China to strengthen legislation on food safety and the International Code

China presented its consolidated 3^rd and 4^th periodic report on the situation of the implementation of the Convention on the Rights of the Child. The next consolidated 5^th to 6^th periodic report is expected by March 2019. The Chinese delegation was composed of 44 members headed by H.E. Mr. Guide Jia, Deputy Director-General at the Department of Treaty and Law and Ministry of Foreign Affairs.

In view of the session, IBFAN presented an alternative report on the situation of infant and young child feeding in China, prepared by IBFAN East-Asia. The report shows that in China breastfeeding declined rapidly during the 1980s due to the promotion of breastmilk substitutes and inappropriate medical practices. With the implementation of BFHI since 1992 and of national regulation on the marketing of breastmilk substitutes (China’s Regulation) since 1995, breastfeeding’s superiority has been recognized and mothers are encouraged and supported to breastfeed their infants. However, breastfeeding promotion in community and work place has not yet received enough attention. One of the challenges regards the popularity of formula feeding and persistence of inadequate feeding practices related to giving water to infants 0-5 months. Another challenge is how to ban the marketing promotion of infant formula which undermines mothers’ confidence on successful breastfeeding. It is difficult for health authorities to supervise, conduct training and reassessments of the baby-friendly health facilities in China given the great number of concerned facilities (over 60 thousands). Finally, it is hard to ensure mothers’ entitlement to paid maternal leave and breastfeeding facilities, especially during the rapid social and live style charging in China.

Discussion on infant and young child feeding

During the dialogue with the government delegation, issues related to breastfeeding and infant and young child feeding have been raised by the CRC Committee, in particular relation to breastfeeding programmes and the baby-friendly hospital initiative (BFHI). The delegation of China did not address these issues in its responses. The Committee pointed out that the exclusive breastfeeding rate is falling, claiming that this is due to incidents of contaminated milk. The Committee insisted on the importance of establishing and reinforcing breastfeeding programmes, as well as promoting the Baby-Friendly Hospital Initiative. The Chinese delegation did not address these issues.

With regards to HIV and AIDS, the CRC Committee asked if there is any programme protecting young people and mothers.

The Chinese delegation answered that the government had implemented a project of HIV prevention and that to date, around 90,000 HIV-positive pregnant women have accessed appropriate services. This has led to a decrease of mother-to-child transmission rate.

Concluding Observations

In its Concluding Observations, the CRC Committee made recommendations on promoting exclusive breastfeeding, BFHI and on adopting the International Code of Marketing of Breastmilk Substitutes. The Committee also mentioned the importance of respecting child rights in relation to the business sector.

Regarding breastfeeding in particular, the CRC Committee was concerned “about the decrease in the exclusive breastfeeding and the incidents of contaminated infant formula in mainland China” (para 64). It strongly recommended that the government of mainland China: “(a) Intensify its efforts to reform laws and strengthen implementation of regulations on food and health safety standards, including for business sector and ensure that any officials or companies violating international and national environment and health standards are appropriately sanctioned and remedies provided when violations occur; (b) Collects systematic data on children affected and take all measures to ensure that all children and their families have access to effective redress, including free medical treatment and adequate compensation; (d) Promote exclusive breastfeeding and the establishment of Baby-Friendly Hospitals and adopt a Code of Marketing of Breast-Milk Substitutes with appropriate controls on the marketing of artificial infant formula” (para 64-65)

In relation to Health and health services, the Committee recommends that “mainland China strengthen its efforts to address, as matter of urgency, the existing disparities in health outcomes and resource allocations in order to ensure that all children enjoy the same access to and quality of health services, paying special attention to children in vulnerable situations, especially children living in poverty and rural areas and children of migrant workers. In particular, it recommends that mainland China take all measures to eliminate child and maternal mortality, including by improving health infrastructure and the availability and accessibility to emergency obstetric and neonatal care and skilled birth attendants at primarily health facilities in rural and poor areas.” (para 62)

The CRC Committee, in its General Comment 16 (2013), specifically calls on States “to implement and enforce internationally agreed standards concerning children’s rights, health and business including the [...] International Code of Marketing of Breast-milk Substitutes and relevant subsequent World Health Assembly resolutions”.

The Committee drew attention of China to its general comment no. 16 in the recommendations related to Child Rights and the business sector. It recommended to mainland China to strengthen the implementation of regulations in order to ensure that the business sector respects international and national human rights and complies with labour, environment and with child rights in particular. The CRC Committee therefore recommended that mainland China: “(c) Establish monitoring requirements for all industries to undertake assessments, consultations, and full public disclosure of the environmental, health-related and human rights impacts of their business activities and their plans to address such impacts; and (d) Investigate and hold accountable government officials, including local officials, suspected of failing to uphold environmental regulations or preventing people from accessing information or medical care, and ensure that children and their families have immediate and full access to effective and medically approved treatment and long-term remedies, including rehabilitation services and compensation” (para 22-23).

Lithuania's lack of support for breastfeeding programme implementation

Lithuania presented its consolidated 3^rd and 4^th periodic reports on the situation of the implementation of the Convention on the Rights of the Child in the country. The consolidated 5^th to 6^th periodic report is expected by November 2018.

The IBFAN alternative report of Lithuania was prepared by the Initiative group of breastfeeding mothers and breastfeeding promoters of NGO "Pradžių pradžia" (IBFAN Lithuania). The report reflected the ‘Declaration on Breastfeeding Support and Relate Issues in Lithuania’ which was addressed to the highest authorities such as the Ministry of Health and Ministry of Education of the Republic of Lithuania, and was also shared with all universities and medical colleges and faculties of the country during the World Breastfeeding Week in 2011.

The report shows that in Lithuania, executive health policy does not direct any attention towards an integral programme on protection, support and promotion of breastfeeding. Dissemination of evidence-unbased information and misleading advertising is the key reason for refraining from breastfeeding or choosing a comparatively short period of breastfeeding. Article 24 of the Convention of the Rights of the Child is not appropriately respected and no mechanisms exist for control of its implementation: a comparatively large number of mothers continue refraining from or choose especially short periods of breastfeeding[1]. Thus, responsible state bodies that do not take action to encourage mothers to feed infants in a natural way, fail implementing public health strengthening actions based on disease prevention, which results in increased personal health care costs and sickness benefits. Currently, no substantial actions are taken to upgrade breastfeeding-related qualifications of health care specialists. Certain seminars on nutrition of infants and children for health care specialists are supported and organized by companies distributing breastmilk substitutes which violate the International Code of Marketing of Breastmilk Substitute and resolutions. What is more, accessibility to personal health care services for breastfeeding women is not sufficiently communicated and organized. There are very few baby-friendly hospitals and in other health care institutions, the quality of services is very low or services that ensure successful breastfeeding are nonexistent. Consequently, a birth-giving mother, limited by time and distance, cannot freely choose a health care institution. Mothers and newborns experience discrimination as they end up in a hospital without the BFHI status.

During the discussion between the government delegation and the CRC Committee, issues related to breastfeeding were not discussed.

Concluding Observations

We regret that the CRC Committee has made no specific recommendation on infant and young child feeding to the government of Lithuania in its Concluding observations.

In par. 39 and 40 regarding health care and services, the Committee regretted the decreasing budget allocations to maternal and child health care programmes. It reminded Lithuania to pay attention to its General Comment no. 15 (2013), which insists on “the right of the child to the enjoyment of the highest attainable standard of health, and recommends that the State party take measures to increase its budget allocations for maternal and child health programs. The Committee also recommends that the State party ensure maternal care for women who choose to deliver at home by providing access to emergency obstetric care, trained care at delivery, and post partum care.”

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[1] Statistical data of research made at Health authority of Lithuania show that: just 30% of infant are breastfeed more than 0,5 year. For more see: http://www.tavovaikas.lt/kudikis/mityba-ir-sveikata/isaiskejo-kiek-sutaupo-seima-per-metus-maitinant-kudiki-krutimi.d?id=62015889

Tuvalu and breastfeeding

Tuvalu presented its initial report on the situation of the implementation of the Convention on the Rights of the Child in the country. The 2^nd to 5^th periodic reports are expected by October 2017.

IBFAN did not present any report.

Discussion on infant and young child feeding

The Committee did not enlarge on the issue of breastfeeding. The delegation of Tuvalu simply mentioned the fact that breastfeeding was actively encouraged, especially among young mothers.

Concluding Observations

In its Concluding Observations, the CRC Committee made recommendations on promoting the implement of breastfeeding programmes.

Regarding breastfeeding, the CRC Committee recognized that Tuvalu has adopted national policy on breastfeeding and has designated Princess Margaret Hospital as a baby-friendly hospital. However, the Committee gave concern on the brief duration of breastfeeding. It therefore recommended Tuvalu to: “undertake specific measures to promote exclusive breastfeeding up to the age of 6 months, including by providing training to all health workers and introducing legal measures to control the marketing and promotion of artificial infant formula” (para 53-54).

Kuwait to regulate business activities in child rights

Kuwait presented its 2^nd periodic report on the situation of the implementation of the Convention on the Rights of the Child. The next consolidated 3^rd to 6^th periodic report is expected by November 2018. The Kuwaiti delegation was composed of 19 members headed by H.E. Dhara Abdul Razzak Razzooqi, Ambassador, Permanent Representative of the State of Kuwait in Geneva.

IBFAN presented an alternative report on the situation of infant and young child feeding in Kuwait. The report, prepared by IBFAN Kuwait, shows that there are very low exclusive breastfeeding rates. This is due to insufficient coverage and low quality of antenatal education about breastfeeding management, weak support for the baby-friendly hospital initiative (BFHI) as well as lack of timely follow-up and competent support for mothers after hospital discharge. Concerning maternity at work, the duration of maternity leave is shorter than the ILO recommendation of 18 weeks, and women working in the informal sector do not enjoy the same rights as those in the formal sector.

Discussion on health care

The delegation of Kuwait informed the CRC Committee that particular attention was being paid to the social and health aspects of the life of the child, which has led, among other things, to reduce mortality rate. The government allocated a considerable budget to health care.

The issue of breastfeeding and infant and young child feeding has not been directly addressed in the dialogue between the CRC Committee and the government delegation.

The Kuwaiti delegation also specified that specialized centres had been established for HIV and AIDS tests and other sexually transmitted diseases. To date, there is in Kuwait a very limited number of HIV-positive cases thank to the effective programme established by the Government.

Concluding Observations

Kuwait did not receive any direct recommendations on breastfeeding in the Concluding Observations of the CRC Committee.

However, the CRC Committee has addressed to Kuwait recommendations on the impact of the business sector on child rights.

The CRC Committee recalled Kuwait the content of the General Comment no. 16 (2013) on State obligations in regard to the importance of the impact of the business sector on child rights. It recommended to Kuwait to establish and implement regulations in order to ensure that the business sector respects the international and national human rights and complies with labour, environment and specifically with children’s rights.

The CRC Committee therefore recommended Kuwait to: “(a) Ensure effective implementation by companies, especially industrial companies, of international and national environment and health standards; set up effective monitoring of implementation of these standards and appropriate sanctioning and providing remedies when violations occur, as well as ensure that appropriate international certification is sought; (b) Require companies to undertake assessments, consultations, and full public disclosure of the environmental, health-related and child rights impacts of their business activities and their plans to address such impacts”.

The Committee also mentioned the importance of respecting the environment in order not to contaminate water. It urged Kuwait to: “(c) Take immediate measures to relocate all families and children subjected to pollution that endanger their life and health status; and (d)  Be guided by the United Nations “Protect, Respect and Remedy” Framework, accepted unanimously in 2008 by the Human Rights Council, while implementing these recommendations” (para 23-24).

Sao Tome and Principe to address maternal deaths and business impact on child rights

Sao Tome and Principe presented its consolidated 2^nd to 4^th periodic reports on the situation of the implementation of the Convention on the Rights of the Child in the country. The 5^th and 6^th periodic reports are expected by June 2018.

IBFAN did not present any alternative report.

Discussion on infant and young child feeding

The Committee did not address issues related to breastfeeding. However, it tackled the question of maternal mortality in relation to HIV/AIDS infections. The delegation of Sao Tome and Principe explained that it is currently taking steps to eradicate these infections by 2015. Counseling centers for sexual health have been established in schools and awareness-raising activities are being organized for young persons.

Concluding Observations

No recommendation specifically refers to breastfeeding in the Concluding Observations. The CRC Committee instead mentioned the importance of a good health care system. It drew attention to its General Comment no. 15 (2013) on the right of the child to enjoy the highest attainable standard of health. It therefore recommended Sao Tome and Principe to: “(a) allocate adequate human, technical and financial resources to improve the quality of health care and provide quality training for the health care personnel, particularly at local levels; (b) Undertake surveys and studies on the extent and root causes of maternal mortality throughout the country and apply the findings therein for formulating and implementing comprehensive programmes for addressing maternal deaths: and, (c) Seek financial and technical assistance from UNICEF and the World Health Organization (WHO), among others, in this regard” (para 48-49).

The CRC Committee also insisted on improving the access to safe drinking water. It recommended the State party to: “(a) intensify its efforts to improve access to safe drinking water and sanitation, and in doing so pay particular attention to rural and outlying areas” (Para 54-55).

Another paragraph was dedicated to HIV/AIDS. The Committee recognized the efforts of Sao Tome and Principe to decrease the mother-to-child transmission of HIV/AIDS rate by spreading HIV/AIDS testing for pregnant women. However, the Committee noticed that regular follow-up on infected mothers and children remain inadequate and that the access to antiretroviral treatment limited. Therefore, the CRC Committee recommends Sao Tome and Principe to: “(a) Sustain the measures in place to prevent the Mother-to-Child transmission of HIV/AIDS and develop a roadmap to ensure the implementation of effective preventive measures; (b) Improve follow-up treatment for HIV/AIDS-infected mothers and their exposed infants[...] and (d) Improve access and coverage of Antiretroviral Therapy and Antiretroviral prophylaxis for HIV infected pregnant women. In doing so, the Committee recommends that the State party seek technical assistance from, inter alia, the United Nations Joint Programme on HIV/AIDS (UNAIDS) and UNICEF” (para 52-53).

Finally, the CRC Committee drew Sao Tome and Principe’s attention to the General Comment No. 16 (2013) on State obligations regarding the impact of the business sector on children’s rights and recommended Sao Tome and Principe to have a clear regulatory framework and effective implementation and monitoring mechanisms to ensure that business activities do not negatively affect the rights of the child. Concerning that issue, the Committee recommended in particular Sao Tome and Principe to: “(b) Ensure effective implementation by companies, especially those of the extractive industries, of international and national environment and health standards, effective monitoring of implementation of these standards and appropriately sanctioning and providing remedies when violations occur, as well as ensure that appropriate international certification is sought; (c) Require companies to undertake assessments, consultations, and full public disclosure of the environmental, health-related and human rights impacts of their business activities and their plans to address such impacts; and, (d) Be guided by the United Nations “Protect, Respect and Remedy” Framework, accepted unanimously in 2008 by the Human Rights Council, while implementing these recommendations” (para 23- 24).