Women's health initiative fails to inspire

The Muskoka Initiative, formally announced Friday, has largely failed to inspire both at home and abroad. Despite the $2.85-billion, five-year commitment of Canadian taxpayer money, the initiative is high on rhetoric but short on detail.

Buzzwords -- like voluntary family planning, country ownership, health workers, information systems, continuum of care, accountability and effectiveness -- are abundant. But the details are missing. How will the initiative be co-ordinated with existing global health activities, particularly the Global Fund? Will the initiative promote universal access to health care for women and children, and if so, how will this be financed? While named in the communiqué, it is not clear how the initiative fits in with the Millennium Development Goals (MDGs) as well as the UN Joint Action Plan for Women's and Children's Health.

The G8 communiqué claims the initiative will prevent the deaths of 1.3 million children five years and under and 64,000 maternal deaths while enabling 12 million couples to access family planning. Yet no information is provided on how these goals will be achieved. Perhaps this lack of specificity is the reason that matching contributions from other G8 countries were disappointingly low. A request for billions of dollars is normally accompanied by a strategic plan.

The lack of enthusiasm abroad is met with skepticism at home. This government recently cut funds to organizations working for the rights of women in Canada and abroad. It also decimated Status of Women Canada, and shut down gender equality units at the Department of Foreign Affairs and the Canadian International Development Agency (CIDA).

If Prime Minister Stephen Harper wants Canada to contribute to reducing maternal mortality, he must recognize that maternal health is not a one-off, stand-alone issue.

Improving maternal health depends on the protection, promotion and advancement of the rights and freedoms of women and girls. Canada needs to push countries to fully respect these rights and support programs at home and abroad that allow women and girls to realize them.

Such rights include the ability to access affordable, appropriate and effective health care, as well as the right to clean water and sanitation. Women have a right to be educated, deserve equal opportunities for employment and credit, as well as protection of their property and inheritance rights. The right of women to mobilize as members of civil society and to seek political office must be supported. Voluntary family planning is only voluntary if women's rights are respected and if they have choice. To quote from the Beijing Platform, women must "have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence."

The Muskoka Initiative also needs to be closely linked to Canadian engagement in broader global health initiatives. In advance of the UN's September MDG Summit, experts are debating how to generate more resources while ensuring that global health interventions are better co-ordinated and managed at the country level. Despite its G8 focus on maternal health, Canada has been largely silent on these debates, nor are they reflected in the G8 communiqué.

This silence is not new. Canada's response to global health challenges has been largely reactive, driven by public policy issues such as the threat of H1N1, or by international processes at the World Health Organization and other multilateral agencies. This policy vacuum is accompanied by institutional fragmentation. Global health responsibilities are dispersed among CIDA, Health Canada, and the Public Health Agency of Canada. CIDA does not even list health as one of its three priorities, while Health Canada has few resources for international programming.

Canada, with its expertise in public health and its experience delivering universal health care to a dispersed and diverse population, should be a natural leader in global health. To realize this leadership potential, the government should articulate a bold Global Health Strategy -- like the U.S. and British strategies -- that identifies how Canada's global health engagement will protect and improve the health of Canadians and of people around the world. This vision would articulate how best to marshal Canadian government, civil society and academic resources, and clearly delineate institutional responsibilities to implement global health initiatives.

Harper can take this opportunity to frame the maternal health initiative as a key component of Canada's larger engagement on global health, and accompany the initiative by championing the rights of women and girls. Doing so will not only allay the cynics, it will provide a more inspirational, successful and sustainable foundation for the Muskoka Maternal Health Initiative.

Valerie Percival is an assistant professor at the Norman Paterson School of International Affairs at Carleton University.