Maternal Mortality and Morbidity

Maternal mortality is the death of a woman during pregnancy, delivery, or six weeks following delivery. Maternal morbidity infers life-threatening complications of pregnancy during or within 42 days of pregnancy. Preventable maternal mortality occurs where a failure to realize women’s rights to health, equality and non-discrimination exists.

Sexual Rights at the 27th UN Universal Periodic Review

The 27th session of the Universal Periodic Review (UPR) was held at the UN Human Rights Council in Geneva from 1-12 May 2017. Eleven countries were reviewed during UPR27: Bahrain, Ecuador, Tunisia, Morocco, Indonesia, Finland, United Kingdom, India, Brazil, Philippines, Algeria, Poland, Netherlands, and South Africa.

Click here for sexual rights related recommendations at UPR27

Opinion: How serious is Trudeau about women’s reproductive rights?

Opinion by Sandeep Prasad, Anu Kumar | Published in Ricochet

Trudeau’s feminism has been put to the test since day one of his election. Today, on the Global Day of Action for Access to Safe and Legal Abortion, it’s time for the Canadian government to turn words into action.

While this new government continues to make inroads in changing the rollback of human rights left behind by Harper — through a national inquiry into missing and murdered Indigenous women, reimplementation of the long-form census, and the historic welcoming of 25,000 Syrian refugees into the country — Trudeau is slow to act on his promises to advance women’s reproductive rights, namely access to safe and legal abortion at home and abroad.Without access to safe and legal abortion, women often turn to unsafe methods. Every minute, some 40 women around the world undergo unsafe abortion because they have little choice and for myriad reasons do not want to continue the pregnancy. Unsafe abortion is one of five leading causes of maternal mortality and is the only one that is completely preventable.

Above all, access to safe abortion care is a fundamental human right. Global human rights bodies have consistently recommended withdrawing criminal penalties against women who undergo abortions and revising laws on abortion so that unsafe and illegal abortions no longer contribute to maternal mortality and morbidity. Canada now has the opportunity to accelerate this progress.

On the home front, many Canadians face challenges in accessing abortion. Across the country, only one in six hospitals provide abortions, most of which are located in big cities within 150 km of the United States border. And while Trudeau may have played a role in what will be PEI’s first on-island abortion clinic, his government is doing little to push the envelope.

Mifepristone — the pill included in the World Health Organization’s list of essential medicines — was finally approved in Canada last summer. Used to medically induce abortion, the pill has huge potential for increasing access, especially in remote areas of the country, but rules imposed by Health Canada on its use are unnecessarily restrictive and unless revised will interfere with the dignity of those seeking abortion care and impede access to these medicines.

But it’s not just about Trudeau’s role in Canada. With the renewal of the Muskoka Initiative, the government has the opportunity to significantly advance the health and rights of women and girls around the world. Minister Marie-Claude Bibeau can and must fulfil her international development mandate and close the gaps in the Muskoka Initiative with respect to reproductive rights and health.

In March 2016, Bibeau took some first steps by announcing Canada’s renewed commitment to improving sexual and reproductive health in developing countries. The government announced support for United Nations Population Fund projects amounting to $76 million with an added $5 million to be earmarked for contraceptive supplies. It was a nod toward ensuring universal access to sexual and reproductive health and rights, but not enough.

World Health Organization data shows that even when contraception is available an estimated 33 million contraceptive users face unintended pregnancy each year. Abortion is an integral part of reproductive health services and shouldn’t be a taboo subject. It should be part of global — and national — efforts to promote universal access to sexual and reproductive health services.

We know from Ethiopia, Nepal, and countries throughout Western Europe that when abortion is integrated with other reproductive health services such as contraception, unsafe abortions are reduced and women’s lives are saved. This benefits families, communities, and nations.

Trudeau has the opportunity to take a stand in respecting a woman’s right to choose and preventing unsafe abortion practices by including safe abortion as an integral part of health care — a historic opportunity to be a bold world leader in promoting and supporting all aspects of sexual and reproductive rights at home and abroad. As Sept. 28 comes and goes, what better time than now. Because it’s 2016.

Sandeep Prasad LLB is executive director of Action Canada for Sexual Health and Rights, a progressive, pro-choice charitable organization committed to advancing and upholding sexual and reproductive health and rights in Canada and globally.

Anu Kumar is the chief strategy and development officer for Ipas, a U.S.-based international non-governmental organization that works to prevent deaths and injuries from unsafe abortion, to advance women’s sexual and reproductive rights and to expand access to safe abortion care.

Maternal, child health: bureaucrats bolster Liberals’ family-planning focus

Family planning and access to reproductive health services and rights are needed to round out the initiative, a departmental evaluation says.

By CHELSEA NASH
PUBLISHED : Wednesday, May 18, 2016 12:00 AM | The Hill Times

An internal departmental evaluation of the Harper government’s signature foreign-aid initiative appears to bolster the Liberal party’decision to put more emphasis on family planning, including abortion services.

An evaluation by public servants with Global Affairs Canada of the former Conservative government’s maternal, newborn, and child health initiative was posted to the department’s website early this month. It covered the foreign, aid, and trade ministry’s spending on the first four years of the ongoing initiative, from 2010-11 to 2013-14.

Stephen Harper’s Conservative government committed to spending $2.85 billion between 2010 and 2015 to tackle child and maternal mortality in the developing world through a program it called the Muskoka Initiative. Toward the end of that period, the government held a high-profile Toronto conference featuring the United Nations secretary general, and pledged another $3.5 billion for 2015 to 2020.

The Liberals have pledged to continue their predecessors’ foreign-aid focus on the health of mothers and kids, with one big change. In last fall’s election, the party’s platform said: “Closing existing gaps in reproductive rights and health care can and will save lives. We will cover the full range of reproductive health services as part of [maternal and child health] initiatives.”

As anti-abortion supporters gathered in the thousands on Parliament Hill last week, International Development Minister Marie-Claude Bibeau told the Senate Foreign Affairs and International Trade Committee that her government plans to cover “a full range of services. So it starts with sex education for teens, family planning, the fight against sexual diseases, safe deliveries, and safe abortion when it’s appropriate.”

She said $3.1 billion of the $3.5 billion the Conservatives announced was already committed before she became minister.

“We informed these organizations that already had the money that they can, if they believe because of the context they’re working in and if they judge it appropriate, enlarge the range of health services they are offering in terms of health with www.health-canada-pharmacy.com and rights for women,” she told Senators on May 12.

The Conservatives had kicked up a storm of controversy when they decided that their signature aid program wouldn’t cover abortion services, even where legally accessible or in the case of rape victims and child brides. The Harper government reasoned that there were enough other worthy ways to support the health of moms and kids.

While the departmental evaluation report was largely positive, it emphasized that the program didn’t do a good enough job of addressing the “root causes” of high maternal and child mortality, including “reducing adolescent pregnancy, gender violence, women’s lack of power in household decision-making and unmet need for family planning.” These issues were “relatively underrepresented among the implemented programs.”

The report recommended: “The department should consider widening the scope of the…initiative programming by placing greater emphasis on addressing factors contributing to high maternal, newborn, and child mortality, such as reproductive health.”

Sandeep Prasad, executive director of Action Canada for Sexual Health and Rights, said he is “quite gratified” by the fact that a formal report has come out saying “exactly what we’ve been saying for years through our monitoring of the program.”

“For a signature maternal health initiative, one would expect there to be a significant increase in funding for contraception services in addition to funding for safe abortion work,” Mr. Prasad, whose charity calls itself progressive and pro-choice, told The Hill Times in an interview.

Later, in an email, he emphasized that access to safe abortions and contraceptives is important because “over 222 million women around the world who want to avoid pregnancy don’t have access to safe and effective contraception,” he said, citing a recent study by the Guttmacher institute.

Conservative MP Deepak Obhrai (Calgary Forest Lawn, Alta.), who is his party’s international development critic, acknowledged the departmental report addressed “hiccups” that occurred under the Conservative government. Because of the sheer size of the initiative, his government was unable to cover every aspect, Mr. Obhrai told The Hill Times in an interview.

Supply vs. demand

The report said the government program “effectively supported” efforts to reach global goals of reducing high rates of maternal and childhood mortality.

The report, though, stated that the initiative needed to focus more on the “demand” end of maternal and child health, rather than simply focusing on the supply.

“The department’s…strategy focused on the supply side of health interventions, namely improving the availability, quality, and equity of health services,” it read.

“The issues of timely care-seeking and access to services for pregnant women (the demand side) receive relatively less attention, although they are known contributing factors to maternal mortality.”

Sara Schulz, the child health policy adviser for World Vision Canada, said that for a project to be effective, both supply and demand need to be addressed. She said the report was “quite well done.”

“Family planning is really something that is so critical and so crucial and really not something we should be afraid of. It is so essential for young women to access contraception, to be able to decide when they want to start their family, to have a role in marriage and a voice to say well let’s space our children by two years so that I can recover and that I can have a healthy child again,” Ms. Schulz said.

While she said she supported the recommendations outlined in the report, she said the initiative as it stood under the Conservative government was still quite strong.

“It was catalytic at the time and brought a lot of players to the table at the time and leveraged a lot of global support that can’t be understated,” she said.

Departmental management agreed to the report recommendations, in a response included in the report.

Minister of International Development Marie-Claude Bibeau has stated on several occasions that women and girls are going to be a big focus of international development during her mandate. She is currently in Copenhagen at the Women Deliver 2016 conference, the world’s largest global conference women and girls’ rights, health, and well-being.

Mr. Prasad said while he and his organization were critical of the Muskoka Initiative as it stood initially, he recognizes the Liberal government wanting to continue with it.

“I can understand the government’s willingness to not want to just scrap that and start over…They have to seek to transform this through additional funding for areas that were neglected and then they need to reinforce those efforts by coherent policy around sexual and reproductive health with www.health-canada-pharmacy.com and rights that would govern all of Global Affairs’ work.”

Mr. Obhrai said he is happy to see the program progressing. “This is forward looking,” he said. “It’s one of the reasons why we have reports. We have reports so that we can identify [where] we can improve.”

Guidelines for the Implementation of Mother-Child Units in Canadian Correctional Facilities

Developed by the CCPHE and University of British Columbia, the publication describes guiding principles, and the practices that are required for optimal child and maternal health inside a correctional facility, including the correctional context, pregnancy, birth, education, correctional and medical care, discharge planning and community partner engagement.

Click here to read the publication

Accountability in Canada’s Muskoka Initiative questioned

Source: The Lancet
By Paul C Webster

Is the Canadian Prime Minster’s billion dollar initiative for maternal, newborn, and child health failing to meet the standards it has urged on the rest of the world? Paul C Webster investigates.

For decades, detailed information about Canadian aid projects has rarely been made public without lengthy, often futile recourse to legal pressure. Accountability has mostly been a matter of trusting largely unverifiable official accounts. So it came as a surprise to Aniket Bhushan, an analyst with the North South Institute, an Ottawa-based group that closely tracks Canada’s CAN$4 billion annual international development budget, when the Canadian Government published an online list of projects for its $2·85 billion Muskoka Initiative for maternal, newborn, and child health. But as Bhushan began probing the newly published information about the Initiative, his hopes quickly turned to disappointment. Although the project list—which included some details on costs and results—represented a breakthrough of sorts, it was riddled with worrying gaps. “It seemed useful at first”, Bhushan explains, “but the numbers don’t line up. They are incomplete. I realised very quickly there was no point working with it.”

Canada’s partial turn toward foreign aid transparency—bittersweet as it has proven for analysts like Bhushan—can be traced directly to Canadian Prime Minister Stephen Harper, who first emerged as a champion for international maternal health during a 2010 summit with the heads of state for the G8 nations in Muskoka, a vacation area north of Toronto. In an initiative that helped deflect attention from the summit’s $1·1 billion price tag, Harper committed Canada to $1·1 billion in new spending for maternal and child health over the coming 5 years on top of $1·75 billion in existing Canadian commitments. As part of the Muskoka Initiative, Harper added, a further $4·5 billion in funding from other nations and private donors had been pledged.

It was a message that pleased many global health advocates; Harper’s conservative Christian power base liked the emphasis on mothers and children as well. To reassure some of its most ardently Christian supporters, the Harper government had previously terminated Canadian development support for abortion services, a move that not only contradicted domestic Canadian law but also the laws of most countries where Canada funds maternal health programmes, according to Sandeep Prasad, executive director, Action Canada for Population and Development.

Accountability focus

In launching the Muskoka Initiative, Harper insisted it would not be another soon-to-be-abandoned exercise in G8 wishful thinking. “Accountability will be the key”, he stressed. “We’ve put increased emphasis on that.” To follow-through on this promise, Harper soon agreed to serve with Tanzanian President Jakaya Kikwete as co-chair of a Commission on Information and Accountability for Women’s and Children’s Health (COIA), established under UN auspices in late 2010. The new commission moved quickly. In May, 2011, just as Canadian aid officials began posting information about Muskoka Initiative projects on the internet—the COIA issued Keeping Promises, Measuring Results, a 31-page report calling for ten key reforms within startlingly short deadlines. For countries with high rates of maternal and child mortality, Harper and Kikwete recommended the establishment of vital statistics registries, adoption of common health indicators, development of national health information systems, and bolstered health spending review capacities, all before 2015. For donor and recipient countries alike, the COIA recommended that, by 2012, “compacts” be written between governments and development agencies to report expenditures, and that all countries establish transparent “national accountability mechanisms”. By 2013, the COIA wanted all stakeholders “publicly sharing information on commitments, resources provided and results achieved annually, at both national and international levels”.

As a final recommendation—in an effort to hold the world accountable for accountability itself—the Commission established an eight-member independent expert review group (iERG) to report to the UN. Perhaps not surprisingly, the iERG (which is co-chaired by Lancet editor Richard Horton) hasreported “checkered” results in many nations with high rates of maternal and child mortality, says Tarek Meguid, a physician based in Tanzania who serves as one of the group’s three Africa-based members. In its 2013 report, the group judged that “half of the recommendations are currently off track, meaning that they will be difficult or impossible to achieve by 2015”. The Commission’s deadlines “weren’t realistic”, says Dean Jamison, professor in Global Health Sciences at the University of California, who serves as the iERG’s sole American member.

Deadlines aren’t the only problem. Although the Commission estimated it would cost $96 million to implement its recommendations, much of this money has yet to materialise. “Transparency costs money”, Jamison explains. “Getting the numbers straight in a way that is accessible is hard work that takes trained people large amounts of time.” So far, only Canada, Germany, and Norway have contributed. At present—although more money may yet be found to help those countries that are implementing the COIA recommendations, according to Ties Boerma, director of the WHO Department of Health Statistics and Informatics—the iERG reports a shortfall of at least $50 million.

Whether the lack of financial support from donor nations for accountability on maternal health reflects a lack of commitment to accountability itself is a question worth asking, Jamison says. “It absolutely would have been better to have secured the funds up front. If the international system really placed a high priority on it, this would happen.”

Donor responsibilities

Although the COIA mostly emphasised the need for reporting, transparency, and accountability in countries that receive aid, Jamison notes, its recommendations also apply to donor nations such as Canada.

In Ottawa, Aniket Bhushan and other Muskoka Initiative analysts believe the Harper government has failed to meet the standards its leader urged on the rest of the world. Jean Francois Tardif, national coordinator for Global Poverty Solutions, a research group that studies Canadian aid commitments, agrees with Bhushan that although the government’s own numbers indicate it may be meeting its commitments to the Muskoka Initiative, the government’s patchy transparency effort makes verification impossible. “You have to trust the powers that be”, says Tardif. “There is an issue of basic accountability in that I cannot reproduce the government’s figures.” Bhushan and Tardif both note that in the period since the launch of the Muskoka Initiative, the Harper government has slashed Canadian aid spending by roughly 20%—amounting to an estimated $800 million in 2013. Canadian aid as a percentage of gross national product is now among the lowest in the wealthy world.

The UN has expressed similar doubts about Harper’s accounting for international commitments to the Muskoka Initiative on its website addressing the initiative. Although the UN notes that $7·3 billion was pledged, it cautions that “it is not clear whether these commitments are additional to other ODA [overseas development assistance] and health commitments”.

Diane Jacovella, assistant deputy minister for Multilateral and Global Programs with the Canadian Department of Foreign Affairs, Trade and Development in Ottawa, says the Canadian Government is “attempting to make the information we have as available as possible”. The government’s Muskoka Initiative website “may not have all of the initiatives that we have in place”, she acknowledges. But Canada is “on track”, she avers, and has disbursed 80% of its Muskoka commitments. A full accounting for the Muskoka Initiative funds will be provided by 2017, she promises. “If the issue is are we committed to making the information available, we are.”

Financial opacity is not the only worry. According to a 2012 study led by Helen Scott, director of the Canadian Network for Maternal Newborn and Child Health (CAN-MNCH), which has received $1·8 million from the Muskoka Initiative to form a network including many Muskoka Initiative grantees, although Harper’s COIA specifically indicated that all countries and organisations should be collecting information about 11 key outcome indicators, only 36% of CAN-MNCH were collecting this information. “While all organisations reported being aware of most metrics reported in the COIA, very few were actually measuring their progress using these metrics”, Scott reported. “Indeed, only one third of organisations reported using any outcome measures to evaluate their program’s impact.” At the Department of Foreign Affairs, Trade and Development, Diane Jacovella acknowledges that progress here has been uneven: “This is one of the most difficult things in terms of getting people to agree on a small set of indicators, and consistently monitoring them.”

Nor have Canadian officials embraced the COIA’s recommendation that results be made fully public. When The Lancet requested outcome reports for five recently completed Muskoka Initiative projects described online, officials refused to release four of them, citing legal concerns. For the fifth project, no outcome report was prepared. “If it is confidential information”, explains Jacovella about the government’s refusal to release outcome reports on projects executed by third parties, “of course we can’t share it”. Nevertheless, she insists, “we do take accountability seriously. We don’t just talk about it”.

Canada keeps its funding promises for world maternal and child health

Source: The Globe and Mail
By Kim Mackrael
Published

The federal government was rolling out a stimulus package aimed at kick-starting Canada’s flagging economy. Two of North America’s biggest car manufacturers had recently been bailed out, and there was widespread concern about whether some of the world’s major economies would recover from a recession that had left millions without jobs.

But in the fall of 2009, Prime Minister Stephen Harper was also taking some time to consider the foreign-aid agenda Canada would champion as host of the next G8 summit of wealthy nations. In the months leading up to the summit, Mr. Harper spoke personally about his plans with billionaire philanthropist Bill Gates and his officials held a series of meetings with Canadian non-governmental organizations to discuss how the G8 might focus its poverty-alleviation efforts.

Nearly five years later, Ottawa is on track to spend some $2.85 -billion on maternal and child health initiatives around the world. The investment will be on display next week when the government convenes a group of global leaders for a summit in Toronto, including the Queen of Jordan, the Aga Khan, and United Nations Secretary-General Ban Ki-moon.

Despite recent efforts by Canada and others, the world is not on track to meet global goals for reducing maternal and child mortality before the United Nations’ 2015 deadline, prompting calls for another round of substantial funding and renewing debate about Canada’s foreign aid efforts.

The pitch

In the lead-up to the 2010 G8 summit, a group of Canadian NGOs launched a collective push to advocate for maternal and child health to be Canada’s primary development cause at the summit.

Their pitch? It was clear that at least two of the UN’s Millennium Development Goals were making limited progress: The number of women who died during pregnancy and childbirth and the number of children who died before their fifth birthday remained stubbornly high.

The idea appealed to the Prime Minister’s Office because the results of the investment would be relatively easy to measure.

There was also some political calculation, according to one former official, who spoke on condition of anonymity: The project could help counter a narrative that the Conservative Party wasn’t concerned about global poverty and foreign aid.

At the same time, Mr. Harper held talks with Mr. Gates, the billionaire founder of Microsoft and co-chair of the Bill and Melinda Gates Foundation, a U.S.-based aid organization. The two already had a working relationship ahead of the summit, and their discussions included how the G8 could improve accountability for its poverty-reduction efforts.

Earlier this week, Mr. Gates’s wife, Melinda, issued a call for more money to be spent on the health of mothers and children around the world, and especially on vulnerable newborns, where progress has been particularly slow. The appeal from Ms. Gates, who will participate in next week’s summit, adds to the pressure for Mr. Harper to deliver additional funding for the cause.

The controversy

Soon after the Prime Minister announced that the G8’s development efforts would focus on maternal and child health, then-Liberal Party leader Michael Ignatieff issued a public call for the funding to include access to safe abortion – an appeal that appeared to catch the Prime Minister’s Office flat-footed. The government responded by saying that abortion would not be part of the initiative, but then-foreign minister Lawrence Cannon later took the idea further, declaring that family planning would also be kept off the table. (That position was quickly reversed.)

One former official called the government’s decision to exclude safe abortion services a “reactive” move that took place in a policy vacuum. But the decision has persisted, and International Development Minister Christian Paradis said in a recent interview that the government has no plans to change its approach.

Sandeep Prasad, who directs Action Canada for Population and Development, called the exclusion “hypocritical” because it approaches abortion abroad differently from how it approaches it at home. Many countries that receive Canadian aid permit legal abortion under varying circumstances, he said, “so we can’t use restrictive laws overseas as an excuse for not funding this. That’s clearly just an excuse.”

The former government official, who spoke on condition of anonymity, said it was felt at the time that abortion was only one aspect of the initiative, and that a greater impact could be made with a focus on other areas of concern, such as midwifery, nutrition, and family planning. Some of the NGO leaders who had argued in favour of the initiative also felt the funding could be focused elsewhere, saying they felt it was better to find common ground that all of their members – and the government – could agree on.

A personal commitment

Today, Mr. Harper is known as a strong supporter for maternal and child health. While he spurned an opportunity to speak at the United Nations General Assembly last fall, the Prime Minister co-hosted a separate UN event on maternal and child health in New York City. He also met with the UN Secretary-General for talks that – along with other global concerns – included a discussion about the need to keep maternal, newborn and child health in focus after 2015.

“A government wants to get political credit for what it’s doing, and you want to do something that’s going to look good. That’s what politicians do. But I think it was much more than that,” said Paul Wilson, a former director of policy in the PMO who now teaches at Carleton University. Mr. Harper “has kept at it for the last four years, being personally involved in this, in a way that I think a lot of people find surprising.”

Outside experts say that, unlike some donors, Canada has so far kept its funding promises on maternal and child health. In 2010, Canada promised $1.1-billion in new funding over a five-year period, on top of $1.75-billion that was already earmarked for maternal and child health, and the government says it has spent 80 per cent of that money so far.

Sering Falu Njie, deputy policy director with the UN Millennium Campaign, said Canada’s efforts have been laudable. “Many times we have these initiatives and we have a number of pledges … but at the end of the day we end up not getting the [money] that’s been pledged,” he said in a recent interview. On maternal and child health, however, “Canada has actually met its commitment.”

A continuing debate

While they don’t dispute the value of added resources for maternal and child health, some experts argue that there are significant gaps in Canada’s approach, beyond the decision not to fund abortion services. Mr. Prasad said Canada should do more to support sexual and reproductive services for low-income countries, including counselling for family planning, sexuality education and the provision of contraceptives.

Rebecca Tiessen, who teaches international development and gender studies at the University of Ottawa, said the initiative’s success has been limited by a failure to address pervasive gender inequalities that often make it harder for women to access services that are being offered.

“It is very much symptom-oriented,” she said of Canada’s funding. “We do need that aspect of it, we don’t want to lose sight of that, but it means so much less – and one might even argue it means nothing – if women are never able to access those services.”

Ghosts of abortion debate haunt maternal, child health summit

Source: Embassy News
Published on Wednesday, 05/14/2014 12:00 am EDT
By Kristen Shane

Sexual and reproductive health needs more attention, say some development workers

The same concerns about a lack of funding for safe abortions and sexual and reproductive health that bubbled up four years ago when Prime Minister Stephen Harper declared maternal, child and newborn health his main development priority threaten to boil over again as Canada and the world look to recalibrate their commitments later this month in Toronto.

Click here to continue reading

Opinion: What Canada Can Do About Adolescent Pregnancy and Forced Marriages

Originally published on Huffington Post Canada
By ACPD (now Action Canada) Executive Director Sandeep Prasad and Rathika Sitsabaiesan (Chair of the CAPPD)
On October 30, UNFPA released its 2013 State of World Population Report on the theme of adolescent pregnancy globally. The report draws critical links between the issue of adolescent pregnancy, early and forced marriage, sexual violence and maternal mortality — all priority development issues for the Canadian government.

These human rights violations can lead to adolescent pregnancy. Over 39,000 girls are married every day and 90 per cent of girls who give birth are in these marriages. The seven in 10 women who experience sexual violence and survive are twice as likely to experience unintended pregnancy. Adolescent pregnancy can also result in other human rights violations, such as the right to life. Over 70,000 adolescent girls still die every year from preventable causes related to pregnancy and childbirth, making it the leading cause of death among adolescents aged 15-19.

In addition to the 2010 Muskoka Initiative on maternal and child health, the Canadian government has recently pledged its support to address issues including child marriage and sexual violence in conflic

t and war. Despite the stark realities identified in the report and the government’s commitments and pledges on these issues, the government’s actual support for sexual and reproductive health programming overseas lags far behind. Even with the Muskoka commitment of $1.1 billion of new funding for maternal and child health over five years, the government’s funding specifically for family planning, which is critical for preventing unwanted pregnancies, has in fact decreased since 2005 from $17.9 million to $6.8 million in fiscal year 2011-2012.

Numerous declarations of Parliamentarians from around the world have set a target for donor governments to allocate 10% per centof foreign aid to sexual and reproductive health. If we include the fact that Canada is well under the mark of contributing 0.7 per cent of GDP to development assistance in general, then we see that it would take a commitment the size of four new Muskoka initiatives devoted entirely to sexual and reproductive health for Canada to be fulfilling its fair share.

Statements on sexual violence and child marriage must come with a firm commitment to contribute to the well-being of survivors of these human rights violations. This includes helping to ensure their sexual and reproductive health needs are cared for.

Recognizing that many unwanted pregnancies occur as a result of sexual violence in conflict settings and among girls, the UN Secretary General himself has deemed access to sexual and reproductive health information and services as critically important.

To be effective and to uphold women’s rights, Canadian funding for sexual and reproductive health must be comprehensive and must also include funding for safe abortion services. Twenty-four out of Canada’s 33 priority countries for development permit abortion on grounds of women’s mental health, rape or without restriction. Canada’s unwritten “policy” to not fund abortion abroad, even in cases where women are legally permitted to access the services, not only contradicts the Canadian Health Act but also national laws in the majority of countries in which the Government supports development initiatives.

Despite UNFPA’s recent report’s findings that 3.2-million adolescents each year undergo an unsafe abortion, the Government has stated it has no intention of funding safe abortion services, even in cases of sexual violence as a result of war or for young women and girls in early and forced marriages. In direct opposition to this approach, the U.K. government has taken active steps towards the realization of women’s and girls’ rights through their commitment to fund safe abortion services abroad.

Moreover, the U.K. government has indicated its desire to engage in serious dialogue with donors that restrict the use of their funds for abortion, with the intention of ensuring that women can access the services they need.

Canada’s claimed leadership on these issues rings hollow in contrast to the U.K.’s approach and to the recommendations of the UN Secretary-General. Without an ambitious and comprehensive strategy in place to respond to the needs of rape survivors and girls forced into marriage, the government will continue to deny them their human rights.

Sandeep Prasad on UNFPA’s 2013 State of World Population Report

During the Ottawa launch of the 2013 UNFPA State of World Population Report, Executive Director of ACPD (now Action Canada), Sandeep Prasad spoke to the role Canada could be playing to addressing adolescent pregnancy overseas.


This is not a theoretical report.  It sets out the commitments relating specifically to adolescent girls that were made in 1994 by 179 governments, including Canada, to guarantee their rights to sexual and reproductive health and what countries must do to respect, protect and fulfill these rights.  The ICPD Programme of Action commits government to make information and services available to help protect girls and young women from unwanted pregnancy and to educate young men to respect women’s self-determination.

The report makes clear that solutions cannot be targeted at changing the behaviour of girls; rather they must be targeted at expanding the choices that girls have in their lives.  It requires a multi-tiered approach that involves addressing the underlying determinants and drivers of adolescent pregnancy, including gender inequality, poverty, sexual violence, early and forced (or “child”) marriage, exclusion from educational or job opportunities, and negative attitudes and stereotypes about adolescent girls, as well as, more proximate causes such as the lack of availability of sexual and reproductive health services and the legal, social and economic barriers that interfere with adolescents’ access to them.

These are complex issues but fortunately this year’s State of World Population report sets out a roadmap to the solutions required.

Issues related to adolescent pregnancy are linked to several stated priorities for the Canadian government, in particular: maternal mortality, sexual violence and early marriage.  About 70,000 adolescent girls die each year from pregnancy and childbirth related causes.  The report also notes that adolescent pregnancy occurs, in the developing world, primarily in the context of early marriages or as a result of sexual violence.

While we welcome the government’s attention to a number of issues that are fundamentally intertwined with adolescent pregnancy through its various commitments, it has much more to do to show itself as a leader on these issues.

And here are some thoughts on what that “more” needs to include:

1. The report lays out very clearly the role that laws and policies can play in both driving the conditions that lead to adolescent pregnancy and we also see how addressing these can lead to realizing the human rights of adolescents.  The government needs to use its representation abroad and its seat at the table as a development partner to actively engage in policy dialogue geared at changing laws and policies.  This includes not only measures to ban early and forced marriage but also the paramount need to criminalize marital rape.  There are still 89 countries in the world in which marital rape is perfectly legal and there is a strong correlation between the countries where this is legal and those where early marriage is prevalent.  We know 9 in 10 adolescent pregnancies occur in the context of marriage, but how many occur as a result of rape within marriage?These representations need to also focus on achieving the reform of laws and policies which restrict adolescent access to contraception and abortion services, including the criminal prohibitions of abortion and spousal and parental consent requirements to access these services.

2. The new DFATD needs to commit to implementing the UN Technical Guidance on operationalizing human rights-based approaches to maternal mortality as a donor and in its multilateral engagements.  Moving beyond a statement of principles, the Technical Guidance has the potential to radically change the way countries design and implement sexual and reproductive health policies. It is a technical guidance focused on ministries of health on how to actually implement a human rights based approach to policies and programmes related to maternal mortality and morbidity, showing what is needed at every stage of the project cycle.  This took a great deal of work by civil society at the international level to bring about, including a substantial amount by ACPD.  We are pleased that UNFPA and other UN agencies agreed one year ago to implement the Technical Guidance and we are excited about the pilot projects happening in 5 countries involving government, civil society and UN agencies.

3. Invest further funding for comprehensive sexuality education and sexual and reproductive health services for adolescents.  On comprehensive sexuality education, if we are committed to a gender transformative approach that this report recommends, then this is a key intervention to bring this about.  Not the way sexuality education is being delivered now in many places – these programmes need to focus on, among many other things, eliminating gender norms.  These norms in and of themselves are harmful to girls, boys, and transgender youth and also perpetuate gender inequality and violence.  On funding for sexual and reproductive health, the Canadian government has fallen short of the mark.  For example, despite the investment in the Muskoka Initiative, the government’s figures show that in FY 2011-2012 it spent about $6.9 million on family planning overseas – much less than the $17.8 million it spent in 2005.  In terms of overall funding for sexual and reproductive health, Muskoka has had a positive impact, but the government’s spending falls far short of the target of allocating 10% of ODA to sexual and reproductive health.  Keeping in mind that the government is far behind in fulfilling its overall ODA commitment of 0.7% of GDP, we would estimate that it would take another commitment of the size of 4 new Muskoka initiatives devoted to sexual and reproductive health for the government to be fulfilling its fair share.

4. The government must rescind its Ministerial declarations prohibiting its funding being used to provide safe abortion services.  The government’s response to this has been two-fold: 1) we can’t provide services that contravene national law and 2) other donors will fund these services so we don’t have to.  On the first point, there is plenty of scope for the government to support safe abortion services as part of a comprehensive and integrated package of sexual and reproductive health services – 24 out of the 33 priority countries for international development permit abortion in circumstances of rape, risk to mental health or without restriction as to reason.  On the second point, we need to learn a lesson from our neighbours to the South. The Helms Amendment in the United States (banning the provision of abortion services as a form of family planning in all US-funded development initiatives) has led to denials of lawful care related to abortion. This includes the denial of lawful safe abortions, post-abortion care, and referrals, counselling and information with regard to abortion services.

5. Lastly and yet crucially, the government must invest in human rights accountability for these issues.  That entails advocating for a strong human rights-based accountability framework in the post-2015 agenda, including not just outcome indicators, but also structural and process indicators.  But even more crucially it requires an investment invoice accountability through building the advocacy capacity of civil society in country, particularly women’s organizations and youth-led organizations.  We know from recent attention to these matters the drastic underfunding that exists for these organizations.

Those are our 5 recommendations related to how Canada can improve its efforts directed at improving the lives of adolescent girls.  To conclude, and with a view to strengthen Canada’s efforts abroad, we must question the Governments’ policy, or lack therefore, refusing to fund safe abortion services abroad. This begins with holding the Government accountable to upholding its human rights obligations. We must do this by carefully monitoring the impact of this policy on women’s access to information and services. There must be accountability for these impacts.

I urge you all to read this year’s State of World Population report and the roadmap that it sets out to realize the human rights of girls and I look forward to questions.