More maternal and child health funding is welcome, but the lack of focus on the human rights of women and girls is not.

In taking stock of last week’s maternal, newborn and child health summit, Prime Minister Stephen Harper gets kudos for pledging more money to achieve UN Millennium Development Goal 4, to reduce child mortality, and Goal 5, to improve maternal health. But the second target of Goal 5, ‘achieve universal access to reproductive health,’ was very much neglected.

When speaking to the press, Mr. Harper gave muted recognition to the need to integrate family planning services and contraceptives into the MNCH initiative, and Melinda Gates spoke even more strongly. But both argued against support for abortion services as an integral part of a MNCH initiative. Mr. Harper even called the issue ‘divisive’.

Two points should be made crystal clear: first, increased development funding for the health of mothers and children is important and welcome; but the lack of focus on the human rights of women and girls is not.

The prime minister, in reaction to a question on vaccination, said on the CBC, ‘I frankly don’t understand people who are walking away in our society from something that’s proven to work… [who do] not listen to the scientific evidence.’
But we know, from evidence, that the greatest risk for maternal mortality (and lasting health damage such as fistula) occurs when girls have children too soon for their young bodies and when women have children too often for theirs.
We also know, from evidence, that more than 200 million women and girls want to delay or avoid pregnancy but don’t have access to a modern, effective method of family planning. And we also know, from evidence, that where women and couples are able to use effective methods of family planning, the rate of abortion declines (although never to zero).

And we know, from evidence, that unsafe abortion accounts for 13 per cent of all maternal deaths, more than 47,000 deaths a year in developing countries.

The table below illustrates why Canada’s medical-only approach to maternal health is inadequate. In the 10 countries of focus for Canada’s MNCH programming, the rates of child marriage (before the age of 18) are very high. And a girl, taken out of school to marry an older man, is in no position to negotiate sex or delay pregnancy. Even if a girl or a woman knows enough to ask for family planning information, there is a large gap in access to services and availability of supplies. Thus, you can read the World Health Organization estimate of the unmet need for family planning by country of focus.

Girls and women are also at risk because they are treated as second-class citizens whose rights as individuals and as citizens are disregarded. And all of Canada’s ‘countries of focus’ rank 111 or lower on the United Nations’ Gender Inequality Index (Canada, by the way, ranks 18th).

We have learned over the years, from evidence, that death from unsafe abortion is rare in countries where abortion is permitted and quality, affordable services are available.

The table reveals that abortion is legal, with restrictions, in all but one of the MNCH countries of focus. This means that Mr. Harper is imposing his Conservative agenda for family planning and access to safe abortion. Divisive?

The MNCH initiative demonstrates how Mr. Harper and his government are getting development wrong despite the much-advertised good intentions. Development co-operation is not about charity or ‘aid’. The women it targets are not victims. Women are producers, not just reproducers.

Canada needs to invest in the hard work of creating and implementing legal frameworks and gender-intelligent policies and programs that ensure respect for women’s rights and the recognition of their crucial role in the development of their countries. Without the needed legal and policy framework, money thrown at the symptoms of poverty and exclusion can only achieve temporary success. And frankly, we are not convinced that the MNCH initiative is working with governments to create sustained systemic change in their health delivery systems and overarching institutions like the constitution, the courts, supreme auditors general who ensure legislation is being implemented. Is this mostly one-time life-saving? Are the workers being trained supported by adaptations to institutional support systems? This is the hard work of effective, sustainable development that we don’t see in this initiative. 

If women and girls are not able to live free of violence and rape, inside or outside marriage, why should they be denied access to a clinic that can provide a next-day pill or a safe abortion, a right that all Canadian women have?

The prime minister’s recent statements will only serve to legitimize ‘bad behaviour’ by other governments and service providers that do not provide a full range of reproductive health services to women and girls (and men and boys).
By paying attention to only part of the evidence, the MNCH initiative does not address why women and girls are at risk but just ensures that, once pregnant, there may be a health system to save them.

Is it divisive to care about the 47,000 women in developing countries who each year lose their lives to botched abortions?

CANADA’S FOCUS COUNTRIES

This chart shows how Canada’s 10 focus countries for maternal, newborn and child health stack up against each other on child marriage, gender inequality and family planning.

This article first appeared in Embassy, June 4, 2014.

Diana Rivington is a senior fellow in the Faculty of Social Sciences at the University of Ottawa. Elizabeth J. McAllister worked for the World Bank and for the former Canadian International Development Agency in senior executive positions. She now consults with international organizations on strategy, results and evaluation. Both are Members of the McLeod Group.

Notes

[1] UNICEF Child Info

[2] Unmet need for family planning: From WHO http://www.who.int/reproductivehealth/topics/family_planning/unmet_need_fp/en/

[3] 2012 Gender Inequality Index: https://data.undp.org/dataset/Table-4-Gender-Inequality-Index/pq34-nwq7

[4] Center for Reproductive Rights: worldabortionlaws.com

[5] L= to save the life of the mother

[6] += additional grounds relating to factors like the woman’s age or capacity to care for a child

[7] F= in case of fetal impairment

[8] I= in case of incest

[9] R= in case of rape

[10] NE= no specific exception in the law to save a woman’s life

The post Mr. Harper’s Maternal and Child Health Summit, Part 4: Is it divisive to care about the 47,000 women who die yearly from unsafe abortions? first appeared on The McLeod Group.

Once again Canada’s development cooperation policies are being driven by domestic interests, not the development outcomes and the results the government claims to be seeking. We are going it alone and indeed this time even pretending that everybody else is following our lead. In truth, maternal and child health has been both a global and Canadian priority for decades, with an accelerated focus on reproductive health and rights following the 1994 UN Population conference in Cairo.

We started waving a bigger cheque-book when we chaired the Muskoka G8 meeting. This was welcome news in a largely bleak scene for Canada’s development contribution. But we were just playing catch-up on most other bilateral and key multilateral donors, except now we pretend to be the leader.

All this grandstanding perplexes many other donor agencies and our partners in the G7. It also conceals our cuts on family planning and access to safe abortion. In these days of tight aid money, people are too nervous to push back. However, our aggressive noise actually undermines donor cooperation in this area. We even sent DFATD officials to block multilateral policy statements that reconfirmed old agreements on reproductive health.

For Canada itself, that distorted policy framework means that the several billion dollars we are spending misses key targets. We rationalise that other donors will fill the gap. But our approach undermines the effectiveness of the very health clinics we fund. We harm women, including those who are victims of forced marriages or rape as a weapon of war, by blocking safe abortions or the supply of emergency day-after contraceptives.

Maybe worse still, by our bullying and financial ‘leveraging’, we are blocking others – civil society organizations and international agencies – from providing such help. We distort programming by UN agencies such as UNFPA and WHO, forcing them to alter priorities in the delivery of maternal and child health services.

Why does our government behave so callously? We condemned backstreet abortions as barbaric in our own society many years ago. Family planning services should be available to all. The distortions we impose are essentially ideological. They are not due to the budget cuts or the confused cost-effectiveness that shapes much of Canada’s diminished aid profile.

Many would say the explanation lies in domestic political opportunism. Crudely put, women and girls are dying in developing countries to appease the still strong anti-choice lobby amongst the grassroots ‘core’ of Conservative supporters. We moralize globally about sexual practices via our aid programs. We boast publically of having policies led by principles, but we practice the opposite, making the poor, women and girls, the innocent victims of residual puritanism in small segments of our population.

We have today the perverse reality that the large team of Canadian officials organizing Mr. Harper’s maternal, newborn and child health (MNCH) ‘summit’ have struggled to find people from major international agencies who can be ‘safely’ invited, people or organizations that will not raise the topic of reproductive rights. It seems opposition MPs fall into the same ‘don’t invite’ category. The few NGOs, some perhaps attracted by new funding offers, which have helped mobilize this event, were told that agenda items had to be screened to avoid the gaping Canadian policy flaws around providing safe abortion or basic contraceptive services.

The ‘summit’ is in truth a show designed for Canadians. A few world leaders are being rolled out to acclaim Mr. Harper as a leader who cares. But those guests are expected to avoid controversy. The agenda is being managed to leave little scope for criticism. Their dilemma is whether to expose the inconsistencies in Canada’s stance. Or will these guests risk going back to their own domestic audiences and be asked to justify attending a ‘summit’ at which they failed to reiterate the key role of sexual and reproductive rights for vulnerable women and girls?

 All this has created a new absurdity in our relations with the United States. For decades, under the Republicans, the US government routinely blocked reproductive health funding for UNFPA and groups such as Planned Parenthood, despite criticisms by almost all other donors, including Canada. Now the roles are reversed. The organizers hesitated to invite Hillary Clinton, a likely next US President, for fear she would again attack the Prime Minister’s position at his showcase event. Her words last time were: “You cannot have maternal health without reproductive health which includes contraception and family planning and access to legal, safe abortions.” They worry whether star guest Melinda Gates will again publically criticise Mr. Harper’s policy stance. No doubt to his chagrin, Canada has no leverage over her independent and well-funded foundation.

Whatever their decision, Canada will not emerge with much advantage, not even new Conservative votes. It will be either egg on our face or private condemnation by those we wish to have as friends and partners. Nothing we do can retrieve the lost lives and damaged bodies of poor women and abused girls that our policies on reproductive rights have ignored so far.

The post Mr. Harper’s Maternal and Child Health Summit, Part 3: Delusions about International Leadership first appeared on The McLeod Group.

The Harper government’s Muskoka Initiative is based on the fact that “women and children in developing countries are significantly more likely to die from simple, preventable causes, due to lack of proven, affordable and cost effective solutions that most Canadians take for granted,” as  the Canadian government puts it.

The idea was—and is—that by committing major funding, Canada and other donor governments can significantly reduce child mortality and the number of women who die during childbirth. Exaggerations notwithstanding about the volume of new money brought by Canada to the challenge, the premise is good as far as it goes. It is worth doing. But there is a huge hole in the middle of it: human rights.

Foreign Minister John Baird has railed against the forced early marriage of girls, but he goes no farther because he and the government don’t want to open a discussion about choice—the choice a woman has, or should have, about whether to get married, to use contraception or to take an unwanted pregnancy to term. In fact, the Canadian government has refused to discuss or to fund initiatives that deal with these issues and the kind of “solutions that most Canadians take for granted.”

The World Health Organization says that 21.6 million women experience an unsafe abortion worldwide each year, 85% of them in developing countries. Every year, some 47,000 women die of complications from unsafe abortion. This represents close to 13% of all maternal deaths. The Muskoka Initiative has absolutely nothing to say about this and Canada won’t put a dime towards stopping it.

And why are there so many unsafe abortions? Because millions of women don’t know their rights and, worse, in many cases don’t have access to those rights: legal rights, sexual and reproductive rights, human rights. They don’t have access to family planning services, education or the options “that most Canadians take for granted.”

The Boko Haram kidnapping in Nigeria has excited world attention over the plight of 200 girls, when in fact violence is a fact of life for hundreds of thousands of girls  in a more silent, but no less terrible way every year.

Not only does the Muskoka initiative ignore these issues, Canada, once a leader in the promotion of gender awareness and women’s rights internationally, has pushed the subject off the agenda as though it never existed. We have become instead a choirmaster for the promotion of technical approaches to problems that are often deeply embedded in systemic human rights abuse.

None of this is mentioned by the NGOs serving as Mr. Harper’s choir: Plan, World Vision, CARE and others. And it’s likely that none of it will be discussed at Mr. Harper’s “summit” on maternal, newborn and child health at the end of May.

Its theme, ironically, is “Saving Every Woman, Every Child.” Well, maybe not every woman. And maybe not every child bride.

The post Mr. Harper’s Maternal and Child Health Summit, Part 2: The Hole in the Donut first appeared on The McLeod Group.

Maternal health should be about women’s health before, during and after pregnancy, not just mothers. Some women who require maternal healthcare will not become mothers because fetuses and babies may not survive or because the women may not choose to raise these children. Therefore, an effective and comprehensive maternal health strategy is key. It should include services that address women’s maternal health needs, while also addressing the broader societal and gender issues which contribute to high rates of maternal mortality.

The Muskoka Initiative on Maternal, Newborn and Child Health (MNCH), however, focuses almost entirely on mothers. We can witness this in Canada’s official statements on the MNCH initiative. For example, in a September 25, 2013 speech, Prime Minister Stephen Harper referred exclusively to mothers when referring to the MNCH, saying: “one of the world’s great tragedies […] is the shocking mortality of mothers and their young children in developing countries”.

The emphasis on mothers is significant here, however, because it is actually women who die. Some of them never become mothers before their death. Other women may die months following a pregnancy as a result of complications, infections and unsafe abortions.

The World Health Organization estimates that, for every woman who dies in childbirth, around 20 more suffer injury, infection or disease related to their pregnancies, affecting approximately 10 million women each year. Thus, the exclusive focus on mothers reduces women to a specific biological activity: giving birth. The focus on mothers rather than women in the maternal health strategy treats women as “walking wombs” and makes it far more difficult to address the broader health challenges women face in their lives.

Responding to these broader maternal health challenges require a better understanding of gender inequality, including gender-related issues such as lack of access to resources, lack of permission from men in the communities to use household funds for maternal healthcare, and gendered institutional practices that result in women having negative experiences in health clinics. As such, maternal health programs cannot be isolated from broader gendered, societal and community issues that women face in accessing healthcare services.

The MNCH initiative’s failure to more explicitly link maternal health needs to women’s disadvantaged position in society relative to men further solidifies Canada’s shift away from a gender-and-development approach to a charity-based model. It fails to address the gendered societal norms that prevent women from accessing health services even when they are available. As a result, the MNCH initiative has limited potential for improving the quality of life for women who still have little or no say over sexual and reproductive rights and child spacing.

A focus on the promotion of gender equality in maternal health programs has the potential to correct for this shortcoming. Such a strategy would include education programs and involving women in the design and implementation of maternal health strategies. However, a gender-sensitive approach to maternal health in Canada’s MNCH initiative is unlikely, as illustrated by the problematic language of “saving” mothers and children.

“Saving” mothers and children through maternal health programs is a common theme throughout many of the official Canadian statements pertaining to the MNCH initiative. The announcement of the May 2014 summit titled Saving Every Woman Every Child: Within Arm’s Reach is further evidence of Canada’s charitable approach to maternal health and a narrative that stresses Canada’s role in saving the “vulnerable other”. In so doing, women are further positioned as objects of development assistance (recipients of charity), as opposed to subjects with agency that are capable of being actively involved in the development process.

For four years, Canada has made MNCH a key priority in foreign aid spending. This initiative, however, has been severely limited by its exclusive focus on “mothers”, the failure to put women and gender equality at the centre of these initiatives, and the ongoing paternalistic references to strategies aimed at “saving” vulnerable groups. If the upcoming summit provides a space to reflect meaningfully on what has been achieved through the MNCH initiative to date, it will most certainly need to begin with some reflection on these and other important weaknesses of Canada’s Muskoka Initiative. A renewed commitment to maternal health is welcomed, but achieving success in maternal health services will require a new direction and purpose: one that begins with an understanding of the causes and consequences of gender inequality.

For additional information see: Krystel Carrier and Rebecca Tiessen, “Women and Children First: Maternal Health and the Silence of Gender in Canadian Foreign Policy” in Canada in the World: Perspectives on Canadian Foreign Policy, edited by Heather A. Smith and Claire Turenne Sjolander, Oxford University Press, 2012, pp. 183-200.

The post Mr. Harper’s Maternal and Child Health Summit, Part 1: ‘Saving’ Women and Children by Targeting ‘Walking Wombs’ first appeared on The McLeod Group.