The federal government was rolling out a stimulus package aimed at kick-starting Canada's flagging economy. Two of North America's biggest car manufacturers had recently been bailed out, and there was widespread concern about whether some of the world's major economies would recover from a recession that had left millions without jobs.
But in the fall of 2009, Prime Minister Stephen Harper was also taking some time to consider the foreign-aid agenda Canada would champion as host of the next G8 summit of wealthy nations. In the months leading up to the summit, Mr. Harper spoke personally about his plans with billionaire philanthropist Bill Gates and his officials held a series of meetings with Canadian non-governmental organizations to discuss how the G8 might focus its poverty-alleviation efforts.
Nearly five years later, Ottawa is on track to spend some $2.85 -billion on maternal and child health initiatives around the world. The investment will be on display next week when the government convenes a group of global leaders for a summit in Toronto, including the Queen of Jordan, the Aga Khan, and United Nations Secretary-General Ban Ki-moon.
Despite recent efforts by Canada and others, the world is not on track to meet global goals for reducing maternal and child mortality before the United Nations' 2015 deadline, prompting calls for another round of substantial funding and renewing debate about Canada's foreign aid efforts.
In the lead-up to the 2010 G8 summit, a group of Canadian NGOs launched a collective push to advocate for maternal and child health to be Canada's primary development cause at the summit.
Their pitch? It was clear that at least two of the UN's Millennium Development Goals were making limited progress: The number of women who died during pregnancy and childbirth and the number of children who died before their fifth birthday remained stubbornly high.
The idea appealed to the Prime Minister's Office because the results of the investment would be relatively easy to measure.
There was also some political calculation, according to one former official, who spoke on condition of anonymity: The project could help counter a narrative that the Conservative Party wasn't concerned about global poverty and foreign aid.
At the same time, Mr. Harper held talks with Mr. Gates, the billionaire founder of Microsoft and co-chair of the Bill and Melinda Gates Foundation, a U.S.-based aid organization. The two already had a working relationship ahead of the summit, and their discussions included how the G8 could improve accountability for its poverty-reduction efforts.
Earlier this week, Mr. Gates's wife, Melinda, issued a call for more money to be spent on the health of mothers and children around the world, and especially on vulnerable newborns, where progress has been particularly slow. The appeal from Ms. Gates, who will participate in next week's summit, adds to the pressure for Mr. Harper to deliver additional funding for the cause.
Soon after the Prime Minister announced that the G8's development efforts would focus on maternal and child health, then-Liberal Party leader Michael Ignatieff issued a public call for the funding to include access to safe abortion – an appeal that appeared to catch the Prime Minister's Office flat-footed. The government responded by saying that abortion would not be part of the initiative, but then-foreign minister Lawrence Cannon later took the idea further, declaring that family planning would also be kept off the table. (That position was quickly reversed.)
One former official called the government's decision to exclude safe abortion services a "reactive" move that took place in a policy vacuum. But the decision has persisted, and International Development Minister Christian Paradis said in a recent interview that the government has no plans to change its approach.
Sandeep Prasad, who directs Action Canada for Population and Development, called the exclusion "hypocritical" because it approaches abortion abroad differently from how it approaches it at home. Many countries that receive Canadian aid permit legal abortion under varying circumstances, he said, "so we can't use restrictive laws overseas as an excuse for not funding this. That's clearly just an excuse."
The former government official, who spoke on condition of anonymity, said it was felt at the time that abortion was only one aspect of the initiative, and that a greater impact could be made with a focus on other areas of concern, such as midwifery, nutrition, and family planning. Some of the NGO leaders who had argued in favour of the initiative also felt the funding could be focused elsewhere, saying they felt it was better to find common ground that all of their members – and the government – could agree on.
A personal commitment
Today, Mr. Harper is known as a strong supporter for maternal and child health. While he spurned an opportunity to speak at the United Nations General Assembly last fall, the Prime Minister co-hosted a separate UN event on maternal and child health in New York City. He also met with the UN Secretary-General for talks that – along with other global concerns – included a discussion about the need to keep maternal, newborn and child health in focus after 2015.
"A government wants to get political credit for what it's doing, and you want to do something that's going to look good. That's what politicians do. But I think it was much more than that," said Paul Wilson, a former director of policy in the PMO who now teaches at Carleton University. Mr. Harper "has kept at it for the last four years, being personally involved in this, in a way that I think a lot of people find surprising."
Outside experts say that, unlike some donors, Canada has so far kept its funding promises on maternal and child health. In 2010, Canada promised $1.1-billion in new funding over a five-year period, on top of $1.75-billion that was already earmarked for maternal and child health, and the government says it has spent 80 per cent of that money so far.
Sering Falu Njie, deputy policy director with the UN Millennium Campaign, said Canada's efforts have been laudable. "Many times we have these initiatives and we have a number of pledges … but at the end of the day we end up not getting the [money] that's been pledged," he said in a recent interview. On maternal and child health, however, "Canada has actually met its commitment."
A continuing debate
While they don't dispute the value of added resources for maternal and child health, some experts argue that there are significant gaps in Canada's approach, beyond the decision not to fund abortion services. Mr. Prasad said Canada should do more to support sexual and reproductive services for low-income countries, including counselling for family planning, sexuality education and the provision of contraceptives.
Rebecca Tiessen, who teaches international development and gender studies at the University of Ottawa, said the initiative's success has been limited by a failure to address pervasive gender inequalities that often make it harder for women to access services that are being offered.
"It is very much symptom-oriented," she said of Canada's funding. "We do need that aspect of it, we don't want to lose sight of that, but it means so much less – and one might even argue it means nothing – if women are never able to access those services."