The Globe speaks to Stephen Harper and Melinda Gates about maternal and child health

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Prime Minister Stephen Harper, who has made maternal and child health a core focus for Canada's foreign aid, sat down with Melinda Gates, co-chair of the Bill and Melinda Gates Foundation, and The Globe and Mail's Kim Mackrael at a school in Toronto on Thursday. The interview took place after Mr. Harper announced $3.5-billion in funding for maternal and child health over the next five years.

Mr. Harper, you spoke yesterday about the importance of keeping the focus on maternal, newborn and child health. What can you tell me about the post-2015 development agenda and what Canada, specifically, is pushing for?

Prime Minister Stephen Harper: Well, as I mentioned today, we will essentially be going farther and with a little bit more resources in the same direction. Our focus will continue to be reducing mortality for mothers and children, and we will be focusing on disease prevention, you know, immunization, vaccination. Also nutrition, as I mentioned, because that's something that Canada's been particularly specialized in getting some of these vital nutrients that are essential for early development. And then we'll be focusing a little more on vital statistics and registry.

You know, in some of the countries like Tanzania and others where you're getting significant progress, you're going to kind of start to hit a wall if you don't have better baseline data. So those really will be our focus. And I'm not saying there aren't other things we'll be doing. You know, obviously we contribute to the Global Fund on malaria, [tuberculosis] and AIDS.

But what I really want to try and urge the world to do is not to multiply the objectives. We have eight MDGs now, and I'm not saying they're necessarily the best eight or that we can only have eight. But I just know from all my experience in government that the more priorities you have the less any of your priorities actually matter.

So we're focusing on two in Canada. But I'd urge the world not to let this list get too long or everything will just become ineffective.

Ms. Gates, your foundation has the reputation and the resources to go to different governments and try to persuade them to put their own resources into what you're working on in development. What has your experience been like in pursuing maternal, newborn and child health, and what has it been like [to work] with Canada?

Melinda Gates: Well, first of all I would say this: maternal and child health is on the global health agenda, in part, really, thanks to what Canada did with the Muskoka Initiative, that people started to really focus and say 'maternal and child health is on the agenda, what should we do?' And we got very practical about it as a world, saying, 'What are the specific targets and indicators we should go for, how do we do that?' And now, the amazing thing is because we have made progress on these under-five deaths, that is child mortalities down, from [12] million deaths now down to 6.6 million in the last year.

Now the new piece that we're adding in, which honestly should have been there before, is the newborn agenda. The World Health Assembly just voted two weeks ago on an every newborn action plan, which is saying, okay, of those 6.6 million deaths, we can now look and see 2.9 million are in the first month of life, a million on the first day, and there is basically a package of very simple, inexpensive interventions that we really should go for as the world, if we want to bring down that neonatal death [rate]. And we can do that.

And so I'm seeing more and more governments come on board to do that, again, thanks to Canada's leadership on this, and we've been really pleased. And I think the neat thing is that you're also seeing the African governments step up and put some of their own money into the equation as well. But they're also building out their health systems. Rwanda, Ethiopia, Tanzania, Senegal. It's those countries building out their health systems that will allow us to continue to add more pieces in that will save mothers and children's lives. But it's that health platform that we can build upon.

Prime Minister Stephen Harper: I think people need to understand, this really has become a proliferating and effective network. Obviously we began this at the G8 with Canada and with some major western governments, but then we got major private organizations, the Gates Foundation was really the very first and the largest. And as Melinda mentioned you now have developing countries that are specifically now starting to funnel some dollars towards their own health systems.

But also, just on the ground. You know in Canada, we now have, part of what's grown out of all this, is 70 organizations, you know, NGOs, academic organizations, etc. Who have now come together in a network. They tell me there's over a million contributors to these various organizations combined, just within this country.

So as I say, it really is here, as well as some other places, we're really getting some real critical mass behind this. And I think it's partly because, not just that the cause is noble, it's because people can see the results. They can understand how results could be achieved and they can see them being achieved.

Ms. Gates, you spoke earlier today about the importance of reproductive rights as part of the continuum of maternal and child health. What role should that be playing as countries like Canada are renewing their commitments? What do you want to see in terms of a focus on reproductive rights?

Melinda Gates: So reproductive health is part of that continuum of great maternal, newborn and child health. And if a woman can plan and space the births of her children, she's healthier and more likely to survive the births, and her children are more likely to be healthy. So part of the investments have to be, also, to reproductive health and that is contraceptives. Making sure that women all over the world [have access.] If you travel to Africa, women will tell you contraceptives are stocked in – if you look at the global reports – but women will tell you they are not. Well, the reason is, what's stocked in are condoms. But women will tell you they can't negotiate a condom and they want access to the different types of tools. Implants, a shot called Depo-Provera that they get.

And if they have access to those tools and education about them, they will absolutely use them because they know it saves their lives and their children's lives. So that has to be part of that whole package of what we call RMNCH, reproductive maternal, newborn, and child health.

And Mr. Harper, do you see that the same way, that reproductive health needs to be a part of the initiative?

Yes, there's actually a myth that we don't fund any family planning or maternal health. That's not true. We do. We, specifically as a result of a vote in Parliament do not fund abortion services but we fund other forms. And yes, I do happen to believe that's an essential part of the continuum.

I want to ask you about a specific aspect of this initiative that has generated some criticism of the way the government has gone forward. That's the decision to exclude funding for safe abortion services. Why have you made that decision, and [since] you're coming to a point where there's some rethinking around [where] the funding is going, is that something you'd reconsider?

Well, as I said, that was a decision of Parliament. And, you know, to put it very simply, what we have been trying to do since 2010 is build broad public and international consensus for saving the lives of mothers and babies. You cannot do that if you introduce that other issue. The fact of the matter is it's not only divisive in our country and in other donor countries, it's extremely divisive in recipient countries where it's often illegal.

And so, as I say, to build consensus, and to get as many partners as we can, we just stay out of that issue. There are obviously some organizations that advance that issue but the government of Canada does not advance that issue.

I want to ask you more broadly about how Canada handles foreign aid. You've been quite active on this, and you've made a number of changes. You've merged CIDA with DFAIT and you've been quite interested in seeing diplomacy, trade and development working together. Can you tell me what your vision is for the future of Canadian foreign aid?

Look, that's a broad question. It's hard to say it all in one word. But let me summarize it. We want to better coordinate what we're doing with trade and other foreign policies. We do know that development in terms of foreign aid and humanitarian assistance, in the long term, if you're serious about lifting people up, can't be completely de-linked from economic development.

So, you know, there used to be a view in the past. And I think not just a Canadian view, a widespread view, that there was humanitarian assistance and then there was, you know, businesses and others building the economy. You've got to marry that, to some degree, if you're going to get the long-term results you want.

The other thing we've been doing, we've actually done even before that, as I was saying to Melinda [Gates] earlier, is we've been moving our aid towards organizations and programs that actually deliver services on the ground.

Now, it's not to say that we never fund a conference, we're funding this conference [the maternal and child health summit]. But we're getting away from talk shops and merely advocacy. Because my experience, our experience has been Canadians want to see results. And one of the things the Gates Foundation has done – I think Melinda probably understates it – I think the Gates Foundation has really shaken up a lot of the humanitarian aid world because it has focused on accountability, on measuring of results about being able to explain how what you're doing actually makes a difference, as opposed to just talking about it.

And that's tended to permeate not just what we're doing but what a lot of international organizations are doing.

I want to pick up on what you said about talk shops. You've chosen not to participate in certain things that the United Nations has worked on partly for that reason. Yet what you're working on here, with the maternal and child health initiative, has a lot of connections to multilateral organizations, to the United Nations, obviously, [with a focus on] two millennium development goals. What makes this different and worth engaging on?

I was going to say, the other thing I should have mentioned, we've done of course in our development policy is try and focus our efforts. You know, we found that if you're on every issue in every single part of the world, you don't accomplish much. So we've obviously tried to focus on this.

I think the truth is you have to examine all of these various organizations and activities and objectives on their own merits. You know, I think there was a view in the past that here was some international body, UN body or some initiative, and Canada's international share is four per cent so Canada should just give four per cent.

Well that's actually not our view. Our view is, is it effective? Is it something we want to focus on, or if it isn't effective, it's something we don't want to focus on. And so I think we're trying to be more selective, more effective and achieve results for Canadians, particularly when dollars are involved.

So it sounds like it's a question of really thinking through which are the circumstances and the particular initiatives that Canada wants to engage on?

The particular initiatives. But also, look, to be blunt, some international organizations, particularly some United Nations bodies are much more effective than others.

You spoke yesterday about calling on Canadians to consider why they should be thinking about foreign aid. When Canadians are thinking about their own economy, when they're thinking about Canada's, in some ways, struggling economy at times, why should their taxpayer dollars be going to developing countries?

I think you only would use the phrase Canada's struggling economy if you didn't go to any other economy. There's a few others that are doing as well, and even a couple doing better than ours. But you know, we're one of the very few large powerful,wealthy and growing economies in the world.

And I don't want to minimize the challenges that, you know, we have as a government between our own domestic priorities or the challenges people have in their own lives, with various financial demands. But I think you would find there are very few Canadians – I mentioned a million who are contributing to this initiative in some way. There'd be very few of those who think that the money they're giving and what they know it's doing, that they don't feel it isn't worth it.

We give this simple example of the Vitamin A capsules. Really a Canadian innovation. Two capsules, two cents each. Four cents a year for a child, reduces mortality by 25 per cent. Whose budget is so tight that they can't see it in their hearts why that would not be worthwhile to do?

Is there an element for Canada, in thinking about foreign aid, of enlightened self-interest?

I suppose. Look, I think we do things for all kinds of reasons. But, look. We're now in a world, we know everything is interconnected. And not just the economy. You know, we had an economic recession in Canada, not because of anything that happened in Canada but because we're in a global economy and our export markets suffered from what people did in other countries. We now have, occasionally, these pandemics crossing Canadian borders, from far away, diseases unknown in this country, not native to this country, suddenly can appear.

So, terror, you know, terrorism, 9/11, Boko Haram. We don't have to talk about all of that. All of these. We're in a truly global world. So I do think it is in our broader, enlightened self-interest to make the world a better place.

But I also do think some of these things are just worth doing in their own right. We are a very wealthy and lucky people. It's not all luck, but you know, we all like to think we're self– made, but most of us were fortunate to be born at this point in history and in this particular county.

And as a consequence of that alone, we have a standard of security and living way above most people. And I just think, give us some perspective to sit back, look at how the rest of humanity lives and survives, and see it in our hearts to share a little bit of that blessing.

My experience is that there has been, Canadians are more than willing to do that. I think there has been, in the past, and not necessarily wrongly, a lot of cynicism about foreign aid. You know, does it work, does it go into the right pockets, what happens to it, is it really effective.

And you know, we know many, many instances in the past where that cynicism is justified. But I also know that when Canadians do contribute and actually see results, that that is something that actually inspires them. And I actually think they find it maybe far more worthwhile than many of the things they did in their own lives.

Melinda Gates: I think it's also worth saying a couple of things. You know, these are lives, these are people's lives we're talking about. This is a baby or a mother, like a Canadian mother. Or a Canadian baby. And if you can save a child's life for a few cents or 30 dollars for the basic set of vaccinations that you get here in Canada that we know save literally millions of children's lives.

Those are lives worth saving. And in addition, when you invest in those mothers and children, those mothers are ploughing back into society. So they're lifting up their family, they lift up their community, and then we actually get GDP results out of this. So we know that these basic health investments, if you then go on to make sure that a woman has in her hand, or a male, the right seeds so that they're growing three times as much yield on their farm and they get a little bit of income, they can put their kids in school. And so when you look at the history of how Canada or the US or now Mexico or Morocco, who've just come, these countries more recently have come from low-income countries to middle –income countries – we can actually look out across Africa now and say in 2030 or 35 you're going to have far fewer low-income economies than you do today.

And so when you think of a world that's a prosperous world, and a peaceful world, we're going to be far better off if we have middle income countries, and it's the right thing to do for humanity.

Prime Minister Stephen Harper: But the real fact is, that a country doesn't have to be very prosperous, with the right interventions, to massively reduce child and maternal mortality. That can be done at very low levels of prosperity.

This is a significant amount of money that was pledged today, $3.5-billion over five years toward [maternal and child health]. Canada has had its aid budget frozen. Is this a sign that there will be an opening up of that [budget] going forward?

You know, I never use one announcement to make another announcement. We'll do one announcement at a time. But as I say this is something we've made a priority of. We've had good results, and Canadians have really responded. And so I'm very confident that Canadians will respond positively to the increase we're putting into this particular program.

This interview has been edited and condensed