Wednesday, 29 January 2014

Breastfeeding Practices in the Russian Federation

The Russian Federation presented its consolidated 4th and 5th periodic report on the situation of the implementation of the Convention on the Rights of the Child (CRC) in the country.

IBFAN presented an alternative report to inform the CRC Committee on Russia’s situation on the issue of infant and young child feeding.

General overview of breastfeeding in the Russian Federation

The alternative report highlighted several obstacles to breastfeeding practices in Russia. First, in 2002, UNICEF
 listed only 12 maternity wards as meeting the requirements of the Baby-friendly Hospital Initiative (BFHI) out of the 277 hospitals in the country. However, exclusive breastfeeding rate is higher in baby-friendly hospitals (88.9%) than in other health facilities (32.6%), and breastfeeding initiation takes place in a median time during the two first hours in baby-friendly hospitals, whereas in other structures, breastfeeding initiation happens only during the 12 first hours. In addition, the report highlighted the lack of public policies and programmes to protect, promote and support breastfeeding and infant and young child feeding, the absence of systematic data about breastfeeding and no action on implementation of the International Code of Marketing of Breastmilk Substitutes in Russia. Thus, there are no legal provisions to regulate the advertisement and marketing of breastmilk substitutes. IBFAN’s report also stressed that, despite the good maternity protection legislation, there is employment discrimination of women. Besides, the occupational segregation in the low-level jobs lead to insufficient maternity protection for the women concerned. Finally, the report pointed out that only 9 regions out of 83 were providing support to prevent mother-to-child HIV transmission.

Discussion on infant and young child feeding

During the discussion between the members of the CRC Committee and the State Party, the question of Russia’s implementation of the International Code has been raised. The Committee also addressed the issue of breastfeeding practices and asked whether any governmental support is provided to working women in order to help them combine their work with breastfeeding. Finally, the Committee enquired about the existence of a national programme which aims to prevent mother-to-child transmission of HIV and the kind of support provided to HIV-positive mothers and children. None of these issues has received response from the Russian delegation.

CRC Committee's Concluding Observations

In its
 Concluding Observations, the CRC Committee made recommendations on the importance of respecting child rights in relation to the business sector (para 21), on the right of the child to health (para 52) and on the necessary measures to prevent mother-to-child HIV/AIDS transmission (para 54). However, no specific recommendation on breastfeeding has been made to the Russian Federation delegation.

The CRC Committee, in its 2013 General Comment N° 16 on State obligations regarding the impact of the business sector on children’s rights, 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”. In the section
 Children's right and the business sector, 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 recommends that the State party establish and implement regulations to ensure that the business sector complies with international and national human rights, labour, environment and other standards, particularly with regard to children’s rights [...]. In particular, it urges the State party to: [...] (d) Ensure effective implementation by companies, especially industrial companies, of international and national environment and health standards, effective monitoring of the implementation of these standards and appropriately sanctioning and providing remedies when violations occur, as well as ensure that appropriate international certification is sought;(e) 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 (f) Be guided by the United Nations “Protect, Respect and Remedy” Framework, accepted unanimously in 2008 by the Human Rights Council, while implementing these recommendations."
The CRC 2013 General Comment N°15 on the right of the child to the enjoyment of the highest attainable standard of health (art. 24) explicitly recognises the importance of breastfeeding for the achievement of the right of the child to health. It urges States, in the effort of diminishing infant and child mortality, to devote particular attention to neonatal mortality and suggests, inter alia, to “pay particular attention to ensuring full protection and promotion of breastfeeding practices”. Moreover, “exclusive breastfeeding for infants up to 6 months should be protected and promoted and breastfeeding should continue together with appropriate complementary foods preferably until two years of age as feasible. States’ obligations in this area are defined in the “protect, promote and support framework”, adopted unanimously by the World Health Assembly in its 2002 Global Strategy for Infant and Young Child Feeding". Regarding Health and health services, the Russian Federation is requested to pay "attention to CRC general comment No. 15 (2013) 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 regularly assess the health conditions of children deprived of parental care and children in difficult situations in order to prevent irreparable damage to their health. The Committee also recommends that the State party take measures to provide all children, irrespective of their legal status in the country with access to medical assistance, in particular preventive health care and emergency assistance, without any discrimination."
Finally, as the Russia Federation seems to have opted for a policy which recommends HIV-positive mothers to avoid all breastfeeding, the Committee in order to address inequalities recommends to "take all necessary measures to prevent mother to child transmission of HIV/AIDS throughout the country by providing sufficient amount of breast milk substitutes and anti-retroviral drugs in all regions, using, inter alia, mobile medical personnel."