In 2019, Canada will host Women Deliver, the world’s biggest conference on women and girls. A few months later, much of Canada’s current funding for women and girls’ health will sunset. This makes it an exciting opportunity for the federal government to shape the future of Canada’s leadership in global health. So, what changes does Canada need to make to ensure it delivers for the world’s poorest women and girls? In April this year, CanWaCH, the umbrella group of 94 women’s and children’s health organizations, hosted a conference to answer these very questions. In an upcoming report, we outline the following areas where we think Canada should focus its attention:
Canada’s leadership on women and children’s health must be gender transformative. Social and cultural norms and power dynamics are major root causes of poor health and of access to health care that is constrained by lack of information, education, autonomy and empowerment. For example, you cannot simply give a woman a method of contraception and expect she will be able to use it. In many parts of the world shame and stigma surround women’s health issues. Close work with local community groups and leaders is needed to better understand and to change harmful norms, myths and stereotypes.
Improving health is never solely about providing health care and services – we must also consider other critical factors that have an impact on health. For example, improved menstrual hygiene means having suitable school washroom facilities; lower rates of preterm births mean recognizing that interpersonal violence is a key risk factor; improved adolescent health outcomes means tackling early, forced and child marriage; and higher child vaccination rates means educating and empowering mothers to make the decision to vaccinate.
Reaching the hardest to reach and most vulnerable
There is universal concern that our efforts are not reaching the most vulnerable and marginalized. Inequities in progress are often masked by averaged data that construes progress of some as progress for all. Starting from a rights-based approach that sees everyone’s lives as of equal value, we must go beyond the “low-hanging fruit” to achieve progress for everyone.
Institutional and systemic change
Much of our work so far has focused on the individual or household level, and more attention needs to be paid to permanent transformation at all levels – individual, organizational, community and national. Time-limited, results-focused projects can become splintered and temporary if they are not part of a coherent strategy of permanent transformation, guided by the UN’s Sustainable Development Goals (SDGs) and other frameworks.
Systemic and institutional change is essential for broader improvements in health and health systems. Examples of such improvements include universal health coverage, capacity building for country-level data collection, and supply-chain management for increased access to vaccination.
Impact and data
We need to make a mindset shift from reporting outputs and activities to donors, to seeing Canadian efforts more widely as part of a collective, global project to make progress on the SDGs and other international frameworks. To do this, we must better understand how outputs lead to outcomes, not just within specific projects but also at subnational, national and regional levels.
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We need to set goals not just for each program, but across all of our work. We won’t get to success unless we first define it, then have the data and check-in points to course-correct if needed. We need more and better data, especially on the hardest to reach, and we need standardized indicators to track progress.
Unequal relationships are not feminist. A feminist approach to partnership means a conceptual shift from seeing people as clients or beneficiaries to viewing them as active partners with agency and as leaders in collective success. This means listening to local people and organizations, and meaningfully involving them as leaders.
The shift to sustainable development requires seeing solutions as community- and country-developed and owned. Donors and implementers need to see themselves as contributors to country-led and country-owned efforts.
Advocacy and political will
Advocacy is key to addressing the root causes of poor health, such as systemic, legal and institutional barriers. Marginalization is a result of deliberate policies, laws and practices, and advocacy is an integral strategy for reaching the most vulnerable and marginalized.
Advocacy drives local and national demand for improved services and outcomes. Without it, there is unlikely to be the political will to increase domestic resources and/or Official Development Assistance to fill the funding gaps for women and children’s health.
While the G7 certainly advanced women’s and girls’ education, it was sadly not possible to make gains on so-called sensitive issues like women’s health. Yet Canada must continue to lead on women and children’s health, and must find other global spaces to do so. The stakes for women and girls around the world are too high for us to fail. We cannot afford gaps in funding, policy or leadership. Expectations are high for Canadian leadership when Canada hosts the global Women Deliver conference next year in Vancouver. We look forward to working with women and girls in the global south, and with governments, and civil society, to shape this next phase of Canadian leadership.
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