Maternal health funding 'the right thing to do' - but what comes next?

Canada has been praised for both its work on maternal, newborn and child health and for pushing the movement to end child marriage too. Questions are mounting, however, about how much the Conservatives put into development and where that money is directed.

Canada winning praise for work to end child marriage, but concerns remain about amount and focus of aid

Martina Daniel, who ran away from home to avoid female genital mutilation and then convinced her parents not to go through with it, now works as a seamstress in a shop in Tarime, Tanzania that employs former child brides. (Laura Payton/CBC)

When Bhoke Peter was 14, her uncle married her off to a 55-year-old man. Her husband paid a bride price of 30 cows and set her to work in his field in a remote part of northern Tanzania, where he would whip her with a stick if she made a mistake. When they got home, he would beat her for not making his lunch fast enough.

He also raped her.

"I didn't have much option because the bride price was already paid and the way the culture here is, once the bride price is delivered, you really have no choice but to obey your husband," Peter told CBC News, sitting on a wooden chair in the shop where she now sews clothes with other former child brides.

When Peter was 17, she took the two children she'd had with her husband and ran away to her grandmother's house. She eventually divorced him.

"I even heard that he is dead and I didn't even go to his funeral because he was torturing me," she said through a translator.

The CBC's Laura Payton is this year's R. James Travers Fellow. The Travers Fellowship provided $25,000 in funding for her pitch to look at whether Canada's maternal, newborn and child health program was working.​ Read more about the project here.

Stories like Peter's are what prompted former Canadian foreign affairs minister John Baird in 2012 to speak out against what's known variously as child, early and forced marriage. Last fall, Baird announced Canada would put $10 million toward programs to fight child marriage around the world.

Rob Nicholson has since replaced Baird at foreign affairs, but officials say the focus on ending child marriage continues.

It's an issue not unrelated to Canada's maternal, newborn and child health focus established at the 2010 G8 summit in Muskoka. Women who give birth before they turn 15 are five times more likely to die during delivery, according to British-based NGO Girls Not Brides. Young women, particularly those without medical care, can have serious complications. Giving birth too young also puts the baby at greater risk.

It's a horrifying reality in many countries, and one that's difficult to defend. But it makes up only a single target among dozens included in next set of global development goals.

Sustainability the new focus

The world has spent 15 years working to reach the UN's Millennium Development Goals. First set in 2000, they come to an end on Dec. 31, 2015. The next set of targets, the Sustainable Development Goals, or SDGs, will be set this fall at the UN.

The new regime will have have twice as many goals and dozens more subtargets. 

It raises the question of whether the world is losing focus on women and children, and the number of preventable deaths: 6.3 million children and 289,000 women a year. 

Guillermo Rishchynski, Canada's ambassador to the UN, acknowledges the challenge to keep the world focused on the needs of women and children.

Salome Pascale, 26, and her two-year-old son, at their home in Tanzania's Nzega district, in the region of Tabora. She is pregnant with her third child and says she doesn't know how to avoid getting pregnant other than that she has to speak to a doctor to find out. (Laura Payton/CBC)

"The challenge of course is to keep this as high a priority as possible. And I can tell you without any hesitation that that is the singular preoccupation for myself and our mission here in New York."

While it's hard to find an organization that won't praise Canada's work, some would like to see adjustments to the next round of funding, already announced at $3.5 billion for 2015-2020.

Shannon Kowalski, director of policy at the International Women's Health Coalition, says the Canadian government was a political leader on ending forced marriage, including on leading discussions at the UN, but some maternal health polices "undermine the goals that they're espousing internationally."

"One thing that we've noticed with Canada over the last several years is that they've really regressed on their commitments to addressing sexual health and rights, particularly in adolescent girls," Kowalski said in an interview.

"And you can't talk about ending child marriage without also talking about young women's access to sexual and reproductive health services and to comprehensive sexuality education," she said.

"So we feel that's a really missing element that's part of the Canadian response that could actually prevent them from achieving what they want to achieve."

'The right thing to do'

The Conservative government has pledged additional billions over the next five years. But it's also pulled back on overall international development funding, bringing it down to its lowest level since 2005. Official development assistance, or ODA, has fallen from $5.7 billion a year in 2011 to $5.4 billion in 2013 to $4.9 billion last year.

Mickey Chopra, UNICEF's chief of health, says the organization — which receives millions in funding from Canada — would like to see an increase.

This bed is from a small clinic in Tanzania's Nzega district in the Tabora region. That type of clinic is known as a dispensary. This bed is used for women who need to give birth at the dispensary. (Laura Payton/CBC)

"Not just because it's the right thing to do, but we also do feel it's a very efficient and effective investment to be made," he said.

"The investments that were made in the development of countries such as China, Malaysia and now India do reap benefits in the medium-to-long-term in increasing the market for Canadian goods or increasing the knowledge base for innovation."

Some money has already been allocated under the 2015-2020 funding, although there's been no announcement so far on the $370-million partnership program that gives money directly to NGOs.

With a federal election coming this fall, there's always the possibility of a new leadership, which could pull back, redirect or otherwise change Canada's development goals.

Prime Minister Stephen Harper and International Development Minister Christian Paradis turned down repeated requests for interviews on their signature policy.

Tom Mulcair, leader of the NDP, said last month the New Democrats would increase aid to 0.7 per cent of gross national income, which would nearly triple it from the current 0.24 per cent. That 0.7 per cent is a global target that few countries have actually met, although the UK reached it this year.

The NDP said it would also maintain the current focus on maternal, newborn and child health, but expand it to put more money toward family planning, including abortion.

Liberal Leader Justin Trudeau said he would keep maternal, newborn and child health a priority, and expand the family planning element, including offering abortion. The party would reverse the cuts the Conservatives made, but isn't making any promises about hitting the 0.7 per cent target.

The organizations delivering aid around the world will be watching.

The CBC's Laura Payton is this year's R. James Travers Fellow. The Travers Fellowship provided $25,000 in funding for her pitch to look at whether Canada's maternal, newborn and child health program was working. Read more about the project here and read her entire series here.