Question Period Note: Forced and Coerced Sterilization

• Forced and coerced sterilization is a deeply troubling violation of human rights.

• Individuals impacted by this issue requiring mental health or crisis support can contact the 24/7 Hope for Wellness Line.

• The Advisory Committee on Indigenous Women’s Wellbeing is guiding our response. The Committee is comprised of National Indigenous Organizations, including women’s organizations, and brings forward gender and distinctions-based considerations and advice towards a range of issues impacting the health and wellbeing of Indigenous women.

• Collaboration is required between all orders of government, and health and social system professionals, to ensure culturally safe health services for all Indigenous women.

Forced and coerced sterilization is a symptom of a broader systemic issue: the absence of cultural safety in health and social systems. Promoting cultural safety in health and social systems cannot be done in isolation. Health Canada has a lead role to play, in partnership with provinces and territories, regional health authorities and regulatory bodies.

The scale and scope of this issue is currently unknown. Health systems (with the exception of Saskatchewan) do not track patient ethnicity. However, since October 2017 a number of legal actions that name Canada as a defendant have been initiated by impacted women. Lawyers indicate they have been contacted by over 100 Indigenous women (including a case that occurred as recently as December 2018). International bodies and parliamentary committees have studied and drawn attention to the issue:

• The U.N. Committee against Torture called on Canada to criminalize, investigate, prevent and provide redress;
• The Third Universal Periodic Review by the U.N. Human Rights Council recommended that Canada investigate complaints, punish those responsible and assist impacted women;
• The Inter-American Commission on Human Rights requested specific information on how Canada is responding;
• The Standing Committee on Health focused on understanding the scope; making reparations to victims; prevention; and engaging with Indigenous women’s organizations; and,
• The final report of the National Inquiry into Missing and Murdered Indigenous Women and Girls raised the issue. Calls to Justice include increasing the number of Indigenous health care professionals and providing cultural competency training to all health care professionals (Calls to Justice 7.6, 7.7, and 7.8).

In January 2020, Indigenous Services Canada supported a national forum on informed choice and consent in Indigenous women’s health services. A forum report was published in February 2021 on the National Collaborating Centre for Indigenous Health website and identifies the following actions for the federal government:

• ensure Indigenous women’s voices and leadership are included in gender-based policy development and action (i.e. bring birth back to communities, provision of escorts, and funding for more midwifery care);
• ensure culturally safe health and social services provision in Indigenous communities;
• formulate policies to support Indigenous self-determination;
• provide guidance and support a coordinated approach to sexual and reproductive options across disciplines;
• address the broader determinants of health, including addressing the policies and funding levels that maintain inequitable access to education, employment, health and social services;
• address data and knowledge gaps relevant to informed choice and consent, including gender violence, forced sterilization, girls and women’s health and violence (through CIHR); and,
• work with provincial and territorial ministries to support a coordinated approach to informed choice and consent.

Following the death last year of Joyce Echaquan, the Government convened two national meetings (in October 2020 and January 2021), bringing together Indigenous partners and governments, provincial and territorial governments, and healthcare providers to hear the lived experiences of Indigenous patients and practitioners. These conversations are ongoing. During the National Dialogue, the Government reaffirmed its commitment to address anti-Indigenous racism in healthcare systems by launching the engagement process for the co-development of distinctions-based Indigenous health legislation to improve Indigenous access to high-quality, culturally safe health care services.

If pressed on forced and coerced sterilization

• All Indigenous women must receive culturally safe health services with fully informed consent.

• To improve cultural safety and quality of service, we are ensuring an expecting First Nation or Inuit mother knows she is entitled to a travel escort through the Non-Insured Health Benefits Program and investing for the first time in midwifery in First Nation and Inuit communities.

• To amplify the voices of Indigenous women, the Advisory Committee on Indigenous Women’s Wellbeing has expanded to provide advice and direction to a number of federal departments on cross-cutting priorities, including Murdered and Missing Indigenous Women and Girls, and anti-racism.

If pressed further on actions being taken

• Forced and coerced sterilization is evidence of racism and the need to improve cultural safety in health and social systems.

• Following the death last year of Joyce Echaquan, the Government convened two national meetings, bringing together Indigenous partners and governments, provincial and territorial governments, and healthcare providers to discuss racism in healthcare and hear the lived experiences of Indigenous patients and practitioners. These conversations are ongoing.

• During the National Dialogue, the Government reaffirmed its commitment to launching the engagement process for the co-development of distinctions-based Indigenous health legislation to improve Indigenous access to high-quality, culturally safe health care services.

• Budget 2021 proposes to invest $126.7M over three years to foster health systems free from racism and discrimination.