IBFAN Statement on the occasion of the 25th Anniversary of the Convention on the Rights of the Child

On the occasion of the 25th Anniversary of the United Nations Convention on the Rights of the Child, IBFAN would like to congratulate the States parties as well as the Committee on the Rights of the Child for the work that they have achieved with the aim of realizing children’s rights at global scale. For more than 10 years now, IBFAN has been collaborating with the Committee and sending regular alternative reports and contributions on the issue of infant and young child feeding, channeling information from its global grassroots network to the international policy-making scene.

Breastfeeding constitutes one of the single most effective interventions in order to fulfill the child’s rights to life and to the enjoyment of the highest attainable standard of health. Article 24 of the Convention specifically mentions the importance of providing parents with education and support related to breastfeeding and the CRC General Comment No. 15 stresses the obligation for States to protect, promote and support breastfeeding through the implementation of the World Health Assembly Global Strategy for Infant and Young Child Feeding.

However, breastfeeding continues to face tremendous commercial pressures from the baby food industry. To date, only 37 countries have enacted a law including all the provisions of the International Code of Marketing of Breastmilk Substitutes and the enforcement of such laws is often problematic. The influence of the baby food industry on parents’ feeding choices through misleading marketing campaigns remains substantial and more than one child out of two is not exclusively breastfed until 6 months of age, despite the official recommendations of the World Health Organization.

Addressing this crucial issue, the Committee has repeatedly re-affirmed the necessity for States to promote and support breastfeeding as well as to implement and enforce the International Code and its relevant subsequent World Health Assembly resolutions. This last recommendation has also been highlighted in two General Comments issued by the Committee in 2013: the General Comment No. 15 on the right of the child to the enjoyment of the highest attainable standard of health and the General Comment No. 16 on State obligations regarding the impact of the business sector on children’s rights.

Protecting the right of every infant and young child to benefit from the most adequate food possible and creating an enabling environment for breastfeeding remain at the core of IBFAN’s engagement and we stay committed to work alongside the Committee of the Rights of the Child in the future. IBFAN will continue to provide information to the Committee and to support the effective implementation of its Concluding Observations in reviewed countries, in particular through the World Breastfeeding Trends Initiative. 

67th Session of the CRC Committee: Recommendations Related to Breastfeeding

The 67th Session of the Committee on the Rights of the Child (CRC Committee) took place in Geneva from 1st September to 19th September 2014. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 5 countries: Croatia, Fiji, Hungary, Morocco, and Venezuela. IBFAN submitted alternative reports on the situation of infant and young child feeding for each of the reviewed countries. The reports on Croatia and Venezuela were prepared by the IBFAN groups in those countries. 

In its Concluding Observations, the CRC Committee referred specifically to breastfeeding in 4 out of 5 countries under review (Croatia, Fiji, Hungary and Venezuela). Morocco did not receive any direct recommendation on breastfeeding, albeit it was addressed several recommendations on various topics indirectly related to breastfeeding.

General measures of implementation 

The CRC Committee called for the timely adoption of a comprehensive policy covering all areas of children’s rights under the Convention in 4 out 5 countries and for the improvement of its implementation in Morocco. 

Furthermore, it recommended that all countries under review take all necessary steps to collect disaggregated data that should cover all areas of the Convention.

Health resources and budget 

The Committee also called for the strengthening of resources allocated to health, by urging Croatia to allocate adequate human resources to maintain the quality of health care and by requesting more generally Venezuela and Morocco to allocate sufficient human, technical and financial resources to the health sector and to effectively used them.

Preventive health

The importance of preventive health has been highlighted in several recommendations.

Morocco and Venezuela were asked to reduce child and maternal mortality. Fiji was specifically requested to reduce under-5 and infant mortality rate, especially by focusing on preventive measures and treatment, including immunization, improved nutrition and sanitary conditions, in particular in remote areas as well as to further reduce maternal mortality, by ensuring the generalization of specific actions to prevent post-partum bleeding and other major causes of maternal death. 

The Committee also recommended that Fiji enforce its efforts to improve prenatal care, including by increasing the training of midwiwes. 

Children’s access to health care was also addressed by the CRC Committee, especially with regard to rural areas. Indeed, Croatia was called to strengthen its efforts to ensure that all children enjoy equal access to health services with particular emphasis on children in rural areas and from minority groups. Hungary was instead requested to take measures to ensure that health care facilities and practitioners, including paediatric and specialized care practitioners, are available throughout the country including in rural areas.

Finally, the Committee showed concern about the lack of specific data in Venezuela. Therefore, it asked Venezuela to collect disaggregated data on children’s health related issues, in particular on child mortality, including under-5 mortality, maternal mortality, vaccination coverage, nutrition and breastfeeding.

Malnutrition

The Committee asked Morocco to take more effective measures to address the nutrition status of young children, while Hungary was requested to provide access to education on nutrition as well as nutritious food to all children in the country. 

The Committee also urged Venezuela to continue its efforts to reduce malnutrition and increase vaccination coverage.

HIV/AIDS

The Committee addressed the issue of mother-to-child transmission, by requesting Venezuela to collect disaggregated data on the number of cases of mother-to-child transmissions and the number of children and pregnant women under treatment. It also urged Venezuela to address the sporadic shortages of antiretroviral drugs and ensure that all HIV/AIDS positive pregnant women receive adequate treatment.

In this regard, the Committee asked Fiji to improve follow-up treatment for HIV/AIDS-infected mothers and their infants to ensure early diagnosis and early initiation of treatment.

Breastfeeding protection 

Full implementation of the International Code on Marketing of Breast-Milk Substitutes has proven to be an effective intervention to protect breastfeeding and to ensure that mothers are provided with adequate information on the best way to feed their infants and young children.

Therefore, the Committee urged Hungary to fully implement the provisions of the International Code and recommends that Fiji as well as Venezuela ensure that every hospital with a new-born nursery is regularly monitored on adequate implementation of the International Code. The Committee specifically asked Croatia to take all necessary legislative and structural measures, including monitoring, to control the marketing of breast-milk substitutes. 

More generally, in light of the CRC General Comment No. 16 on State obligations regarding the impact of the business sector on children’s rights, Morocco was asked to examine and adapt its legislative framework concerning legal accountability of business enterprises and their subsidiaries operating in or managed from the Morocco’s territory. The Committee also requested Morocco to establish monitoring mechanisms for the investigations and redress of violations of children’s rights with a view to improving accountability and transparency. 

Breastfeeding promotion 

The Committee expressed concern over the lack of awareness of the benefits of exclusive breastfeeding and risks of formula feeding in Croatia and Fiji. It also showed concern with regard to the high number of children aged up to 6 months who are not being exclusively breastfed in Fiji and the lack of information on this rate in Hungary. Finally, it expressed concern over the low number of baby friendly hospitals in Hungary. 

Therefore, it asked Fiji to raise awareness on the importance of breastfeeding and on the risks of formula feeding. Fiji was also urged to promote proper breastfeeding practices, as well as develop a policy on infant and young child feeding practices, which includes infant feeding and HIV. 

The same kind of recommendations was addressed to Croatia and Venezuela. Croatia was indeed requested to take action to improve the practice of exclusive breastfeeding, through awareness-raising measures, the provision of information and training to relevant officials, particularly staff working in maternity units, and parents. Venezuela was instead called to increase its efforts to promote breastfeeding by developing a comprehensive programme of action to promote exclusive breastfeeding, including for staff in hospital maternity wards, and to develop awareness raising campaigns. 

Finally, the CRC Committee recommended that Hungary specifically encourage exclusive breastfeeding of infants until 6 months of age, provide data on the rate of breastfeeding as well as increase the number of baby friendly hospitals. 

Breastfeeding support 

No specific recommendation on breastfeeding support (e.g. inclusion of knowledge on optimal breastfeeding practices in health curricula) has been issued by the CRC Committee following its 67th Session.

Table 1. CRC Committee - Session 67 / 2014 - Summary of Concluding Observations on IYCF

Country		IBFAN report	Summary of specific recommendations on IYCF
1	Croatia (3rd-4th periodic report)	yes	Indirect – General measures of implementation (§ 9, 15): adoption of the new National Strategy for Protection and Promotion of the Rights of the Child from 2014-2020 and ensure that it includes concrete goals and measures with clear indication of the roles and responsibilities of relevant bodies at all levels; expeditiously improve its data collection system. Health (§45): ensure that all children enjoy equal access to health services; allocate adequate human resources to maintain the quality of health care.  Direct (§49): improve the practice of exclusive breastfeeding, through awareness-raising measures, the provision of information and training to relevant officials, particularly staff working in maternity units, and parents; take all the necessary legislative and structural measures, including monitoring, to control the marketing of breast-milk substitutes.
2	Fiji (2nd-4th periodic report)	yes	Indirect – General measures of implementation (§§ 9, 15): take all necessary steps to provide for a timely adoption of a national comprehensive policy and strategy for children; establish a comprehensive data collection system. Health (§42): reduce the under-5 and infant mortality rate, especially by focusing on preventive measures and treatment, including immunization, improved nutrition and sanitary conditions, in particular in remote areas; improve prenatal care and further reduce maternal mortality, including by increasing the training of midwives and ensuring the generalization of specific actions to prevent post-partum bleeding and other major causes of maternal death.  Direct (§54): ensure that every hospital with a new-born nursery is regularly monitored on adequate implementation of the International Code of Marketing of Breast-milk Substitutes; raise awareness on the importance of breastfeeding and on the risks of formula feeding; promote proper breastfeeding practices, as well as develop a policy on infant and young child feeding practices, which includes infant feeding and HIV.
3	Hungary (4th-5th periodic report)	yes	Indirect – General measures of implementation (§§ 8, 10): improve the collection of data; adopt a comprehensive policy covering all areas of children’s rights under the Convention and ensure that its strategies and action plans are provided with necessary human, technical and financial resources for their effective implementation; Health (§47): ensure that health care facilities and practitioners, including paediatric and specialized care practitioners, are available throughout the country; provide access to education on nutrition.  Direct (§§ 50-51): encourage exclusive breastfeeding of infants until 6 months of age and provide data on the rate of breastfeeding; increase the number of baby friendly hospitals and take measures to fully implement the provisions of the International Code of Marketing of Breast-milk Substitutes.
4	Morocco (3rd-4th periodic report)	no	Indirect – General measures of implementation (§§ 7, 13, 23(a)): address previous recommendations related to data collection; ensure that the Integrated Policy on Children encompasses child protection and covers all areas under the Convention and all children; the Committee draws the State party’s attention to its general comment No. 16 (2013) on State obligations regarding the impact of the business sector on children’s rights and especially recommends that the State party examine and adapt its legislative framework concerning legal accountability of business enterprises and their subsidiaries operating in or managed from the State party´s territory. Health (§55(a)(b)): sufficient resources must be allocated for the health sector and effectively used; develop and implement comprehensive policies and programmes for improving the health situation of children and facilitating a greater and equal access to quality primary health services by mothers and children in all areas; take more effective measures to address maternal and infant mortality and the nutritional status of young children.
5	Venezuela (3rd-5th periodic report)	yes	Indirect – General measures of implementation (§§ 11; 20): finalize the design of the National Plan of Action for Children and Adolescents; expeditiously complete and implement the data collection system. Health (§§ 53(a)(b)(c)(d); 61(a)(c)): collect disaggregated data on children’s health related issues, in particular on child mortality, including under five mortality, maternal mortality, vaccination coverage and nutrition; allocate adequate human, technical and financial resources to the national public health system; building on data related to the causes, design a strategy to reduce child and maternal mortality, which includes the implementation of the two existing protocols on maternal and neonatal mortality; reduce malnutrition; collect disaggregated data on HIV/AIDS related issues, in particular on [...] number of cases of mother-to-child transmissions, [...] and number of children and pregnant women under treatment; ensure that all HIV/AIDS positive pregnant women receive adequate treatment.  Direct (§53(a);(e)): collect disaggregated data on breastfeeding; promote breastfeeding by developing a comprehensive programme of action to promote exclusive breastfeeding, including training for staff in hospital maternity wards, closely monitor the implementation of the International Code of Marketing of Breast-milk Substitutes and develop awareness raising campaigns.

Croatia at the CRC: Job Insecurity for Working Mothers and Low Rate of Exclusive Breastfeeding

On the 15th September 2014, the Committee on the Rights of the Child considered the combined Third and Fourth Periodic Report of the Republic of Croatia on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Croatia was led by the Assistant Minister for Social Policy, Strategy and Youth, Ministry of Social Policy and Youth, Mr. Hrvoje Sararić and includes the Senior Expert Advisor, Service for Children and Family, Ministry of Social Policy and Youth, Ms. Sabina Morosini Turčinović.

On this occasion, IBFAN presented an alternative report to inform the CRC Committee on the situation of infant and young child feeding in Croatia.

General overview of breastfeeding in Croatia

Information related to breastfeeding is not part of the national data collection survey. Such data are instead based on reports prepared by individual institutions or researchers.

In Croatia breastfeeding is generally considered the appropriate and desirable way to feed a newborn baby. Indeed, the rate of early initiation of breastfeeding is high (98%-99% in 2008-2009 and 91%-94% in 2011). However, there is a lack of awareness of the benefits of exclusive breastfeeding and the risks associated to formula feeding. This leads to premature cessation of breastfeeding. Indeed, the rate of exclusive breastfeeding at 6 months is very low (14.8%). Finally, Croatia lacks also of human milk banks, as there are none in the country.

In 2006 a National Breastfeeding Committee (NBC) was established by the Ministry of Health. In 2007 the National Program for Breastfeeding Protection and Promotion was completed by the NBC. However, such Program has not been implemented yet.

The Ordinance on Baby Foods for Infants and Young Children and Processed Cereal-Based Foods for Infants and Young Children (OJ 74/08) transposes the International Code of Marketing of Breastmilk Substitutes for the first time into a national legal measure. However, an appropriate monitoring system is missing.

It is worthwhile to mention that numerous courses on breastfeeding are available for health professionals in Croatia, albeit on a voluntary basis. However, the knowledge, attitudes and practices of most health professionals are still deficient.

The Baby-Friendly Hospital Initiative (BFHI) was successfully revived by UNICEF Croatia in 2006. As a consequence, 30 out of 31 maternity facilities are currently designated as ‘Baby-Friendly’. However, there has been a rapid drop in ‘Baby-Friendly’ standards following the BFHI designation.

Croatian job market (in both private and public sectors) discriminates against women. In particular, contracts are often terminated when the woman becomes pregnant or gives birth. By contrast, different kinds of maternity leave are available. Moreover, during the first 12 months after the child’s birth, mothers who are breastfeeding are entitled to two hours absence from work.

Plans of action and accompanying materials need to be prepared and finalised by the NBC and the Ministry of Health in order to be capable of coping with future emergencies.

Discussion on infant and young child feeding

The Committee specifically addressed the issue of breastfeeding. It welcomed the increase of mothers who choose to breastfeed (95%). However, it expressed concern with regard to baby food companies’ marketing and advertising concerning formulas and breastmilk substitutes.

The Delegation of Croatia pointed out the adoption in 2012 of a specific program aiming at promoting breastfeeding as the best practice and encouraging women to breastfeed. It also stressed the existence of a Committee for the Promotion and Protection of Breastfeeding.

Croatia expressed satisfaction with regard to the results brought by such a Program, especially in relation to breastfeeding in the first 3 months of life. Indeed, according to the Delegation, in the 3-year period of implementation of such Program, exclusive breastfeeding have increased dramatically. 95% of women exclusively breastfeed during the first days, whilst this rate decreases with time going by. In particular, 40% of women exclusively breastfeed after six months.

By addressing a specific concern of the Committee, the Delegation clarified that children can stay day and night with mothers who breastfeed while in hospitals.

The Delegation highlighted then the existence of a group for support led by nurses which gathers women and advised them in relation to breastfeeding. Furthermore, 8 counselling teams exist, which are well-recognised also outside the country.

It was acknowledged that until 2007, women in hospitals used to receive the so-called “happy baby” package, which contained advertisement for baby formulas. However, in 2007, a guideline was adopted prohibiting this package as well as other kind of advertisement in hospitals. Nonetheless, in the knowledge of the Delegation, this kind of advertisement is currently made in pharmacies, shopping malls and other places. Croatia declared its willingness to persist with the above-mentioned Program and continue to encourage breastfeeding. It also asserted that aggressive advertising will be prohibited, even outside the hospital system.

Furthermore, the Committee asked more generally for further information with regard to children’s rights and the business sector. Mr. Sararić, the Head of the Delegation, acknowledged that a balance between personal and working life is difficult in Croatia. However, the Croatian Government is endeavouring to better tackle this issue through the National Family Policy which is still under progress. Relevant measures need to be identified yet. In particular, Mr. Sararić mentioned the necessity to raise awareness about the strong need of family-working life balance within the business sector.

Concluding Observations

In its Concluding Observations, the Committee made several indirect recommendations. With regard to the general measures of implementation, it urged Croatia to “expedite the adoption of the new National Strategy for Protection and Promotion of the Rights of the Child for 2014-2020 and ensure that it includes concrete goals and measures” (§9) and “to expeditiously improve its data collection system” (§15).

Regarding health issues, the Committee recommended that Croatia “strengthen its efforts to ensure that all children enjoy equal access to health services” as well as “allocate adequate human resources to maintain the quality of health care”.

Additionally, the Committee issued direct recommendations related to infant and young child feeding (§ 49). It requested Croatia to “take action to improve the practice of exclusive breastfeeding, through awareness-raising measures, the provision of information and training to relevant officials, particularly staff working in maternity units, and parents”. It also recommends that the Government “take all the necessary legislative and structural measures, including monitoring, to control the marketing of breast-milk substitutes”.

Oral statement to Committee on the Rights of the Child 2014 Day of General Discussion – Digital Media and Children’s Rights

Thank you Madame Chair. I represent IBFAN, the International Baby Food Action Network, and I would like to raise your awareness about the way infants and young children’s right to health is violated through digital media.

As you may already know, breastfeeding is recognized as a crucial intervention to ensure a healthy start in life for infants and young children. It is the single most effective intervention for saving lives. Unfortunately, more than 60% of babies are not enabled to follow optimal breastfeeding practices. One important challenge breastfeeding faces is aggressive marketing of breastmilk substitutes. To protect breastfeeding against such marketing, the WHA has adopted the International Code of Marketing of Breastmilk Substitutes, which your Committee has integrated last year into its General Comments No 15 and 16. However, Code violations are still widespread. Moreover, misleading marketing of breastmilk substitutes through digital media is a growing trend that has taken considerable proportions in the recent years.

Despite the article 5 of the Code, which prohibits baby food companies to advertise and promote their products to the general public, baby food companies are increasingly using social media as well as mobile and web-based technologies to interact directly with pregnant women and mothers. Participative websites, blogs, mobile applications and “mothers clubs” offer parents “ nutritional advices” on pregnancy and infant and young child feeding through chats or hotlines. These strategies to reach mothers lead to creation amongst parents of a brand loyalty, a corporate culture in which industrial feeding is the norm. In addition, when entering these corporate “clubs”, parents often receive free samples, promotional offers and invitations to try products, another set of marketing practices prohibited by the Code. 

IBFAN is also very concerned by the so-called development of “viral marketing”, when attractive video clips, often claiming that industrial baby foods have positive effects on babies’ health, are published by companies on YouTube and social media, getting then picked up by users who share them widely. Recently, a Nestlé video clip, supposedly promoting breastfeeding, but subtly promoting breastmilk substitutes, was viewed more than a million times on YouTube. Last but not least, companies are increasingly engaging in ‘image transfer’ public relations activities. The global campaign launched by UNICEF and WHO to improve health and development through adequate nutrition during the first 1000 days from conception is one such case. Both Nestlé and Danone, leading companies in the baby food sector, have co-opted this slogan and launched their own commercial campaigns on these first 1000 days.

Despite this confusing situation, appropriate roles of different actors have clearly been defined in the Global Strategy on Infant and Young Child Feeding: companies have the obligation to comply with the Code in all contexts while States have the duty to protect, promote and support breastfeeding. Therefore, States should be urged to fully implement the International Code into their national legislation, ensure its effective monitoring, implement deterrent sanctions against violations, launch modern and attractive digital campaigns on breastfeeding promotion and support, and implement their Extraterritorial Obligations.

Through these actions, breastfeeding could be duly protected at a global scale and thus, the right to health of every newborn and young child upheld. Thank you for your attention.

Hungary at the CRC: Lack of Data, but Willingness to Further Consider Breastfeeding

On the 9th and 10th September 2014, the Committee on the Rights of the Child considered the combined third to fifth periodic reports of Hungary on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Hungary was led by the Deputy State Secretary, Ms. Tünde Fürész and it includes a desk officer of the Department of Health Policy, Ms. Gabriella Kissné Erdélyi as well as the Acting Head of Department of the General Directorate of Social Affairs and Child Protection, Gulyásné dr. Kovács Erzsébet.

On this occasion, IBFAN presented an alternative report to inform the CRC Committee on the situation of infant and young child feeding in Hungary. 

General overview of breastfeeding in Hungary 

Hungary shows a high rate of caesarean sections (30.8%) which might have a negative impact on the rate of early initiation of breastfeeding. However, the latter information is not available. Moreover, there is no available data on exclusive breastfeeding in the first 6 months for the recent years. The most recent data show a low rate of exclusive breastfeeding at the age of 6 months (±42%).

Generally, Hungary shows a poor monitoring of key breastfeeding as well as infant and young child feeding (IYCF) indicators. Furthermore, since 2002, there is neither information on courses on breastfeeding nor on others efforts to promote breastfeeding in the country. There is also a lack of information concerning the past and current activities conducted by the National Committee on Breastfeeding.

According to our IBFAN International Code Documentation Centre, only few provisions of the International Code of Marketing of Breastmilk Substitutes have been fully implemented into the national legislation. Moreover, the national Baby-Friendly Hospital Initiative (BFHI) coordinator, Dr. Cholnoky, also emphasized that baby food companies systematically violate the International Code by providing free sample and promotional materials to mothers.

In 2002, Dr. Cholnoky deplored that the BFHI was not followed by the medical professionals. At that time, the lack of knowledge about breastfeeding practices was identified as the main barrier to the widespread of the BFHI. However, the practice of ‘rooming-in’ (allowing mothers and infants to remain together) was common. Currently, out of 119 hospitals, there are 17 hospitals certified as “baby-friendly” in the country.

Hungary shows low fertility and female employment rates that are largely explained by insufficient support for parents to reconcile work and care commitments. Maternity leave lasts 24 weeks and the amount of maternity leave benefits is of 70% of the daily average gross earnings of the previous year. However, mothers working within the informal sector are not entitled to maternity leave benefits.

Data shows that in Hungary the number of pregnant women living with HIV who received antiretroviral medicaments for preventing mother-to-child transmission were of 5 in 2010 compared to 9 in 2009.

Finally, there is no information available on any emergency preparedness plan which may ensure an integrated response capable of protecting and supporting breastfeeding in case of emergencies.

Discussion on infant and young child feeding

The Committee showed particular interest in health issues and asked the Delegation to provide information about actions taken in this regard, especially to tackle deficiencies within the health system which affect children. A lack of well-trained health professional on pre-natal period was highlighted. The Committee mentioned the WHO and UNICEF recommendations related to children’s right to health as the correct path to follow.

In this framework, breastfeeding was specifically addressed and given particular attention. The Committee expressed concern in relation to the very low rate of infant early initiation of breastfeeding which is caused among others by aggressive marketing policies consisting in the distribution of free sample in maternity wards. In this regard, the Delegation clarified that every single formula given in hospital contains a clear notice affirming that breastfeeding is the best practice. Furthermore, it stressed that marketing in hospitals is prohibited.

The Committee also asked for further explanations with regard to the hospital rule preventing mothers from keeping their children with them while in hospital. The Delegation asserted instead that children must stay with mothers in hospital, unless mothers ask to put children in another room. The Delegation is therefore willing to promote further the “rooming-in” practice as well as breastfeeding. In particular, Hungary aims at introducing the so-called “kangaroo mother care” system.

The Delegation of Hungary pointed out the existence of a National Committee on Breastfeeding, whose main task is to assess the quality of hospitals as “baby-friendly”. Moreover, the Delegation repeatedly stressed their leader position in Europe in breastfeeding rates. According to the Delegation, the global average is of 4 women who exclusively breastfeed in the first 6 months out of 10 (40%). In Hungary, 36% of women exclusively breastfeed in the first six months.

The Committee solicited further the Delegation for obtaining information about work-family life balance and maternity leave in the informal sector. The Delegation answered by mentioning the Hungarian Labour Act, according to which women must be given the opportunity to breastfeed during working hours.

Finally, the Committee highlighted the high rate of C-section cases, which have an impact on early initiation breastfeeding. The Delegation acknowledged that in the period 2008-2012 the rate of induced births was indeed quite high, thereby stressing the willingness to consider the issue further.

Concluding Observations 

In its Concluding Observations, the Committee made few indirect recommendations. At the level of general measures of implementation, it urged Hungary to “adopt a comprehensive policy covering all areas of children’s rights under the Convention and ensure that its strategies and action plans are provided with necessary human, technical and financial resources for their effective implementation” (§10).

With regard to health issues, the Committee recommended that Hungary “take measures to ensure that health care facilities and practitioners, including paediatric and specialized care practitioners, are available throughout the country including in rural areas” and that the Government “take measures to provide access to education on nutrition” (§47). 

In addition, the Committee issued direct recommendations related to infant and young child feeding (§51). It recommended that Hungary “take all necessary measures to encourage exclusive breastfeeding of infants until 6 months of age and provide data on the rate of breastfeeding in its next periodic report. The Committee also recommends that the State party increase the number of baby friendly hospitals and take measures to fully implement the provisions of the International Code of Marketing of Breast-milk Substitutes”.

Morocco at the CRC: Important Decline of the Exclusive Breastfeeding Rate

On the 3rd September 2014, on the occasion of the review of Morocco’s combined third and fourth periodic reports on the situation of the implementation of the Convention on the Rights of the Child in the country, IBFAN presented an alternative report to inform the Committee on the Rights of the Child about the situation of infant and young child feeding in the Kingdom.

General overview of breastfeeding in Morocco

The report highlighted the decline of exclusive breastfeeding of 23.3% between 1992 and 2011 (51% in 1992 and 27.8% in 2011). In 2005, the Ministry of Health has even declared that the decline of breastfeeding constitutes a concern of public health. An overall lack of knowledge about optimal breastfeeding practices has also been pointed out; indeed, more than 2 infants out of 3 are not breastfed within one hour after delivery, while the rate of predominant breastfeeding under 6 months of age is higher (45.5%) than the rate of exclusive breastfeeding, notwithstanding that predominant breastfeeding has been associated with an increased risk of diarrhoea. The addition of sugar in infants’ meals has also been highlighted as problematic. Finally, regional disparities have addressed: in rural areas, mothers are more likely to breastfeed, while in urban areas, breastfeeding rates are lower and bottle-feeding is more common.

In Morocco, only few provisions of the International Code on the Marketing of Breastmilk Substitutes have been implemented into law, despite the prohibition of the distribution of free baby food samples since 1992. Furthermore, some 43% of the hospitals and maternities of the country are certified as “baby-friendly” (43 out of 112). In addition, the report reflected the concern raised by the initiative “Rising to the Challenge” (convened by WHO, UNICEF and UNFPA in collaboration with other partners) about the lack of commitment of medical and paramedical institutions in raising awareness of the health professionals on the public health approaches and on the Ministry of Health primary health care guidelines in a sustainable manner and with a good standard of quality.

Finally, the report pointed out some others concerns related to infant and young children feeding: the absence of maternity leave for women working in the informal sector, the lack of knowledge on different ways of mother-to-child transmission of HIV as well as the lack of information on the current status of the 2008 pilot programme “Prevention of mother-to-child transmission of HIV”, and the absence of information on any emergency preparedness plan to ensure integrated response to protect and support breastfeeding in case of emergencies.

Discussion on infant and young child feeding

The Committee expressed concerns about the fact that only 43 hospitals out of 112 are certified as "baby-friendly" as well as about the fast decrease of the exclusive breastfeeding rate in the country. The Committee emphasized the emotional attachment between mothers and their child thrived through nursing and asked what are the measures set up by the government in order to support young mothers to breastfeed. In addition, the Committee highlighted the fact that in Morocco, only few provisions of the Code have been implemented into national legislation.

The Moroccan Delegation first stated that there are persisting differences between rural and urban areas in terms of access to reproductive health services. The government has therefore developed an action plan to improve health care provision in remote areas through hospitals and mobile health care services. The aim is to reach the ratio of 95% of skilled attendant present at birth. In terms of reproductive health, the government has implemented a national strategy and a booklet on this issue has been published in collaboration with the WHO. Regarding breastfeeding, the Delegation indicated that the 2011-2019 national strategy on nutrition focuses among other things on strengthening the nutrition of infants. In addition, the Delegation mentioned the existence of the national plan to encourage breastfeeding. It further stated that a bill aimed at encouraging breastfeeding has been prepared in the framework of the 2012-2016 national plan of action for child health. 

The Committee further asked what is done against companies that advertise their products in hospitals and if there is a national law implementing the Code and protecting breastfeeding against aggressive marketing of breastmilk substitutes.

The Delegation answered that breastfeeding is promoted within health facilities throughout the country.

Concluding Observations

In its Concluding Observations, the Committee made several indirect recommendations. With regard to the general measures of implementation, it urged Morocco “to take all necessary measures to address those recommendations that have not been implemented or not sufficiently implemented and, in particular, those related to data collection” (§7). It also asked Morocco to “ensure that the Integrated Policy on Children encompasses child protection and covers all areas under the Convention and all children” (§13).

Additionally, the Committee draws Morocco’s attention to “its general comment No. 16 (2013) on State obligations regarding the impact of the business sector on children’s rights and especially recommends that the State party examine and adapt its legislative framework concerning legal accountability of business enterprises and their subsidiaries operating in or managed from the State party´s territory” (§23(a)).

With regard to health issues, the Committee recommended that Morocco “ensure that sufficient resources are allocated for the health sector and effectively used, and develop and implement comprehensive policies and programmes for improving the health situation of children and facilitating a greater and equal access to quality primary health services by mothers and children in all areas of the country”. It also called the Government to “take more effective measures to address maternal and infant mortality and the nutritional status of young children” (§55 (a)(b)).

However, the Committee did not issued any direct recommendation related to breastfeeding.

Fiji at the CRC: BFHI Implemented, but Still to Be Strengthened

On the 4th and 5th September 2014, the Committee on the Rights of the Child considered the combined Second to Fourth Periodic Report of Fiji on the situation of the implementation of the Convention on the Rights of the Child in the country.

On this occasion, IBFAN presented an alternative report to inform the CRC Committee on the situation of infant and young child feeding in Fiji.

General overview of breastfeeding in Fiji

The alternative report showed that 39.8% of infants aged six months or less are exclusively breastfed. Furthermore, a large proportion of children aged 6 months or less are given water (79.6%) as well as sweetened drinks. These data reveal therefore a lack of knowledge about optimal breastfeeding practices.

According to the 2011 World Breastfeeding Trends initiative (WBTi) report on Fiji, a national Infant and Young Child Feeding/Breastfeeding policy was adopted by the Government. Such a policy provided a National Breastfeeding Committee that is however now defunct. Moreover, the WBTi report stresses that “Information, Education and Communication” materials are available only in English.

The Government of Fiji has fully implemented the International Code of Marketing of Breastmilk Substitutes (the Code) in its entirety. However, an informal monitoring in a supermarket in November 2011 highlighted that complementary food labelling the product as suitable for age 4-6 months has been only partially obscured, which constitutes a violation of the Code.

The report highlighted that Fiji has established a national Baby-Friendly Hospital Initiative (BFHI) coordinator. By the beginning of 2009, all its 12 public hospitals were certified as “baby-friendly”. Nevertheless, two main problems have been encountered in its implementation. Firstly, hospitals fail to refresh BFHI courses every two years (as the WHO recommends) and, secondly, mothers are not provided for contacts of health care persons.

According to a study conducted by the Fiji Journal of Public Health, 57% of women who do not exclusively breastfeed pinpoint work as the obstacle to exclusively breastfeeding. The Fijian legislation provides indeed only 84 consecutive (12 weeks) days as maternity leave entitlement. For the first three births, such a leave is paid at the normal remuneration rate, whilst from the fourth child, the mother is entitled to only half the normal salary. Additionally, it is worth noting that there are no provisions concerning paid or unpaid breaks during work hours.

As far as HIV and infant feeding is concerned, it must be noted that a comprehensive policy on infant and young child feeding that includes infant feeding and HIV is lacking.

In coordination with UNICEF and WHO, Fiji developed a flyer on infant feeding during emergencies. However, neither a national plan nor a focus person has been identified to coordinate activities.

Discussion on infant and young child feeding

The Fijian Delegation first stated that the infant mortality rate in Fiji is of 13.7 per 1,000 live births and that perinatal mortality represents an important component of the mortality of children under 5 years old. Regarding maternal health, the Delegation indicated that last year, 4 maternal deaths have been registered in the country. The family health units deal particularly with women’s health, children health (including immunization) and reproductive health as well as with the fight against HIV. The Delegation also indicated that according an immunization state study, the immunization coverage rate is of 84.9%. It further stated that in 2014, collaborative, comprehensive guidelines on child protection aimed at health workers have been issued and that trainings of health professionals on this issue have been organized. Community health trainings are supported by family health units and include training of health professionals on issues related with neonatal intensive care units.

The Committee asked how many women breastfeed their child, by emphasizing that breastfeeding ties very closely with child’s health as well as whether the National Breastfeeding Committee is still operational.

The Delegation noted that suboptimal breastfeeding practices in Fiji contribute to increase the burden of Non-Communicable Diseases (NCDs). Therefore, breastfeeding and infant and young child feeding are part of the National Strategic Plan for NCDs. The Delegation also indicated that during the first decade of 20th century, Fiji has developed the implementation of the BFHI; during this period, the 3 main hospitals of the countries have been certified as “baby-friendly”. However, there is a current decline in the implementation of the BFHI. The Delegation further emphasized Fiji’s endorsement of the International Code on Marketing of Breastmilk Substitutes and informed the Committee that the National Breastfeeding Committee’s plans to hold a meeting on the 24th September 2014. Finally, the Delegation indicated that “Information, Education and Communication” materials are now available in Ataque language but have not been translated into other languages yet.

The Committee expressed further its concern about the current decline of Code implementation. It also highlighted that regular monitoring of the national legislation implementing the Code through an effective monitoring mechanism is crucial. With regard to the implementation of the BFHI and the Ten Steps to successful breastfeeding, the Committee noted that the training of health professionals and the monitoring of these trainings are very important. Finally, the Committee insisted on the importance of monitoring the marketing practices that occur in hospitals in order to make sure that Code policies are followed.

Concluding Observations

In the Concluding Observations, several indirect recommendations were made by the Committee. With regard to the general measures of implementation, it urged Fiji “to take all necessary steps to provide for a timely adoption of [a national comprehensive policy and strategy for children], and to ensure that sufficient human, technical and financial resources are allocated to facilitate its implementation" (§9). It also recommended that Fiji “take all necessary efforts to establish a comprehensive data collection system” (§15). 

Concerning health issues, the Committee recommended that Fiji “strengthen its efforts to further reduce the under-5 and infant mortality rate, especially by focusing on preventive measures and treatment, including immunization, improved nutrition and sanitary conditions, in particular in remote areas”. It also requested the Government to “enforce its efforts to improve prenatal care and further reduce maternal mortality, including by increasing the training of midwives and ensuring the generalization of specific actions to prevent post-partum bleeding and other major causes of maternal death” (§ 42).

Furthermore, the Committee issued direct recommendations related to infant and young child feeding (§54). It recommended that Fiji “ensure that every hospital with a new-born nursery is regularly monitored on adequate implementation of the International Code of Marketing of Breast-milk Substitutes. It also urged Fiji to “raise awareness on the importance of breastfeeding and on the risks of formula feeding” and to “promote proper breastfeeding practices, as well as develop a policy on infant and young child feeding practices, which includes infant feeding and HIV".