Posted: Monday, 14 June 2010

Earlier this year, Prime Minister Stephen Harper announced that Canada would “champion a major initiative to improve the health of women and children in the world’s poorest regions.” Two days later, Harper reiterated his intention at the World Economic Forum in Davos, Switzerland where he stressed that the campaign will become a significant part of Canada’s lead in the upcoming G8 and G20 Summits.

Canada is one of 189 countries committed to the achievement of the eight UN Millennium Development Goals (MDGs). MDG 5, which commits to improving maternal health by reducing maternal deaths by three-quarters and achieving universal access to sexual and reproductive health care and MDG 4, committing to child health, are the furthest from being achieved by 2015. As such, Harper’s announcement to invest in maternal and child health care is welcomed, but his reluctance to include access to contraceptives as part of the initiative raises cause for concern - especially when officials publicly devalue the importance of sexual and reproductive health care rights.

A full spectrum of sexual and reproductive health care rights are needed in order to achieve the MDGs related to maternal and child health. It is necessary in order to help individuals and couples plan their pregnancies and to provide timely antenatal, delivery and postpartum services. In turn, the achievement of MDG 5 will contribute to the advancement of several other MDGs. For instance, it will improve the educational prospects for children, especially girls, help stem HIV transmission, and contribute to gender equality and poverty reduction.

Using 2008 estimates1, we know that:

• Approximately 215 million women who want to avoid pregnancy are not using an effective method of modern contraception due to a lack of access;
• Only one-half of the 123 million women who give birth each year receive antenatal, delivery and newborn care from a doctor or midwife. Many who do receive care, do not receive all of the components of the care they need;
• Over half a million women, including adolescent girls, die due to complications during pregnancy and childbirth every year;
• Approximately 20 million women have unsafe abortions each year. Three million women who experience complications caused by unsafe abortions do not receive medical attention. Approximately 68,000 women die each year due to unsafe abortions – that’s nearly 15% of all maternal deaths attributed to these “procedures”.

The importance of promoting sexual and reproductive health rights

At this time, it is still not known what types of modern contraceptives and sexual and reproductive health care services are being considered, however, the Canadian government has made it perfectly clear that it refuses to “open up the abortion debate.” US Secretary of State, Hillary Clinton, rebuked the plan stating: “You cannot have maternal health without reproductive health, and reproductive health includes contraception, family planning and access to legal, safe abortion.” There are signals that other members of the G8 side with Ms. Clinton’s position. Not only that, investing in a full spectrum of family planning and reproductive health care services just makes good financial sense.

According to the Guttmacher Institute and the United Nations Population Fund (UNFPA), combined investments in family planning and maternal and child health services can achieve the same outcomes for $1.5 billion less than investing in maternal and child health services alone. Analysis shows that meeting the need for both family planning and child health services would have dramatic health-related and socio-economic benefits(2):

• Seventy percent of maternal deaths would be averted by allowing women to delay motherhood, space births, avoid unintended pregnancies and unsafely performed abortions, and stop childbearing when they have reached their desired family size;
• Unintended pregnancies would drop by more than two-thirds from 75 million (in 2008) to 22 million per year;
• Unsafe abortions would decline by 73%, from 20 million to 5.5 million (assuming no change in abortion laws), and the number of women needing medical care for complications due to unsafe procedures would decline from 8.5 million to 2 million;
• Greater use of condoms for contraception will reduce the transmission of HIV and other sexually transmitted infections, helping to curb the HIV/AIDS pandemic. In some regions as many as 60% of infections are among women.

The Government of Canada should advance sexual and reproductive health rights by recognizing the need for access to safe, legal abortion, in addition to family planning and sexual and reproductive health care services.

Implementing the initiative – how will it be done and with what money?

While Harper has pledged to prioritize women and children at this year’s G8 and G20 Summits, stakeholders continue to echo the same concerns, in that they feel that the plan lacks credibility, clarity, transparency, and ultimately, accountability. The Guttmacher Institute estimates that, annually, $24.6 billion dollars (USD) are needed in order to meet the existing need for modern family planning and maternal and child newborn health services. But where will this money come from?

Recent announcements regarding Canadian development aid, especially on aid in Africa, confuse the issue of maternal and child health even more.

First, in February 2009, the Canadian International Development Agency (CIDA) pulled a significant portion of its development funds out of eight African nations, redirecting it to Latin American countries.

Second, Foreign Minister Lawrence Cannon recently announced that Canada will freeze aid to Africa until the government assesses how previous aid was spent. A surprising decision as, in 2008, sub-Saharan Africa, the poorest region in the world with the most dire record on maternal and child health, received only one-fifth of Canada’s development assistance to begin with.

Third, there are no plans to increase foreign aid after this year. Canada’s aid budget of 0.33%, which ranks an abysmal 18 out of 22 donor countries, will decrease to 0.28% by 2014. Clearly the goal of dedicating 0.7% of gross national income to development assistance will not be met.

Harper’s suggestion to invest in “the world’s poorest countries” leaves many unanswered questions as to whether or not Canada will reinstate or increase levels of aid to Africa. It can be assumed that the government’s contributions to the initiative can only be accomplished by diverting funding from other development programs.

The Government of Canada must restore confidence in the maternal and health initiative by clearly outlining a costed plan of action, demonstrating how it will meet the funding requirements needed to launch such an ambitious endeavour. Likewise, the Government of Canada should meet past commitments to devote 0.7% of GNI to official development assistance, and redirect aid back to Africa.

The labour movement and the protection of maternal and child health

The problem of maternal and child health will not be solved unless the root causes of gender based discrimination and poverty are addressed concurrently. Women continue to face multiple forms of discrimination in social and intimate relationships, as well as in the workplace. Women account for an increasing proportion of the world’s working poor, they are more vulnerable to volatile labour markets and face higher levels of unemployment, and are concentrated in low-paid, unprotected or casual work. According to ILO statistics, women make up 60% of workers in the informal economy. If agriculture is taken into account, this percentage is even higher.

As a result, millions of women lack maternity protection rights and quality public health care services, preventing them from accessing the care they need. Women are dying for lack of access to affordable, quality maternal health care, often a consequence of low wages, precarious work and inadequate social protection.

Experience has shown us that the labour movement is well positioned to positively influence women’s representation in the workforce, while simultaneously promoting decent work for women (through the ILO Decent Work Agenda) and gender equality. Consequently, women’s involvement in local labour unions encourages national centres to promote better labour legislation and policies or practices relevant to women and their families, such as maternity protection, pay equity and access to quality public services. Herein lies the connection between labour rights and maternal and child health. Labour unions are advocates for maternal and child health rights, alongside our civil society allies.

Maternity protection has been a core issue for the International Labour Organization (ILO), and informs the work of the Canadian Labour Congress. ILO member States have adopted the Maternity Protection Convention, 2000 (No. 183) which states that “the need to provide protection for pregnancy...are the shared responsibility of the government and society” and extends coverage to all employed women, regardless of occupation or type of undertaking (including women employed in atypical forms of work).

The ILO Maternity Protection Convention, 2000 (No.183) states that:

• Medical benefits shall be provided for the woman and her child...[and] shall include prenatal, childbirth and postnatal care, as well as hospitalization care when necessary;
• To the extent possible...care given in a doctor’s office, at home or in a hospital or other medical establishment by a general practitioner or specialist;
• Maternity care given by a qualified midwife or by another maternity service [provider];
• Any necessary pharmaceutical and medical supplies, examinations and tests prescribed by a medical practitioner.

Governments must take the lead in scaling up efforts to improve maternity protection and health, using the workplace (in all of its forms) as an important entry point.

The Government of Canada must promote the principles of maternity protection and ratify the ILO Maternity Protection Convention, 2000 (No.183). All governments must work in collaboration with local and national trade union centres to ensure that quality medical benefits and care are accessible to women workers, as per the articles outlined in the Convention.

Improve access to quality public services for the promotion of maternal and child health

Deteriorating health care and infrastructure, evident in much of the developing world, are the result of internally and externally driven policies which promote the privatization of public services. Persistently high levels of national debt and outdated fiscal policies, further aggravated by the current economic crisis, have ultimately led to reduced government expenditures on health and education. Underfunded health care facilities and severe shortages of essential drugs, sterile equipment, obstetric equipment and supplies have meant that women do not have access to the public services they require.

Moreover, privatized services transfer rising health care and education costs onto the individual, and ”out-of pocket” costs act as another barrier to women’s access to reproductive health rights and push households deeper into poverty. The results are witnesses in our inadequacy and inability to provide safe and reliable services to women and their infants. Under these conditions, it is no surprise that nearly all maternal deaths occur in developing countries, primarily in Africa and South Asia.

Governments which seek to improve health care management, through the decentralization of health care services, are operating under the false assumption that public health care facilities are inefficient compared to services provided in the public sector. However, studies have shown that for-profit hospitals, on average, provide a lower quality of care than their non-profit peers.

The Government of Canada must resist outmoded ideas about decentralization, both domestically and abroad, and should invest in quality public services, including public health and education programs. Such services must be universally accessible, publicly funded and delivered, while at the same time ensuring that health care workers are well trained and have access to decent work – this is the essence of quality public services.

Recommendations for successful implementation of the maternal and child health care initiative

At the upcoming Summits in Canada, the Canadian Labour Congress calls upon Prime Minster Stephen Harper to lead the G8 in showing accountability and leadership on achieving past commitments, including the Millennium Development Goals, the ILO Decent Work Agenda and its Maternity Protection Convention, 2000 (No. 183). In order to reach its full potential, the maternal and child health initiative must include comprehensive sexual health and reproductive health rights, including universal access to contraception, family planning services, options counselling, and access to safe, legal abortion, while similarly promoting social and economic equality for all through the provision of quality public services.

In this vein, the Canadian Labour Congress is calling on the Government of Canada to demonstrate leadership and accountability by:

1. Promoting sexual and reproductive health rights, including the rights of women to access safe and legal abortion, as part of its maternal and child health care initiative;
2. Meeting prior commitments on development aid at a rate of 0.7% of GNI per year, and redirecting a significant portion back to Africa;
3. Encouraging Country Ratification of the ILO Maternity Protection Convention, 2000 (No.183) and;
4. Increasing and sustaining investments in quality public health care for the effective delivery of maternal and child health services.