continued to describe their contribution as an emergency measure. They served in order to free up men so that they could do the fighting. As you know, women were barred from combat roles until the late 1980s. As a then-popular saying put it, these women were “the girls behind the boys behind the guns”. They were not employed because of their right or need to work, and which was often the case after the economic crisis of the 1930s. They were really employed because the situation was urgent, exceptional and temporary. This emphasis on their status as time-limited guests had a dramatic impact on the way they were treated as veterans after the war.

Veteran nurses, for example, were expected to rejoin the civilian health care system as soon as possible, whereas some of them hadn't done the same type of work for nearly four years. Women veterans who had served in other roles during World War II were expected to favour marriage as a career option. Steps were also taken to ensure they did not compete with men veterans, who were given priority for jobs.

In closing, this very brief summary shows that the social and military context in which Canadian woman's military service evolved, which, by the way, includes the hypermasculine warrior culture, marginalized women and minimized their more than 100‑year-long contribution to Canada's military history.

Thank you very much.

[The Chair, Liberal, Emmanuel Dubourg]

Ms. Morin‑Pelletier, thank you very much for that historical information that you have presented.

Now I'd like to invite Ms. Chris Edwards to take her five minutes, please.

[Chris Edwards, Researcher, As an Individual]

Thank you for the opportunity to speak to all of you today. This is a very important subject area for me, so I'm very grateful.

I'll be speaking to you today as a researcher and a civilian who supports members of the Canadian Armed Forces, our first responders and veterans.

My research focus at this time is how biological sex, reproductive health and occupation are related to musculoskeletal injuries. I will likely be referring to musculoskeletal injuries as “MSKI”, because it's a lot easier to say.

Women have been serving in Canada for over a hundred years in both military and RCMP contexts. Research, training, infrastructure, equipment and resources for both serving and retired female members do not reflect this. In fact, when I conducted my first literature review in 2018 to build evidence-based rehabilitation and physical training programs for the CAF members I was supporting, there wasn't a single study published on the common injuries among Canadian servicewomen. As a world leader for the integration of women into careers that are historically open only to men, we need to do better.

What do I mean by “do better”? I'm now going to share, with permission from the sources, some examples and quotes from female members.

One says, “The sexism that is systematically built into our medical care also makes it so that any female-specific medical issues aren't taken seriously. I also hear that's health care in general though, so I guess it doesn't matter if it's documented. It won't really help.”

Another says, “I had my breasts basically removed to fit my kit. Yes. Having a surgically modified chest designed specifically to be flatter has helped me better fit my kit and that is super messed up because women shouldn't have to cut their boobs off to be able to do basic military tasks without the injury risks by just wearing their kit they're forced to wear.”

This is another: “I went in with bad cramping and asked to have my IUD removed. They wouldn't look at me because I was being posted out soon and they said just to do it when I get to my next posting. When I got there, it took eight months before someone would take out my IUD and they just gave me naproxen. They offered me more drugs, but I just wanted the thing out because I'm pretty sure it wasn't put in right in the first place. This experience has stopped me from going to the MIR when needed, I would rather pay out of pocket to be taken seriously.”

This one says, “I am avoiding putting my claims in through VAC because they're notoriously horrible to deal with and I don't have the bandwidth to do that on top of everything else.”

Finally, this says, “No woman I know wears the front plate. I end up just wearing two back plates on my frag vest because at least it kind of fits.”

I'm now going to speak to the research that I've been a part of at the Adamo Lab at the University of Ottawa.

Females serving in the CAF experience higher rates of pelvic floor dysfunction when compared to the civilian population. Female CAF members experience higher rates of overuse injuries when compared to their male colleagues. Female members experience higher rates of injuries during their annual physical force test compared to their male colleagues. Female members who have given birth are more likely to sustain overuse injuries than their nulliparous peers and also males. Only 6.7% of CAF members who have been pregnant while serving received specialized physical training support—that's 6.7%.

To conclude, Canada has taken a gender-neutral and female-inclusive approach. Unfortunately, evidence-based “gender-neutral” means “man”, because of the lack of women representation in research. Until the physiology, biomechanics and anatomy of females are included in the CAF health services training courses, prioritized in research and required to be supported by the defence team, the needs of female CAF members and veterans will not be understood, and they will continue to be invisible.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you very much, Ms. Edwards.

Now I'd like to invite from Veterans Emergency Transition Services, Ms. Debbie Lowther, to open the mike and begin.

You will have five minutes. Please, go ahead.

[Debbie Lowther, Chief Executive Officer and Co-Founder, Veterans Emergency Transition Services]

Mr. Chair and committee members, thank you for inviting me to speak with you today as you undertake this very important study on the experience of women veterans. Honestly, I find it disheartening that in 2023 there is an overwhelming need to even have this conversation.

As a national registered charity with an aim to provided immediate, on-the-ground support to Canadian Armed Forces and RCMP veterans who are homeless, at the risk of becoming homeless or otherwise in crisis, VETS Canada has had the privilege to interact with thousands of veterans since our inception in 2010. According to figures based on the 2021 Statistics Canada census, women represented 16.2% of veterans but women veterans currently account for just over 19% of our caseload. Because of this, we are in a position to have many experiences shared with us.

The stories we hear are all unique, but there are many common themes. First of all, almost every female veteran we have worked with has disclosed having experienced military sexual trauma and sexual harassment. The other common themes we hear are that women veterans feel invisible, they feel a strong sense of betrayal and they feel more judged by VAC than their male colleagues.

We have many women veterans who tell us that by the time they released from the Canadian Armed Forces, they were so physically and mentally exhausted from working twice as hard to earn half the respect as their male counterparts received that they didn't have the capacity to effectively manage their own lives and they completely fell apart. Many women veterans have told us that their time in the CAF wounded them, and then they went to VAC only to have salt added to the wounds.

We hear from numerous male veterans that their erectile dysfunction is an approved, pensioned condition through VAC, but then we have women veterans who tell us that they experience sexual dysfunction but have been regularly denied any recognition of their condition. Some women veterans have told us that when they are discussing their situation or their symptoms with health care providers or VAC case managers, they have been told, “It's all in your head,” or “You're being dramatic.” We have never had a single male veteran tell us that they have been called “dramatic”.

If we could provide any recommendations to improve the experiences of women veterans, a couple would be as follows.

The first recommendation is for the CAF, not VAC. They say prevention is the best medicine, so if there was a segment of training included in basic training around what constitutes sexual misconduct or sexual harassment, maybe we could prevent some of the military sexual trauma. I realize that we shouldn't have to train people to be decent human beings but, sadly, it seems that we do.

Next, there are six ministerial advisory groups but none specific to women veterans, and there should be. I think it's important for VAC to listen to women veterans, but a good representation of women veterans. Last year, VAC held a women and 2SLGBTQI+ veterans forum, which consisted of a series of panel discussions. There were 11 veterans and currently serving CAF members on the various panels. One was a retired sergeant and one was a retired master corporal, the rest were all officers. I don't think that was a realistic representation of women veterans' voices.

Finally, there is something that just hit me last week as I was preparing a report for VAC as a requirement of our funding from the veteran and family well-being fund. There is a question in the report, as there was in the original application for funding, around GBA+. When I got to that question, I thought, with all of the inconsistencies and deficiencies in the experiences of women veterans, maybe VAC needs to apply a GBA+ lens to their own policies and programs.

Thank you all for listening. I look forward to your questions.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you very much, Ms. Lowther.

Now we're going to start the first round of questions.

I'm pleased to invite Mrs. Wagantall for six minutes, please.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you very much, Chair.

Thank you, all, for being here today. I know that what we're hearing today is going to make a big difference to this study.

I'm going to begin with our friend Deb Lowther with VETS Canada.

Thank you for all the work that you've done since 2010. I note that you began as a service for those who were homeless and since then have expanded, Deb, into helping those in financial need or mental health crisis, specifically in regard to women but also in general.

On those two areas of need, have you found that they play a role in homelessness? Is it the chicken before the egg or which...? What have you learned since taking on those areas as well?

[Debbie Lowther]

We've learned that there are lots of circumstances that lead to homelessness, with financial need being one of them. We do support veterans who are not homeless but could possibly be on the trajectory to become homeless because of a financial crisis. Lots of mental health issues have led veterans to need our support—mental health and addictions. Those are almost always related to their service.

We've also, in the last little while, started supporting a number of still serving members, as we see the rising prices of everything. Everybody seems to be struggling, so we're trying to help as many people as we can.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Sure. Thank you.

Can you tell me how many are women? What's the ratio, or what have you found in the past while? There's a little bit more recognition of the fact that our women veterans are suffering. They're suffering in ways we hear today, of course, that are contrary to what other veterans may suffer.

[Debbie Lowther]

We actually see that about 20% of the veterans coming to us looking for support are women. That's been an increase over the last couple of years. I would say, probably about seven or eight years ago, we were only at about 13% of female veterans on our caseload. Now we're between 19% and 20%.

They deal with lots of other challenges that male veterans don't face. Lots of them are fleeing domestic violence. In the situations we see, most of them have children with them. They're more apt to come forward, not stay in shelters and sleep rough, because they have children. They're more likely to come forward and ask for help.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Ms. Edwards, I would like to ask you a question. Probably some of my colleagues wouldn't necessarily know the answer to it.

You talk about overuse injuries. Can you define that for us, please?

[Chris Edwards]

Often when we're looking at musculoskeletal injuries we classify them in two different ways. When we have an acute injury, there's a clear mechanism. You fall off a curb and break your ankle. We know what happened.

Overuse injuries are the accumulation of microtraumas over time. Something that's common in the news right now is MTBI, mild traumatic brain injury. It's subconcussive trauma over time. Fractures, tendinitis and bursitis would be examples of that. Those types of injuries are what I'm talking about.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you very much.

That is an issue that we're finding, of course. Lots of times what CAF or VAC responds to are more of the critical incident injuries.

Can you speak a little bit more to the importance of recognizing—especially in women and the challenges they're facing—these repetitive tasks or circumstances where they find themselves being injured on a long-term basis and it's harder to deal with?

[Chris Edwards]

To start, overuse injuries are preventable. By definition, they occur over time. There are many time points where we can intervene and stop these from becoming a really big issue.

They impact females at a greater rate than they do males. In the Canadian Armed Forces it's 76% of females, compared to just around 70% of males. The disparity doesn't seem that big, but when you break it down into occupational roles, that actually expands.

For females, everything that they do isn't designed for them. We have this in other contexts as well, such as a female interacting with a keyboard. A keyboard is designed for a man's hands. We have to stretch. A female is more likely to get carpal tunnel in a non-military context.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you very much. I appreciate that response.

I have a short minute left.

Ms. Morin-Pelletier, I wanted to just ask very briefly how you determine what you study in regard to those often overlooked by history.

[Mélanie Morin-Pelletier]

Can you repeat the question?

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

I'm sorry. How is it that you determine what you're going to study and write about?

[Mélanie Morin-Pelletier]

At the War Museum—

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

You can use French if that's more comfortable for you. I can take the interpretation.

[Mélanie Morin-Pelletier]

At the War Museum, I'm a trained historian in women's history. I came with that passion. I started studying military nursing more than 20 years ago. I brought that expertise with me. Now my mission is to give these women a voice that they didn't necessarily have in traditional military history. I'm very lucky to be able to do that at the War Museum.

[Cathay Wagantall, Conservative, Yorkton—Melville, SK]

Thank you so much.

[The Chair, Liberal, Emmanuel Dubourg]

Thank you very much, Mrs. Wagantall.

Now I'd like to invite Mr. Miao for six minutes, please.

[Wilson Miao, Liberal, Richmond Centre, BC]

Thank you, Mr. Chair.

Thank you to all the witnesses joining us today, online and here, including all the guests.

Through the chair, I'd like to direct my first question to Ms. Edwards.

Thank you for being here.

In your research, you have been particularly interested in how childbirth and occupational roles influence injury risk in service members. We have heard from previous witnesses about the need to have more research about women in the CAF and about women veterans. Can you please share with us more about your research on that particular topic?

What we can do to influence how women veterans should be treated?

[Chris Edwards]

First of all, we're navigating systems that haven't been built to support a female through their lifespan in a career in the CAF. Female reproduction wasn't considered in the medical system when we stood it up, and it's not captured in the supports we have.

Again, for the 6.7% of CAF members who have received physical training support during or after a pregnancy, that includes through a pregnancy and the postpartum period. They can take a year to 18 months after childbirth, if they want. It's really up to them when they return to duty. They have to complete their FORCE test—which is our physical fitness standard—to be able to DAG green, which means that they're able to deploy.

We notice that after pregnancy, there is a decrease in physical fitness, so they need to take time, just as they would after an injury, to rehabilitate the body to be able to again perform the tasks to the same capacity they would have before.

We have these females who are preparing for their FORCE test, and they also have to be adapting to their life demands, which have changed. Realistically, most of the time they are the primary parent, providing services to their kids. If they're in a dual-service relationship, their partner is probably gone, so they're having to prepare physically for a test that may or may not pertain to the duties in their job. They have to then also prepare for the tasks of their job. They're doing all this without specialized support.

Most of these females have never gone through a kinesiology or physiologist training program—that's a fairly unrealistic expectation. Their medical support doesn't have women's health training, so when they go to their medic and explain that they pee themself whenever they're running and ask if it's normal, they're told it is. However, they've never actually gone through training to understand that, after six weeks, if we gradually return someone to a running program and provide pelvic floor physio, urinary incontinence is not actually a normal thing. It's a common experience postpartum, but it's not normal.

We don't have medical support that can ask appropriate questions. I'm getting a little off track here, but I'm talking about the physical demands for occupations as well.