Renewed initiative shines spotlight on Canada’s deeply divisive MNCH approach

By Flavie Halais
01 December 2014

The Millennium Development Goals on improving maternal health and reducing child mortality will not be met next year, despite progress in all regions of the developing world.

At least one country, however, will not be blamed for not trying hard enough.

Building on a legacy of development programming in maternal and child health spanning decades, Canada has become a champion of the cause under the current government of Prime Minister Stephen Harper. At the 2010 G-8 summit, Harper increased Canada’s five-year contribution to the Muskoka Initiative to 2.85 billion Canadian dollars ($2.5 billion). The initiative commits G-8 member nations to spend an additional $5 billion on maternal, newborn and child health between 2010 and 2015. In the same year, Harper was named to co-chair the U.N. Commission for Information and Accountability for Women’s and Children’s Health alongside Tanzanian President Jakaya Kikwete.

More recently, in May this year, the prime minister announced not only that the Muskoka Initiative will be renewed for another five years but that Canada will be contributing CA$3.5 billion as well — higher than the CA$3.25 billion funding Canadian nongovernmental organizations asked for. Last month, the Department of Foreign Affairs and Trade launched a CA$370 million call for proposals for NGO initiatives that will help speed up progress on maternal, newborn and child health.

Unsurprisingly, Canada garnered praise not just for its large contributions to maternal, newborn and child health, but also for setting up an unprecedented cross-sector partnership between NGOs, medical practitioners and researchers across the country that leverages the skills and expertise of Canadian health professionals in a unique way.

Over the course of its implementation, however, the Muskoka Initiative has deeply divided Canadian NGOs and elicited questions about its role in the country’s approach to foreign aid. How so?

Rights-based organizations sidelined

In the lead up to the 2010 G-8 summit during which the Muskoka Initiative was first announced, the Canadian government declared it wouldn’t fund programs that provide access to abortion. This came even as WHO noted that unsafe abortions accounted for 13 percent of maternal deaths.

“That caused a lot of soul-searching for some of the organizations,” remembers Janet Hatcher Roberts, a longtime international public health expert who was then the executive director of the Canadian Society for International Health.

Before the first Muskoka Initiative, MNCH groups self-organized themselves into a network. But because of the government’s stand on abortion, Roberts said organizations that were seen to be more right-based were not invited to meetings with the minister or even to low-key gatherings.

“Other organizations were so afraid that there wouldn’t be any funding at all if they pushed too hard on rights and reproductive health services,” she told Devex.

Since Muskoka and the creation of the Canadian Network for Maternal, Newborn and Child Health, a government-funded umbrella group for organizations working on MNCH, these organizations have been reintegrated into the more inclusive network. The network, however, has officially chosen to adopt a neutral stance on the issue of abortion, a procedure that was legalized in Canada in 1969 and rendered accessible to all women in 1988.

“Our partners have a range of views on the abortion issue,” Director Helen Scott said. “Not all of their funding comes from the government, so organizations are free to do as they wish with their own funding … That one issue could derail our efforts, because of the lack of consensus.”

The Canadian government has since reaffirmed its position on funding abortion programs overseas, specifying the decision would also apply to the country’s CA$5 million financial support for the U.N. initiative to address sexual violence in conflict zones. It is likely that the funding ban will apply as well to the CA$10 million envelope that foreign minister John Baird announced last week in support of organizations working to end child marriage.

Scant funding for reproductive health

It now appears that abortion was not the only aspect of maternal health the Canadian government did not feel comfortable funding. Reproductive health as a whole, although officially part of the Muskoka Initiative and outlined as part of MDG 5 has been receiving a considerably reduced share of financial support.

Aniket Bhushan, a researcher at the now-defunct North-South Institute, analyzed data DFATD provided on MNCH programming between 2010 and 2013. He found most of the funding was spent on nutrition, basic health care, and control of sexually transmitted diseases and infectious diseases. Family planning received just 1.3 percent of total funding, while reproductive health care got 5 percent.

As a whole, DFATD funding for sexual and reproductive health programming currently comprises 4 percent of Canada’s overall international assistance, less than the 10 percent agreed by various donor countries. The guidelines outlined in the latest call for proposals for the second round of the Muskoka initiative indicate priorities are set to remain the same.

For some members of Canada’s international development community, the lack of attention given to reproductive health is just one of the signs that indicate the government has adopted an old-fashioned approach that focuses almost exclusively on childbearing.

“Women’s health is more than just having babies,” Roberts said. “The reduction of women to just the maternal part, while hugely important, is also negating all the other parts of a woman’s life.”

The name given to the global summit on maternal, newborn and child health held last May in Toronto, “Saving Every Woman, Every Child,” didn’t help.

“The government’s approach is very much a charitable approach,” said Julia Sanchez, president of the Canadian Council for International Cooperation. “In civil society, we feel we’ve moved on from that.”

Improved government-civil society relations

But apart from the controversy surrounding reproductive health services, Sanchez told Devex the Muskoka Initiative marked a significant improvement in the relations between Canadian civil society organizations and the government.

“The role of civil society has been very important compared to anything else that we’ve seen in recent years, for sure,” she said.

Sanchez noted that DFATD addressed many of the recommendations made to the government for the new call for proposals in some form. The new call notably includes separate streams for projects below and above CA$20 million and limits the numbers of proposals organizations can apply for. Sanchez said this would help small and midsize organizations compete with larger ones, a welcome move considering the difficulty that smaller organizations have experienced in securing funding over the past few years.

The positive climate established by the government for the second phase of the Muskoka Initiative comes during lean times for Canadian international development. The country’s foreign aid budget has been frozen until next year to help reduce the deficit, and currently stands at 0.27 percent of gross domestic product, well below the 0.7 percent target agreed upon by donor countries. When urged by U.N. Secretary-General Ban Ki-moon to increase development spending during last May’s global summit on MNCH, Harper said: “It’s the philosophy of our government and, I believe, of Canadians more broadly that we do not measure things in terms of the amount of money we spend, but in terms of the results we achieve.”

Last month, however, it was revealed that CA$125.9 million of the CA$792 million share of the federal budget dedicated to foreign aid in 2013-2014 were left unspent — a development some critics say will help Harper present a balanced budget in time for next year’s elections.

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About the author

Flavie Halais is a freelance journalist based in Montreal who covers cities and international social issues. In 2013-2014, Flavie was an Aga Khan Foundation Canada International Fellow, reporting for Nation Media Group in Nairobi, Kenya. She’s also reported from Rwanda, Brazil and Colombia.

Posted on 2014-12-01
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