By Sandeep Prasad
Originally published in Ricochet
Elections represent key moments for decision-makers and the parties they represent to make commitments to Canadians. Speaking points on our economy, security and energy are repeated ad nauseam, yet sexual and reproductive health — an issue that affects us all — is often missing on the campaign trail.
Political parties generally chalk it up to jurisdiction, but the reality is that the federal government has an important role to play in ensuring a consistent standard of health care services across the country, and it has the constitutional spending power to do so.
In order to receive health transfers from the federal government, provinces are required to comply with regulations set forth in the Canada Health Act. This includes universal coverage for all insured persons for medically necessary hospital and physician services, including sexual and reproductive health services.
As Canadians, we have a reputation for prioritizing universal health care. However, we allowed the Canada Health Accord to expire, (which, when combined with the planned federal cuts in health care transfers, will result in the creation of 14 different health systems in which access to services depends on where you live and your ability to pay). We also have no national drug plan, which means, for example, that many of us must pay for contraceptives out of pocket. On top of that, medically necessary services including abortion are riddled with barriers.
These barriers are particularly challenging for those who live in rural or remote areas. Only one in six hospitals provide abortion services in Canada, the majority of which, like free-standing sexual health clinics, are disproportionately dispersed across the country and primarily located in urban centres. P.E.I. offers zero abortion services, and only four facilities cover Nunavut, the Yukon and the Northwest Territories. The limited availability is compounded by other barriers to access such as the patient’s age, financial resources and migration status; wait times; and physicians refusing to provide services on moral and religious grounds.
In terms of access, the federal government can begin by withholding cash contributions to provincial and territorial governments who fail to ensure their availability and accessibility and initiating dispute resolution procedures. The Up for Debate campaign and Munk Debate have both provided opportunities for political parties to speak up on this issue during the election, and only two parties have committed to holding provinces accountable through the Canada Health Act.
As with health care, the federal government, in fulfilling young people’s sexual and reproductive rights, has a role to play by creating national guidance to support provinces in implementing standardized sexual health education. Sex ed needs to go beyond the birds and the bees. Ensuring comprehensive sexuality education as the standard can provide young people with the tools and information they need to live healthy sexual lives, address stigma and discrimination and end gender stereotypes.
Unfortunately, sex ed in Canada has been neither consistently nor effectively implemented. This has meant persistent stigma and discrimination on the basis of sexuality and an overall lack of knowledge on sexual and reproductive health among our youth. In 2010, over one-quarter of positive HIV tests were attributed to young people, and young Canadians reported the highest rates of sexually transmitted infections — 81 per cent of new cases of chlamydia, 67 per cent of new cases of gonorrhea and 27 per cent of new cases of infectious syphilis occurred among young people.
Recognizing progress at the provincial level (e.g., Ontario’s new curriculum), the federal government can take a first step by revising the outdated Public Health Agency of Canada Guidelines for Sexual Health Education, conducting regular monitoring of sexual health indicators and developing awareness-raising campaigns based on current realities.
The federal government can also take a number of legislative steps to significantly improve the health of Canadians. Introducing legislation to add real or perceived gender identity and gender expression to the list of prohibited grounds for discrimination in the Canadian Human Rights Act and making it illegal to willfully or publicly incite hatred based on these grounds in the Criminal Code would have a huge impact on the lives of many. Such legislation would go a long way in addressing the heightened levels of verbal harassment at school reported by 74 per cent of transgender youth and the physical violence reported by one in three.
Similarly, swift action is required to address the health and safety of sex workers. In 2013, a clear decision from the Supreme Court of Canada struck down elements of the Criminal Code that were determined to violate the human rights of sex workers. When asked to produce new legislation, the government reinstated provisions very similar to those struck down by the court.
This type of legislation forces sex workers into unsafe and unprotected areas, restricting access to important safety strategies that protect their health, security, safety, equality and human rights. The federal government needs to repeal the Criminal Code sections that individually and as a whole threaten sex workers’ health and safety. It is a matter of human rights. Such legislative change must be accompanied by measures to improve the safety of individuals selling sexual services and to assist those who wish to transition out of the sex industry.
These are just a sampling of actions that the government needs to take. Countless intersecting pieces still need to be addressed. Access to programs related to family life and childcare, immigration policies, and the targeting and profiling of racialized communities, just to name a few, impact how individuals can exercise and claim their sexual and reproductive rights and access quality sexual and reproductive health services and information.
The Canadian government needs to take action at home and abroad across all of the issues that make up sexual and reproductive health. In Canada, it’s about taking the first steps to address these intersections. Globally, it’s about development assistance and a foreign policy on sexual and reproductive rights that includes ending the ministerial refusal to fund abortion service.
Getting the attention of decision-makers on these issues — our human rights — isn’t always easy. But now is the time. The federal government, in meeting its human rights obligations, has a responsibility to take action. Change starts with asking your candidate questions during local events in the coming weeks, contacting your political representatives to ask them where they stand on these issues, and speaking up for human rights.