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.

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 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 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.”

Posted on 2016-05-18
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