Friday, 17 January 2014

Yemen still faces Challenges regarding Protection and Promotion of Breastfeeding

The Republic of Yemen presented its consolidated 4th periodic report 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 CRC Committee on Yemen’s situation on the issue of infant and young child feeding.

General overview of breastfeeding in Yemen

With a low rate of children initiated to early breastfeeding (30%) and insufficient rates of exclusive breastfeeding till 6 months (12%), Yemen still has a lot to do in order to protect and promote breastfeeding among the population. Bad feeding practices, such as the habit of giving other liquids than human milk to babies and premature introduction of complementary foods are common, leading to high stunting and infant mortality rates. More than 53% of the children under  6 months are stunted and 57 children die before the age of 1 for every 1000 live births. Although the International Code of Marketing of Breastmilk Substitutes has been partially translated into law in 2002, its effective enforcement and monitoring has not been ensured. Moreover, there are no
 baby-friendly hospitals in Yemen.

Discussion on infant and young child feeding

During the presentation of its report, the Yemeni delegation has admitted that malnutrition is a crucial problem for Yemen, causing almost half of child mortality in the country. In 2012, some 58% of children were stunted, while 15% of them were in danger of death. Together with various international and national partners, the delegation reported that the Ministry of Health has launched different programmes addressing this important issue. An academic conference on malnutrition has recently been held and this topic is to be included in each curriculum for health professionals.  Other programmes have been launched, with focus on prevention and identification of solutions to improve nutrition for children and women, especially mothers. In addition, the government is currently developing a programme to raise awareness about breastfeeding among the population. Finally, a campaign focusing on nutrition in remote areas, targeting mothers and children, has started in 2013. 

CRC Committee members asked further clarifications on the information provided by the delegation. They addressed issues related to breastfeeding, such as the enforcement and monitoring of the 2002 law to protect breastfeeding and implement the International Code of Marketing of Breastmilk Substitutes, and the concrete efforts made to increase the rate of exclusive breastfeeding until 6 months. CRC Committee members also asked whether Yemen has the intention to increase its budget line for health in general, and what is the budgetary allowance allocated to tackle malnutrition. Finally, a question on the way to measure the results of the awareness raising campaigns on malnutrition has been posed.

The Yemeni delegation responded that in 2006, 11% of children under 6 months received exclusive breastfeeding, a percentage which the government is currently trying to increase to 20% by 2015. Besides, the project entitled “Programme for advice regarding nutrition of infants” provides a training module aimed at health professionals to increase awareness about breastfeeding. Regarding the budgetary allocations, the delegation explained that even though the Ministry of Health has no specific budget line for nutrition, 3.5% of its budget is devoted to fight malnutrition. For instance, the Ministry of Health is currently trying to address nutrition and hygiene issues through a national educational TV channel, where information is regularly transmitted. The government claimed its intention to increase the budget for health. Apart from its own budget, Yemen has received funds from international donors, such as UNICEF, World Bank, World Food Programme and International Medical Call, in order to tackle malnutrition through different programmes. According to the delegation, results of such programmes can be measured after 30-40 years only, depending on the issue tackled. The reduction of stunting and wasting among the population will be seen long time after measures have been taken, although field indicators show an improvement of nutrition status.

Finally, the delegation explained that since the law to protect breastfeeding and implement the International Code was adopted in 2002, the marketing of infant formulas is strictly regulated and infant formulas producers are allowed to advertise their products only if their allegations are based on scientifically verified measures. According to Yemen, the marketing of infant formulas within hospitals and clinics, such as free samples distribution, is currently prohibited. However, the issue of the monitoring and enforcement of the 2002 law remained unanswered.

CRC Committee's Concluding Observations

In its 
Concluding Observations, the CRC Committee made recommendations on the importance of data collection (para 18), on the right of the child to the highest attainable standard of health, mentioning the necessity to promote breastfeeding and implement the International Code of Marketing of Breastmilk Substitutes (para 56), and on HIV/AIDS programmes (para 64).

The CRC reminded Yemen its 2013 General Comment N°15 on the right of the child to the enjoyment of the highest attainable standard of health (art. 24) explicitly recognizes 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, Yemen is required to pay attention to CRC General Comment N° 15 on the right of the child to the enjoyment of the highest attainable standard of health (art. 24) and to “(a) ensure that appropriate resources be allocated to the health sector, with particular attention to specific maternal and child health care and develop and implement comprehensive policies and programmes to improve the health situation of children, in particular to respond to high rates of malnutrition and diarrhoea infections; (c) ensure access to safe water and sanitation services in rural and poorest areas [...]; (d) enhance efforts to promote exclusive breastfeeding practices, by ensuring the implementation and compliance with the International Code of Marketing of Breast-milk Substitutes, and establish a monitoring and reporting system to identify violations of the Code. This includes the establishment of baby-friendly hospitals with the promotion of breastfeeding from birth”.

The CRC Committee also stressed the importance of collecting disaggregated data on a comprehensive scale and therefore, urges Yemen to expeditiously improve its data collection system.
In addition, the Committee expressed its concern about the scarcity of information provided with respect to the implementation of the National HIV/AIDS Prevention and Control Programme, as well as about the limited provision of antiretroviral prophylaxis to prevent mother-to-child transmission and general stigmatization of HIV/AIDS within the Yemeni society.  Therefore, it urged the government to expand the coverage of the national HIV programme and to ensure universal coverage for HIV testing and free antiretroviral drug provision.