Thank you very much, Mr. Chair. It's an honour for UNICEF to be here today.
As an agency of the UN, UNICEF works in more countries and saves more children’s lives than any other humanitarian organization. UNICEF Canada was established 60 years ago, and we work as part of the UNICEF family to do whatever it takes to ensure that children survive and thrive, by providing health care and immunization, clean water, nutrition, education, and protection from violence. Here in Canada, we promote public policy and practices in the best interests of children to contribute to the fulfillment of children’s rights, as outlined in the Convention on the Rights of the Child, here in Canada and around the world.
UNICEF and Canada have a long history of partnering to improve the health and well-being of children around the world. For decades—for more than 30 years—the Government of Canada has consistently been one of the top ten government donors to UNICEF, and we've worked in partnership to address some of the most urgent needs of children and their families in the areas of health, nutrition, protection, education, and emergency assistance.
Despite the progress that's been made over the last 25 years, we still know that 17,000 children die every day from preventable causes, where simple low-cost interventions exist to save them. Almost one third of those deaths are preventable by vaccines. Immunization is one of the most cost-effective public health interventions, and UNICEF is the world's leading agency for vaccine procurement. We must continue to support these efforts of vaccination around the world and here in Canada too.
Some of the recent significant progress that we've seen has been in polio, which is almost eradicated. Last year, we were down to about 400 cases in the difficult-to-reach places of the world. Also, in maternal and neonatal tetanus, we have a partnership between UNICEF and Kiwanis that has reduced the number of countries that have to deal with tetanus, from 59 down to 24, over the last 15 years.
We also have partnerships with the Canadian private sector. Diarrhea is one of the leading killers of children, and we work together in India with Teck Resources of Vancouver in scaling up effective diarrhea treatment and strengthening health care systems in some of the most marginalized communities there. We're educating health workers on the effectiveness and use of zinc supplements, along with oral rehydration salts, and strengthening the local supply chain to make sure these treatments are accessible to even the hardest-to-reach children.
Almost half of the child deaths that happen every year have malnutrition as an underlying cause. I wanted to show the members this middle-upper-arm circumference bracelet. Since I'm not a medical person, this is the thing that helps me see what malnutrition means.
A child's bicep doesn't change much between six months and five years, so you can put this middle-upper-arm circumference bracelet—forgive me, those of you who are medical and would give better details than I can—around their bicep, pull it, and then see whether or not they're malnourished. If it's in the green part of the bracelet, they're sufficiently nourished, but if it gets into the yellow and into the red, you have malnutrition. For a child who is suffering from chronic malnutrition—in the yellow—their arm is the size of a toonie. That's what malnutrition is. Not only does it cause half of the deaths, but it also is a huge contributor to stunting.
Stunting affects almost 200 million children under five years of age. It can trap those children in a cycle of poverty, but we know that key interventions, when delivered during the critical 1,000-day period from conception to two years of age, can lead to a reduced prevalence of stunting. Improved maternal and child nutrition gives children a much better start in life.
HIV/AIDS also remains a disproportionally heavy burden on the world's children and adolescents. We project that almost two million children will still require HIV treatment in the year 2020. We believe that the Government of Canada must ensure that investments in the prevention and treatment of AIDS remain central to our maternal and newborn child health efforts.
Something that crosses between health and protection is birth registration. Some 230 million children around the world have not been registered at birth. Without a birth certificate, unregistered children are far less able to access vital social services and the protection they deserve. Birth registration is a means of protection because it can protect children from being prosecuted or punished if they come in contact with the law. A valid birth certificate is so important to enforce minimum age legislation that can protect children from early child marriage, recruitment of children in armed forces, or some of the worst forms of child labour.
We know that protection is a vital part of rearing a healthy child. Canada has been a respected defender of children's rights. It has a strong history of protecting the world's most vulnerable children from violence. We welcome Canada's leadership at the UN General Assembly in securing a resolution towards preventing and eliminating child, early, and forced marriage. We share this commitment to end child marriage along with all forms of violence against children.
Protecting children from violence, exploitation, and abuse helps ensure that those children who survive and benefit from Canada's investment also have the opportunity to thrive. These two efforts—keeping children healthy and safe—work together. Children cannot thrive if they are immunized and well nourished but then suffer from violence. Violence and abuse affect the child's physical and mental health in the short and in the long term. It can impair their ability to learn and socialize, which will impact their transition to adulthood, with adverse consequences later in life.
A child-safe private sector is also key to the protection and realization of children's rights. Businesses have direct and indirect impacts on children's lives through their policies and operations. UNICEF, Save the Children, and the UN Global Compact have developed children's rights and business principles to equip businesses to address their impact on the rights and well-being of children. We at UNICEF Canada are engaging the Canadian extractive sector through the development of guidance and tools and through individual initiatives with companies, associations, and consultancies.
The Government of Canada has a responsibility and an opportunity to ensure that the Canadian private sector is enhancing efforts to protect children from violence, exploitation, and abuse through committing to support the Canadian private sector in respecting and supporting children's rights in their overseas operations. That is why we encourage the government to tie the children's rights and business principles and child rights impact analysis into any funding that goes to the private sector overseas.
This is a critical year for children. World leaders are setting out a road map for human progress that will drive investment and action over the next 15 years. Negotiations for the new post-2015 development agenda are well under way. Over the coming months, discussions will culminate into two critical milestones: the framework for the sustainable development goals, the SDGs, which are set for adoption at the General Assembly in September; and the framework for financing for development in Addis Ababa in July.
UNICEF is firmly committed to ensuring that children remain at the centre of the next development agenda as they have been with the millennium development goals. Furthermore, we believe that an equity-based approach is essential to ensure that the most disadvantaged children are included in future development progress. It's not just the right thing to do. It's in everyone's interest.
I'd like to acknowledge and welcome the Government of Canada's publication and request for feedback on Canada's priorities for the post-2015 development agenda. We see strong synergies with UNICEF and Canada's priorities. UNICEF Canada is pleased to see Canada's commitment to making a priority in child protection, to ending child, forced, and early marriage, and to renewing the global effort to end preventable child and maternal deaths and ensuring access to quality education. We also welcome the fact that Canada has recently become a member of the Group of Friends on Children and the sustainable development goals to advocate for the rights of children and ensure that issues relating to the survival, development, and protection of children are central during negotiations on the SDGs, and to the discussion on financing for development.
In July, the international community will agree on the financing strategies to attain the SDGs, and investing in children is essential for these. We encourage the Government of Canada to work to introduce and support strong language on investing in children into the Addis Ababa outcome document, because investing in the early years of a child's life in child nutrition, in cognitive development, in child protection, yields long-term benefits for the individual and for society.
Adequate and equitable investments in children are a precondition for sustained economic growth. Unequal opportunities for children and persistently high levels of malnutrition, child mortality, and child poverty impose large burdens on the future growth potential of our societies. Investing in children is the prerequisite for the eradication of extreme poverty and ending poverty in all forms, so that the devastating cycle of intergenerational poverty can be broken.
Private and innovative sources of finance will be of increasing importance in financing the new SDG framework, and we welcome Canada’s leadership in promoting innovative ways to finance development. But official development assistance remains critically important for countries that have limited capacity to raise public resources domestically, as does halting the decline of ODA to the world's poorest countries. Official development assistance and concessional finance should be targeted at those countries with the greatest needs, and an increased amount of ODA allocated for spending on children.
In closing, I want you to know that Canada's investment in children is paying off. In fact, we're in the middle of a child survival revolution that's happening around the world. Fewer children are dying before the age of five than ever before in human history. Fewer children are not going to school than ever before in human history. More people have access to clean water than ever before in human history.
This is the child survival revolution, and it doesn't look like it in this room, but we are in fact all revolutionaries and part of making this global change. This is a foundation for the future.
Now we need to take the next steps. We need to be sure that children have birth certificates, that they have quality secondary schooling, that they have strong laws to protect them from exploitation and abuse, so that all of these children—our children in the world—will not only survive, but thrive in peace and prosperity in the years ahead.
Thank you very much, Mr. Chairman.
On behalf of the Canadian Society for International Health, I thank the committee for providing this opportunity to us to share with you our perspective and our recommendations about the mechanisms to protect the health, livelihood, and well-being of children and youth in developing countries.
The Canadian Society for International Health is a national, non-governmental, membership-based organization and charity working to improve the health for all people, to reduce global health inequities. and to strengthen health systems.
I'm not a doctor. My background is actually medical geography, and my career in public health and community development began in 1976. Over the past four decades, I’ve worked both in Canada and overseas with CARE, CIDA, IDRC, and up until June 2013, with the Canadian Public Health Association. I became a member of the board of directors of CSIH in November of last year.
My colleague Eva Slawecki is CSIH's interim executive director. She brings 15 years of experience in international health and health system strengthening, both in Canada and overseas.
Before I share our society's perspective and recommendations, I would like to define the term “global health”. A number of definitions exist, but I will present the two that, according to the Canadian Society for International Health, reflect best principles and practices in global health better than others.
The first definition, put forth by colleagues from New Zealand, defines global health as an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide.
Global health has also been defined as the worldwide improvement of health, the reduction of disparities, and the protection against global threats that disregard national borders. Global health entails the design and putting into place of effective strategies for health improvement, whether population-wide or individually focused, that support and strengthen disease and injury prevention, health promotion, health protection, as well as treatment and care of the sick, the injured, the disabled, and the dying, with actions across all sectors, not just the health sector, to achieve the goal of health for all.
We appreciate that your committee is looking particularly within the theme of protecting children and young people in developing countries on issues related to trafficking, early marriage and forced marriage, the sex industry, female genital mutilation, and online abuse of children and youth.
The Canadian Society for International Health does not work directly on those issues, but thanks to its field experience in developing countries, it has seen first-hand the serious consequences those issues have on the health of mothers, children and youth.
Child marriage is a reflection of many of the social determinants of health, including poverty, poor education, and a lack of opportunities for safe and meaningful employment. Several organizations appearing before this committee proposed actions to modify the drivers of early marriage.
Too-early marriage can lead to adolescent pregnancies and increased maternal mortality, increased cases of fistula, heightened infant mortality, and disabilities owing to complications arising from mistreatment, abuse, poor living conditions, including malnutrition, limited access to health services, and premature labour. Too-early marriage can also have an impact on the health of newborns. For example, malnutrition indicators have been found to be worse for children born to mothers married as minors.
As Dr. Peter Singer of Grand Challenges Canada remarked in his presentation to this committee in June 2014, that Canada's approach to child protection should start just before the time of conception, with adolescent girls, and follow through to protecting pregnant women and the newborn child’s mental and physical development throughout the first few years of life.
We appreciate that the health sector cannot improve health and health equity by itself. Addressing and ending child marriage requires a preventive, integrated, and multi-sectoral approach that goes beyond the health sector with action led by and supported through other sectors. These actions might include culturally appropriate communication messages, flexible education systems that allow young adolescent mothers to return to school following the birth of their baby, nutrition supplementation, and social welfare engagement.
One of the best value for money and highest return on investment public health-based strategies identified by the World Economic Forum and the Harvard School of Public Health for improved health and well-being is improved maternal, fetal, and newborn care, linking health care, public health, social, and educational strategies. A health systems approach to protect the health of young girls and women, and which could contribute to reduce and ultimately end child marriage, involves the deployment of fully and adequately trained community health workers and skilled birth attendants, skilled anesthesiologists and medical practitioners, the availability of information that enables young girls to make informed choices about their reproductive health, a good referral system to the next level of care, adequate transport for emergency obstetric cases, and a safe blood supply.
CSIH and the Canadian Public Health Association, through separate CIDA-funded initiatives in the post-war Balkans a few years ago, demonstrated the value of youth-led safe places where they could discuss issues they face and come up with strategies to reduce the risk of sexually transmitted diseases, sexual exploitation, drug use, and abuse. Youth-oriented models and initiatives were developed to increase access to counselling, prevention, diagnosis, treatment, and education for young people, thereby promoting healthy choices for youth.
As our colleagues from the Right To Play and War Child organizations explained when they appeared before your committee, there are several ways to empower children and young people, including by helping them become their own agents of change when it comes to safety and protection, by allowing them to actively participate in discussions about their safety, and by ensuring that they have real legal protection. Our society supports those strategies. We encourage you to give them your full attention and consideration.
Our colleagues have also commented on the need to engage and support the family in their efforts to care for children. CSIH would like to add to that the importance of ensuring that health professionals are also equipped to protect children and youth.
We seem to have a tendency to put lessons learned from projects in a drawer once the initiative is completed, rather than referring back and gleaning information from them. We always seem to want to reinvent the wheel, when so often we might already have the answer. I suggest we take time to re-examine lessons learned from past initiatives funded though Canada before we launch into new ones.
In Mali, CSIH and its partner organizations helped create a better integration and coherence between the various levels and components of the health system, particularly related to HIV/AIDS prevention, reproductive and sexual health, and nutrition, thus resulting in improved quality and access to, and use of, medical and social services offered in community health settings. There are as well important strategies to protect children and youth to be gleaned from CIDA-funded initiatives, such as the maternal-child health initiatives carried out in Zambia and Malawi several years ago.
And let’s not stop once mother and child are discharged from the hospital or health clinic. Adequate and appropriate follow-up are prerequisites to a healthy life. I’d like to present an example from another former CIDA-funded initiative to rebuild public health capacity and services in the post-war Balkans region. Administered by the home-visiting nurses in the city of Belgrade, this service provided much-needed postnatal counselling and services to ensure the health of mother and newborn. It also identified health high-risk situations. Although the service focused on health, it served as well to protect women, newborns, children, and youth against abuse and neglect. This model was adopted recently by UNICEF as a best practice model in Europe and Central Asia. I think it's something we could learn from.
Another population health intervention with a high return on investment to protect children and youth is universal comprehensive immunization against vaccine-preventable diseases.
Canada has made and continues to make significant investments in global vaccination programs. Although considerable progress has been made in terms of reducing the burden of vaccine-preventable diseases, much remains to be done. Developing countries are facing a number of challenges in terms of vaccination, including the introduction of new vaccines, the impact on the vaccination of outbreaks of other diseases such as Ebola and the replacement of less effective vaccines with more effective ones.
An issue that has also been referred to by other witnesses and which has a significant impact on immunization programs is the effectiveness and reliability of civil registration. If a newborn's birth is not registered, then it is likely that he will not be vaccinated. Through CSH's work in Tanzania, we witnessed the impact of a lack of reliable baseline census and registration data on the capacity of health managers and planners to effectively allocate scarce resources to the most needed programs, places, and people.
The improvement in civil registration will help national immunization programs to achieve the goal of reaching every child. But one shouldn't stop just at civil registration. Investment should also be made in improving national census capacity, and not only in terms of collecting but also its analysis and utilization. National census data is critical to determining the effectiveness of health programs and how they protect women, children, and youth.
Before concluding my remarks, I'd like to return to the term “worldwide” within the definition of global health. Whatever the government of Canada decides to do in funding and strategies aimed at protecting children and youth in developing countries, it should ensure that it matches, if not surpasses, its overseas commitments with action on issues related to protecting children and youth in Canada. The Government of Canada can be commended for the international mother-newborn-child health initiative. We suggest a comprehensive national MCH program for Canada should also be considered.
In closing, thank you for your attention.
Ms. Slawecki and I look forward to your questions and further dialogue with you on this issue.
Thank you. Merci.
Good morning. I am very grateful for the opportunity to appear before your committee. I am sorry that I couldn't be in Ottawa in person.
I'll say a word about our centre as we start. I am the chair of global child health and policy at our Centre for Global Child Health at the Hospital for Sick Children. I am also one of the seven member experts in the independent Expert Review Group of the UN Secretary-General for monitoring the MDGs and chair of the countdown process for monitoring trends.
Let me speak generally in terms of the issues that your committee has set in front of itself and start with the whole discussion on the millennium goals. I'll try very hard not to repeat and underscore some of the important points made by the preceding speakers.
Ladies and gentlemen, the last decade has been a phenomenal decade in human history. When we started the millennium development goals journey in 2000, the world had set itself a huge target of reducing child mortality by two-thirds and maternal mortality by three-quarters from a 1990 base by the year 2015, the year we are in. As we approach September 2015, when many of these targets will be reviewed, I think the last decade has seen tremendous progress. Today, from a base figure of around 12.5 million child deaths in 1990, we have been able to bring those down to around 6 million deaths worldwide, and maternal deaths worldwide from about 580,000 to a figure of around 280,000.
That has been a remarkable success in many geographic areas, including in global awareness of the importance of this issue. But it has also come with the realization that perhaps the focus on survival and on reducing this burden of premature mortality over the last decade has also led to several gaps. Those gaps have been highlighted by several of the presentations you have heard today.
One of those gaps was a lack of focus on equity. We have recognized that the bulk of the global progress and change has been driven by progress in a handful of countries, the Brazils and Chinas of the world. If you look at inequity in maternal and child health and survival today in the world, there are many countries that are still far away from achieving those survival targets. I very strongly underscore the huge role Canada has played, and is playing, in ensuring that we keep our eye on that principal focus of reducing premature mortality in some of the poorest countries of the world.
There has also been the recognition that in our desire and quest to achieve these goals perhaps we have not paid equal attention to several aspects that are important in terms of your committee's task. One of those is not having adequate focus on the determinants, particularly the social determinants, of maternal and child health and survival.
As I speak, I am very cognizant of the fact that over the last decade and a half, because of a lack of targets, the survival of newborns and the reduction of stillbirths have been orphaned as global priorities. As we speak, of the six million children who die prematurely every year before reaching their fifth birthday, around half or 45% die within the newborn period—the first four weeks of life—and the vast majority of them within the first few days of life. As my colleague David Morley pointed out, many of these are a direct consequence of inadequate maternal nutrition and factors that sometimes transcend one pregnancy, and maybe even a generation.
There hasn't been enough focus on morbidity and consequences. As we move toward sustainable development goals and the important issue of trying to address human capital and human development, we haven't paid enough attention in the last several decades to the whole concept of morbidity, mental health, and the important issue of child and family development. These are extremely important when you consider some of the tasks you have set in front of yourselves.
I want to underscore the whole issue of adolescence, particularly adolescent girls but also adolescent boys. This has not been on the radar screen over the last 20 years or so while we have been focused on the development of the MDGs and the post-MDG process.
As we speak, it is a startling statistic that around 60 million births every year, around 11% on average—in some populations, it's close to around 20% of all births—are by adolescent girls. In some parts of the world, these also include a substantial number of pregnancies in girls under 15 years old.
There are not just socio-cultural factors that contribute towards child marriage in many communities. They also reflect the lack of attention towards gender empowerment, the ability of girls to be in schools, and ensuring that state systems provide equal opportunities to boys and girls in those environments.
When, yes, we move towards the whole issue of trafficking and protection, it is important to recognize this is also a very important issue. What do we need to do to address the global tragedy of early child marriage, of children having children, which has consequences across generations?
We now know, colleagues, that close to a fifth of all stunting in children at six months of age is determined by the nutritional status of the baby. The nutritional status of the baby in turn is closely dependent upon the nutritional status of the mother. The nutritional status of the mother in turn depends upon what she was like when she was a girl. If you just do the statistics, it turns out that for around a third of all small-for-gestational-age births worldwide—babies who were born less than five pounds in weight and are therefore exposed to a developmental trajectory that's very different from their normal counterparts—the root cause lies in the way we support young mothers, young girls, in opportunities for development and education.
This is also very closely intertwined with the issue of how societies protect girls and the issue that you're tackling around female genital mutilation. The stunning figure is that of the 125 million individuals who are victims of female genital mutilation in the world today, the vast majority, or close to 80%, are from the 29 African and Middle Eastern countries. In these countries, it is also recognized that close to a fifth, around 18% to 20%, of all these female genital mutilations are at the hands of health care professionals.
I would very strongly underscore what my colleagues have said around the importance of Canada engaging, in our support to these countries around maternal, newborn, and child health, on these important areas of child rights and child protection, and particularly in working with governments to ensure that there are opportunities provided for girls' education and for their fulfilling their complete potential for contributing to society.
I want to say a word or two about boys as well in terms of the important subjects around conflict, child-trafficking, and exposure to violence. Very few people are aware of the global statistic that around a third of all under-five deaths and maternal deaths worldwide are now in geographies that are affected directly or indirectly by conflict. In many of these countries, as you are aware, perhaps better than others, children are not only just being exposed to violence; children are being forced, conscripted, to become part of that violence themselves. You just need to see what is happening at the hands of ISIS in Syria, and in geographic areas like Nigeria and Somalia, to see how important this whole issue of child soldiers is. Most of them are forced to play a part in this.
I wrote a paper, given my work in Afghanistan some 15 years ago, talking about the children of war, talking about the potential consequences of children being exposed to nothing but violence as they were growing up. As David has said, some of the problems we face today are because a generation has grown up facing nothing but violence. I feel very strongly, although I come from a child survival and maternal survival background, that, as we move forward to the sustainable development goals, we keep our eye on the importance of child rights and protection. We need to ensure that these children bearing arms, these children being confronted with violence in many of these geographies, are protected. I feel that whatever mechanism we have at hand, be it through development assistance or be it through working with countries as we implement our Muskoka II initiatives, we can support this through mechanisms that are promotive, protective, and legislative.
Lastly, I want to say a word or two about school-aged children. I say that with the recognition that the global science and public policy community hasn't sufficiently addressed the issue of school-aged children in relation to their morbidity, mortality, exposure, and the importance of this particular group in helping them enter adolescence in optimal shape.
We have focused largely on under-five survival and under-five needs as an agenda. There hasn't been enough focus, in the very countries that have about a 95% burden of maternal and child mortality, on addressing the issue of what happens in schools to health, nutrition, and development of children. They are very closely intertwined.
I would like to thank you, ladies and gentlemen, for your attention and the opportunity to share this testimony with you. I would like to underscore the fact that social determinants of health, which are the living conditions in which many women, children, and families in these developing countries live, are a reality. As we move forward, we need to expand our repertoire of work to include social determinants of health, not just social determinants of survival.
Do you want me to answer that one? Okay.
Thank you very much for the question. Actually, it's an interesting question, because we just held the 14th World Congress on Public Health in India two months ago. I was the chair of the planning committee for that event, and we had more than 1,650 people from 70 countries. One of the topics discussed was the ebola situation. Actually, it was at a session organized by our own International Development Research Centre.
One of the critical elements that people felt should be looked at was that disease surveillance systems needed to be upgraded drastically. First, emergency preparation plans had to be put in place and applied, not just written up and put in a desk drawer, which has happened; and we needed to have sufficient internal response, basically country capacity response, for these emergencies.
Unfortunately, as we saw in the countries that were affected, many of the medical staff were affected by ebola and several of them died. Once you've lost a highly trained person in these countries, you've lost a generation of people. So how do we improve the internal capacity to take care of public health emergencies?
I think one of the other issues that came to light was the whole issue—and it reflects on sociology and anthropology—of understanding people's belief systems. One of the issues that was dealt with was the preparation of dead people, the washing of bodies; and of course, this couldn't be done with someone who had been infected with ebola, but people refused to bury them without doing these practices. So how do we, as health people, understand these practices and work with communities in order to protect them but, at the same time, take into account these very important social aspects?
I'll leave it at that for the moment.
In particular, what has been successful in the last decade for child mortality reduction is immunization. The scaling up of vaccinations and the provision of these vaccines to countries that would have had no hope of ever getting them through GAVI and other mechanisms has been an extremely important factor.
There has also been a considerable impact of improvements, where they have taken place, on provision of skilled birth attendants. Maternal mortality reduction, to a large extent, has been related to changes in practices, moving from home births to births within facilities, and thereby there have been reductions in some of the morbidities and causes of maternal deaths.
Be that as it may, as I pointed out, this progress isn't universally distributed amongst the countries that have the highest burden. A lot of this is, in the global scenario, dictated by a relatively small number of countries, countries like Brazil, China, and perhaps to a certain extent India. There are also remarkable examples of countries like Bangladesh, which has made tremendous progress through concerted government effort and a focus on provision of care to remote areas, to women, through community health workers, through provision of interventions, through innovations, and again, through health workers who can reach populations that were difficult to reach.
I did want to take the opportunity of making just one point around this important issue of reaching babies early, reaching mothers and babies within the critical period around childbirth. There is a huge opportunity with this important focus on birth registration. Now, we don't necessarily only do this because it makes good sense; it can actually have an impact on mortality. Our data indicates that it does: a post-natal visit to a mother and baby can have an impact on survival, on picking up on problems. But I think there is a huge opportunity here of incentivizing that.
In many countries there is this importance of linking some of that early documentation, such as immunizations, to things like school entry and admissions. I wonder if there isn't an opportunity of tying it all together to incentivize the important issue of registration at birth, coupled with strategies to reach those families in difficult-to-reach slums and rural populations, with the benefits that will come out of such a birth registration process that are tangible and visible to families, such as benefits in terms of school entry and other benefits that can be linked to conditional cash transfers, etc.
Thank you very much, Mr. Chair.
I'll start with a few comments. Maybe I am more optimistic than Madam Brown. I am not quite sure about donor fatigue, as the OECD registered a significant increase in ODA from various countries—not Canada, of course—last year. This year there is still an increase, so I am not quite sure we can speak about donor fatigue. Sorry, it's a French word and I can't pronounce it in English.
I was quite struck by your comments, Mr. Chauvin, that we should look at ourselves also. Would it be used in Canada or public health institutions, or even the census maybe? That is my point of view. I think it matches very well with the sustainable development goals that are being developed and that are going to be universal, which means that we will have to look at ourselves also.
I was struck by the answer you gave, Dr. Bhutta, about female genital mutilation. I lived in Senegal for a few years, and they basically managed to get rid of female genital mutilation, which indeed was not linked to a religious belief or anything like that. As you said, it was through working with community leaders and religious leaders, and also offering an alternative job to the women who used to do that, which is a very practical thing—training them to become nurses, midwives, and other things—along with education. It did work.
I am finally getting to my question. The issue of education is absolutely key. Do you think that sexual education is also important and can help prevent early and forced marriages?
Maybe Dr. Bhutta can begin, and then anybody else who has something to add. It's sexual education and women's empowerment, of course.
I think there is language in the post-2015 sustainable development goals that does address young people, adolescents.
What I was pointing out is that the language is disproportionate in terms of what is there for young girls as opposed to young boys; boys seem to have an education target and girls have more than one.
First, I think it's a bit late now to be...and there has been a very involved process. With all due respect to everybody who's been engaged, this has been, as I said, very inclusive. Perhaps one of the reasons we have these 160 plus indicators, which we have to bring down to 100, is that everyone wants their favourite indicators in there.
Be that as it may, I think the proof of the pudding will be in the implementation of these sustainable development goals. After we have reached a consensus this year, the big challenge I see will be working with countries to make sure that they are as engaged in this process as they were with the millennium goals, particularly millennium goals IV and V.
One big concern that I have, and I indirectly expressed it in today's conversation, is that we don't want to lose sight of our goals and declare premature victory in the maternal and child mortality scenario. We still have 6 million children dying every year. We still have close to 280,000 women dying around childbirth and in childbirth every year. That's a huge global challenge. In the quest for new indicators and new targets we shouldn't lose sight of that core function.
I think what will happen, and what should happen—and this is where Canadian leadership is so important because of Muskoka ll and the fact that, as a society, we have very strong feelings on this—is that as we move forward next year we must ensure that we don't throw the baby out with the bath water; that we have our four health indicators; that we open the door to integrating some of the other indicators for social determinants of health, including education, empowerment, gender empowerment in particular, and particularly things that relate to a safe environment, which is so important moving forward; and that we bring them closer to the health indicators, which is the third millennium development goal.
I think this will happen, but what we require is concerted pressure until September and then even more pressure beyond that for their adoption by countries.