Friday, 24 January 2014

Portugal and the Issue of Breastfeeding in the Perspective of Child's Rights

Portugal presented its consolidated 3rd and 4th periodic report on the situation of the implementation of the Convention on the Rights of the Child (CRC) in the country.

IBFAN presented to the Committee an alternative report and an annex showing examples of violations of the International Code on the Marketing of Breastmilk Substitutes that were noted in the country.

General overview of breastfeeding in Portugal

The alternative report presented by Portugal states that in 2012, 78.9 % of mothers of the country have initiated their child to breastfeeding within the first hour of delivery. However, statistics show that exclusive breastfeeding starts to decrease after 5 to 6 weeks to reach a low rate of 22.4% at 5/6 months. Furthermore, use of follow on formulas and toddler milks is recommended by health professional after 6 months in Portugal, regardless of the WHO’s statement of the 17th July 2013 that states: “ […] as well as being unnecessary, follow-up formula is unsuitable when used as a breast-milk replacement from six months of age onwards. In addition, although Portugal has implemented the EU Directive 2006/141/EC on infant formulae and follow-on formulae, which is weaker than the International Code, through the adoption of a law (Decreto-Lei 217/2008), this law has not been monitored yet. Besides, there are no enforcement mechanisms in place either. Thus, industries are not sanctioned when they violate the International Code. The advertisement of breastmilk substitutes is widespread: for example, free samples of infant formulas are distributed through the health care system. Although a government body has been established with a mandate to report such violations, no monitoring of the law is done at a national level.

Breastfeeding courses are then mainly provided by NGO’s. Concerning the Baby-Friendly Hospital Initiative (BFHI), only 10 hospitals out of the 40 maternity wards have been certified as “baby-friendly”.

Discussion on infant and young child feeding

During the interactive dialogue between the CRC Committee and the delegation of Portugal, the issue of breastfeeding was tackled in the context of health care. The members of the Committee addressed their concerns about the health budget allocation and the lack of coordination within the different bodies of the government.

The Portuguese delegation confirmed that Portugal had received a recommendation to improve the coordination between the different bodies of the government by the UPR, as it had been reviewed during its 6th session in 2009. . The delegation also highlighted the difficulties to increase the health budget allocation due to the economical crisis that lasts since 2009. The health budget allocation decreased in 2013 from 11 Mio to 7 Mio Euro. However, the government managed to increase the budget allocation to 9 Mio Euro for 2014. Besides, the government works closely with NGOs to guarantee to all children the right to health care.

The Committee then raised questions about breastfeeding, especially the implementation of the International Code and the training of health professionals on breastfeeding issues. 

The Portuguese delegation first acknowledged the WHO recommendation for exclusive breastfeeding until 6 months and then continued breastfeeding until 2 years or more. It stated that the government officially recommends exclusive breastfeeding until 6 months. On the question of health professionals, the delegation asserted that they are 
aware of the crucial role of breastfeeding in regard of infant and young child nutrition and that they are called to respect WHO resolutions, particularly the International Code. The delegation then mentioned the monitoring activity of the association Mama Mater that is collecting data about breastfeeding. These data should be further analyzed in order to understand the rates of exclusive breastfeeding after 6 weeks. About BFHI, the delegation stated that 11 maternity wards are currently certified as "baby-friendly", but the government intends to increase this number in the coming years. It then explained that “breastfeeding corners” (Cantinhos de Amamentação) are disseminated among the hospitals of the country, allowing mothers to receive advice regarding breastfeeding even after they will have left hospital. The delegation noted the engagement of several NGOs in peer counseling on breastfeeding. The government finally expresses its will to inform the population about the benefits of breastfeeding through a national youth health programme.

The members of the Committee also raised issues about corporal punishment, juvenile justice, integration of migrants, road traffic injuries and drowning, participation of children in bull fighting, child trafficking, education, children with disabilities, adoption and family support.

CRC Committee's Concluding Observations

In its Concluding Observations, the CRC Committee made recommendations on the importance of collecting data on children (para 18), on the right of the child to the highest attainable standard of health, mentioning the negative impact of budget restrictions on health care (para 48), and on the necessity to promote and support breastfeeding practices and to regulate the marketing of infant formulas (para 56).

First, 
the CRC Committee emphasized the importance of establishing a more comprehensive and integrated data collection system on children.

Then, the Committee drew Portugal’s attention to its 2013 General Comment N°15 on the right of the child to the enjoyment of the highest attainable standard of health (art. 24), which explicitly recognises the importance of breastfeeding for the achievement of the right of the child to health. The General Comment N° 15 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, Portugal is specifically demanded to “minimize the impact of financial restrictions in the area of health care, and further recommends that austerity measures in the area of health should be evaluated on the basis of a child’s right’s impact assessment to ensure that such measures do not have a negative impact on child health and well-being.

Lastly, despite all measures taken to encourage breastfeeding, the Committee expressed its concern about the decline of exclusive breastfeeding rates between four and six months of age, and the practice of providing complementary foods to infants from the age of four months in Portugal. It therefore recommended the State Party to “improve the practice of exclusive breastfeeding for the first six months, through awareness-raising measures including campaigns, information and training for relevant officials, particularly staff working in maternity units, and parents”. Portugal is also demanded to “strengthen the monitoring of existing marketing regulations relating to breast milk substitutes”.