Recommendations related to Breastfeeding by the 65th Committee on the Rights of the Child

The 65^th Session of the Committee on the Rights of the Child (CRC Committee) took place in Geneva from 13 to 31 January 2014. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 6 countries: Congo Brazzaville, Germany, Holy See, Portugal, Russian Federation and Yemen. IBFAN submitted 5 alternative reports on the situation of infant and young child feeding for Congo, Germany, Portugal, Russian Federation and Yemen. The reports were written in collaboration with IBFAN groups in the countries. In its Concluding Observations, the CRC Committee referred specifically to breastfeeding in only 4 out of the 6 countries (Congo, Germany, Portugal and Yemen). The Holy See and the Russian Federation did not receive any direct recommendation on breastfeeding.

The right of the child to health

A particular emphasis has been put on the importance of respecting the right of the child to the enjoyment of the highest attainable standard of health. The CRC Committee referred to its 2013 General Comment N° 15 on the right to health (art. 24) in its recommendations to all reviewed countries, including the Holy See. The General Comment N° 15 explicitly recognizes the importance of breastfeeding for the achievement this right. This General Comment urges States, to devote particular attention to neonatal mortality in their effort to diminish infant and child 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. The Global Strategy calls, among other, for the improvement of the quality and availability of sex-disaggregated data, an issue that has been included in recommendations to Congo, Germany, Portugal and Yemen.

Protect

A great focus was placed on the need to regulate the impact of the business sector on children’s rights. In its recommendations to Congo, Germany and the Russian Federation, the CRC Committee expressly drew attention to its 2013 General Comment N° 16 on State obligations regarding the impact of the business sector on children’s rights, which specifically calls on States Parties 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” (hereafter referred as “the International Code”). Therefore, these three reviewed countries are recommended to ensure the compliance by companies of both international and national health and environmental standards and ensure appropriate sanctions in cases of violations. Congo and the Russian Federation are also recommended to require companies to undertake assessments of the environmental health-related and human rights impact of their business activities.

In addition, the CRC Committee expressly urged Germany to take every necessary measure to ensure the access to breastfeeding through the control of infant formula. More specifically, the CRC Committee urged Yemen, Congo and Germany to respectively implement and strictly enforce the International Code, while Portugal is asked to strengthen the monitoring of its marketing regulations related to breastmilk substitutes.

Promote

In the case of Congo, the CRC Committee stressed that preventable diseases, including diarrhoea, continue to impact negatively on child mortality rate. Thus, it urged the government to promote infant and young child feeding practices, in particular breast milk, and to adopt a holistic early childhood development strategy covering healthcare, nutrition and breastfeeding.

Furthermore, the CRC Committee raised the issue of new morbidity related to attachment disorders in Germany, which could be related to declines in exclusive breastfeeding practices. It underlined the decline of exclusive breastfeeding rates of children between four and six months and the aggressive marketing of breastmilk substitutes in Portugal. In the case of Yemen, it showed concern about the high rates of chronic malnutrition (stunting), acute malnutrition (wasting) and communicable diseases, especially diarrhoea, among children, linked to the lack of awareness about exclusive breastfeeding practices. Accordingly, the CRC Committee recommended Germany, Portugal and Yemen to promote exclusive breastfeeding.

In regard of General Comment N°15, Germany is specifically requested to better promote healthy eating habits and to pay special attention to children in vulnerable situations.

Support

Congo is urged to ensure provision of primary health care services for all pregnant women and children within accessible health care service with trained health care providers. It is specifically recommended to increase the quality and coverage of training to staff at socio-health units.

The CRC Committee also stressed the need for Yemen to establish baby-friendly hospitals.

The CRC Committee also focused on the need to prevent mother-to-child HIV/AIDS transmission by ensuring the implementation of effective HIV/AIDS preventive measures (Congo), by expanding the coverage of the National HIV/AIDS Prevention and Control Programme (Yemen) and by providing sufficient amount of breastmilk substitutes and anti-retroviral drugs in all regions (Russia).
                                                                                    

Table 1. CRC Committee - Session 65 / 2014 -Summary of Concluding Observations on IYCF

Country		IBFAN report	Summary of specific recommendations on IYCF
1	Congo (2nd to 4th periodic report)	yes	Indirect – Data collection (para 19): improve data collection system. The data should cover all areas of the Convention and should be disaggregated by age, sex, geographic location, ethnic and national origin and socioeconomic background in order to facilitate analysis on the situation of all children, particularly those in situations of vulnerability. Children’s rights and the business sector (para 27): establish a clear regulatory framework for the industries operating in the State party to ensure that their activities do not negatively affect human rights, especially those relating to children’s and women’s rights; ensure effective implementation by companies, especially industrial companies, of international and national environmental [...]  health standards, effective monitoring of implementation of these standards and appropriately sanctioning and providing remedies when violations occur; 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 impact; be guided by the United Nations “Protect, Respect and Remedy” Framework. Health care (para 59 a): ensure provision of primary health care services for all pregnant women and children with focus on development of accessible health care services with trained health care providers, intervention to reduce preventable and other diseases, particularly diarrhoeas, acute respiratory infections and undernutrition; strengthen and expand access to preventive health care, and therapeutic services for all pregnant women and children, particularly infants and young children under five years old; continue to disseminate health information and promotion of health education; increase quality and coverage of training to staff at socio-health units and ensure units are adequately staffed and have essential facilities, including obstetric supplies and emergency medicines for children and pregnant women; sustain the measures in place to prevent mother-to-child transmission of HIV. Direct (para 59 b; 66 b): promote IYCF practices, particularly breast milk and infant food based on local foods; adopt a holistic early childhood development (ECD) strategy and invest in the training of ECD teachers and provision of integrated formal and community-based programmes involving parents and covering healthcare, nutrition and breastfeeding, early stimulation and early learning for children for birth to the first year of school.
2	Germany (3rd and 4th periodic report)	yes	Indirect – Data collection (para 16): establish a comprehensive and integrated data collection system on children covering all Länder and the entire period of childhood up to the age of 18, and to introduce indicators on children’s rights on which progress in the realization of those rights could be analysed and assessed. The data should be disaggregated by age, sex, disability, geographical location, ethnicity, migration status and socio-economic background. Children’s rights and the business sector (para 23): establish a clear regulatory framework for the industries operating in the State party to ensure that their activities do not negatively affect human rights [...], especially those relating to children’s rights; examine and adapt its legislative framework (civil, criminal and administrative) to ensure the legal accountability of business enterprises and their subsidiaries operating in or managed from the State party’s territory, regarding violations of child and human rights; comply with international and domestic standards on business and human rights with a view to protecting local communities, particularly children, from any adverse effects resulting from business operations, in line with the UN “Protect, Respect and Remedy” Framework and the Guiding Principles on Business and Human Rights and by the Committee’s own general comment N° 16. Health care (para 57): advocate and raise awareness through programmes targeting schools and families, emphasizing [...] healthy eating habits. Direct (para 57; 63): [in regard of General Comment 16] take every necessary legislative and structural measure to ensure that every child within the State party has access to breastfeeding through the control of infant formula which will promote better bonding between infants and mother; strengthen efforts to promote exclusive and continued breastfeeding by providing access to materials, and educating and raising awareness of the public on the importance of breastfeeding and the risks of formula feeding; strictly enforce the International Code of Marketing of Breast-milk Substitutes.
3	Holy See (2nd periodic report)	no	none
4	Portugal (3rd and 4th  periodic report)	yes	Indirect – Data collection (para 18): establish a more comprehensive and integrated data collection system on children covering the entire period of childhood up to age 18, and to introduce indicators on children’s rights on which progress in the realization of those rights could be analysed and assessed. The data should be disaggregated by age, sex, geographic location, ethnicity, migration status and socio-economic background to facilitate the determination of the overall situation of children. Health care (para 48): [in regard to General Comment 15] minimize the impact of financial restrictions in the area of health care; 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. Direct (para 56): take action 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; strengthen the monitoring of existing marketing regulations relating to breast milk substitutes.
5	Russian Federation (4th and 5th  periodic report)	no	Indirect - Children’s rights and the business sector (para 21): pray attention to General Comment 16 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, particularly with regard to children’s rights; ensure effective implementation by companies, especially industrial companies, of international and national 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; 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 impact; be guided by the United Nations “Protect, Respect and Remedy” Framework. Health care (para 52; 54): pray attention to General Comment 15 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;; 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, irrespective of their legal status in the country.
6	Yemen (4th periodic report)	yes	Indirect – Data collection (para 18): improve its data collection system. The data should cover all areas of the Convention and should be disaggregated by age, sex, geographic location, ethnic and national origin and socioeconomic background in order to facilitate analysis on the situation of all children, particularly those in situations of vulnerability. Health care (para 16; 56; 64): establish a budgeting process, which includes child rights perspective and specifies clear allocations to children in the relevant sectors and agencies, including specific indicators and a tracking system; increase substantially the allocations in the areas of health and education; 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; expedite the process to join as a full member the Scale Up Nutrition Initiative (SUN) and to take effective measures to address the widespread and serious undernourishment affecting children; strengthen its efforts to develop outreach services, including a network of mobile health-care facilities in conflict-affected areas, particularly targeting children and pregnant women, as an interim measure, and ensure that health-care facilities are rehabilitated and not re-occupied for military purposes by either the armed forces or non-State armed groups; ensure universal coverage for HIV testing and free antiretroviral drug provision; pay particular attention to pregnant adolescents in rural areas, pregnant mothers with HIV and children born to mothers with HIV. Direct (para 56): 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.

Informations complémentaires au communiqué de presse de IBFAN-GIFA, du 11 février 2014

"IBFAN-GIFA avance trois bonnes raisons pour soutenir la révision de l'art. 60 al. OLT 1 concernant les pauses allaitement" 

Rappel du texte de la Convention No 183 (2000), adoptée par l’Organisation internationale du Travail en 2000 : « La femme a droit à une ou plusieurs pauses quotidiennes ou à une réduction journalière de la durée du travail pour allaiter son enfant. » ; « La période durant

laquelle les pauses d'allaitement ou la réduction journalière du temps de travail sont permises, le nombre et la durée de ces pauses ainsi que les modalités de la réduction journalière du temps du travail doivent être déterminés par la législation et la pratique nationale » ; «Ces pauses ou la réduction journalière du temps de travail doivent être comptées comme temps de travail et rémunérées en conséquence ».

La convention No 183 (2000) était accompagnée d’une recommandation sur la protection de la maternité (No 191), également adoptée par les pays membres : « Sur présentation d'un certificat médical ou autre attestation appropriée, telle que déterminée par la législation et la pratique nationales, le nombre et la durée des pauses d'allaitement devraient être adaptés aux besoins particuliers. » ; « Lorsque cela est réalisable, avec l'accord de l'employeur et de la femme concernée, les pauses quotidiennes d'allaitement devraient pouvoir être prises en une seule fois sous la forme d'une réduction globale de la durée du travail, au début ou à la fin de la journée de travail. » ; « Lorsque cela est réalisable, des dispositions devraient être prises en vue de la création de structures pour l'allaitement des enfants dans des conditions d'hygiène adéquates sur le lieu de travail ou à proximité ».

Rappel des propositions du SECO : La nouvelle disposition définit précisément la durée des pauses d'allaitement qui doit être accordée aux mères à titre de temps de travail rémunéré: elle est de 30 minutes pour les mères qui travaillent jusqu'à 4 heures par jour, de 60 minutes pour celles qui travaillent plus de 4 heures par jour et de 90 minutes pour celles qui travaillent plus de 7 heures par jour. Ce temps peut être pris en une seule fois ou fractionné. Ces durées s'appliquent pour chaque enfant.

Cette disposition présente une règle claire pour toutes les personnes concernées. La solution retenue est par ailleurs proche de celles mises en place dans des pays voisins comparables à la Suisse. En Allemagne, en Autriche et au Luxembourg, par exemple, la législation prévoit la possibilité d'une ou deux pauses d'allaitement d'une durée totale de 90 minutes par jour pour les mères qui travaillent pendant plus de 8 heures. Lorsqu'elles travaillent pendant un nombre d'heures allant de plus de quatre heures et demie à 8 heures, la durée totale maximale des pauses d'allaitement auxquelles elles ont droit durant la journée se réduit à 60 minutes (en Allemagne) ou à 45 minutes (en Autriche). Aux Pays-Bas, les mères qui allaitent ont même droit jusqu'au 9e mois de l'enfant à autant de pauses que nécessaire, pour autant que leur durée totale ne dépasse pas un quart du temps de travail. 

Le texte proposé introduit un changement de système: D'une part, la différence dans la façon de comptabiliser le temps consacré à l'allaitement comme temps de travail selon que l'allaitement a lieu à l'intérieur ou à l'extérieur de l'entreprise est abolie. D'autre part, l'employeur est désormais tenu de rémunérer, dans certaines limites, le temps consacré par la travailleuse à l'allaitement. Cette solution s'appuie sur les règles retenues chez nos voisins. Elle est conforme à l'art. 10 de la convention C 183.

Communiqué de Presse : IBFAN-GIFA avance trois bonnes raisons pour soutenir la révision de l’art. 6O al. 2 de l'OLT 1 concernant les pauses allaitement

La Suisse s’est engagée à ratifier la Convention 183 de l’Organisation internationale du Travail (OIT) sur la protection de la maternité. Afin de pouvoir ratifier cette convention, le SECO a proposé une révision de l’art. 60 al. 2 de l’Ordonnance 1 relative à la loi sur le travail (OLT 1) pour se mettre en conformité avec la Convention 183 de l’OIT au sujet des pauses allaitement. Nonobstant, la Fédération des entreprises romandes (FER) ainsi que l’Union Suisse des Arts et Métiers (USAM), organisation faîtière des PME suisses, s’opposent au nouveau projet de loi (Le Courrier, 20 janvier 2014, page 6 ; Le Matin, 23 janvier 2014 ; Courrier de la FER au SECO, 10 janvier 2014). Elles exigent notamment des pauses allaitement plus courtes que celles prévues dans le projet de loi et sont opposés à l’abolition de la différence entre allaitement dans l'entreprise ou à l'extérieur, qui permettrait aux femmes concernées de quitter leur travail plus tôt afin de pouvoir allaiter leur enfant. 

L'Association Genevoise pour l'Alimentation Infantile (GIFA), membre du réseau International Baby Food Action Network (IBFAN) et dont l'expertise en matière d'allaitement est reconnue au niveau international, régional et national, est favorable à la ratification de la convention OIT 183 par la Suisse. Dans cette perspective, elle soutient pleinement la révision de l’art. 60 al. 2 OLT 1 proposée par le SECO pour les 3 raisons suivantes :

1. Les employeurs ont intérêt à rémunérer des pauses allaitement adéquates. De nombreuses études montrent que l’instauration de pauses allaitement adéquates rémunérées réduit l’absentéisme des mères (dont les bébés sont moins souvent et moins longtemps malades), rendent les travailleuses plus fidèles et loyales envers leur employeur (dont elles apprécient le « geste » et s’en souviennent pendant de nombreuses années), augmentent leur productivité, diminuent leurs départs et le tournus au travail, et donnent une image moderne et plus avenante de l’entreprise. Par ailleurs, de telles pauses représentent une charge modeste pour l’entreprise.
2. Des pauses suffisamment longues sont importantes du point de vue physiologique. Le processus de l’allaitement ne saurait être chronométré. Chaque expérience d'allaitement est différente. Il est scientifiquement prouvé que les bébés tètent en moyenne entre 8 et 12 fois par 24 heures les 12 premiers mois, que le lait maternel s’adapte aux besoins de l’enfant et que la fréquence et la durée des tétées varient significativement d’une mère/bébé à l’autre. La longueur des pauses allaitement proposées par le SECO est donc totalement justifiée, et pourrait même être rallongée. La Fondation Suisse pour la Promotion de l’Allaitement Maternel propose d’ailleurs de prolonger de 10 min la durée d'une pause allaitement afin de permettre aux mères de se rendre sur le lieu où elles vont tirer leur lait ou allaiter leur bébé, et pour éventuellement pouvoir se changer (voir prise de position sur www.allaiter.ch).
3. Le nombre et la durée des pauses d'allaitement devraient être adaptés aux besoins particuliers, selon la recommandation 191 de l'OIT qui précise que les pauses quotidiennes d'allaitement devraient pouvoir être prises en une seule fois sous la forme d'une réduction globale de la durée du travail, au début ou à la fin de la journée de travail, pour autant que cela soit réalisable et en accord avec l'employeur et la femme concernée. La recommandation OIT prône également la création de structures pour l'allaitement des enfants dans des conditions d'hygiène adéquates sur le lieu de travail ou à proximité.

Par sa ratification de la Convention des droits de l'enfant (CDE) et la Convention sur l'élimination de toutes les formes de discrimination à l'égard des femmes (CEDAW), la Suisse s'est engagée légalement à adopter des mesures spécifiques nécessaires pour soutenir les femmes et leurs nourrissons au travail, en accord avec la Convention 183 de l'OIT sur la protection de la maternité. Les employeurs, tout comme les citoyens, doivent soutenir ces mesures essentielles pour la santé publique ainsi que pour le bien-être des enfants et des familles.

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A l'intention du lecteur: IBFAN-GIFA est partenaire du Département des Affaires régionales, de l'Economie et de la santé de l'Etat de Genève (DARES) pour le volet promotion de l'allaitement, dans le cadre de la stratégie cantonale de prévention de l'obésité. GIFA est également financé par la Ville et le Canton de Genève dans le cadre d'un projet de protection promotion et soutien de l'allaitement maternel en Afrique 2014-2015. Autres documents utiles: 

- Allaitement au travail: Comment protéger et soutenir vos employées au mieux, GIFA

- Lettre ouverte de GIFA à Liliane Maury-Pasquier, du 8 août 2013 

- En collaboration avec HUG Contrepoids, Fourchette Verte, Service Santé de l'Enfance et de la Jeunesse: campagne et brochures Miam la Vie 

IBFAN's contribution to the OHCHR consultation on the mortality and morbidity of children under 5 years of age (HRC Resolution 24/11)

About the International Baby Food Action Network (IBFAN) 

A world-wide network. IBFAN is a 35-year old coalition of more than 273 not-for-profit non-governmental organizations in more than 168 developing and industrialised nations. The network works for better child health and nutrition through the protection, promotion and support of breastfeeding and the elimination of irresponsible marketing of breastmilk substitutes.

Our commitment. IBFAN is committed to the Global Strategy on Infant and Young Child Feeding (2002) – and thus to assisting governments in implementation of the International Code of Marketing of Breastmilk Substitutes (International Code) and its relevant resolutions of the World Health Assembly (WHA) to the fullest extent, and to ensuring that corporations are held accountable for their International Code violations. In 1998, IBFAN received the alternative Nobel Prize, called the Right Livelihood Award, “for its committed and effective campaigning for the rights of mothers to choose to breastfeed their babies, in the full knowledge of the health benefits of breastmilk, and free from commercial pressure and misinformation with which companies promote breastmilk substitutes”.

A crucial underlying determinant to prevent child mortality and morbidity

Breastfeeding, the most effective intervention to save children lives. Breastfeeding is a key element to combat mortality and morbidity of children under 5 years of age; it is the single most effective intervention for saving lives.[1] Optimal breastfeeding practices, including exclusive breastfeeding for the 6 first months, have proven to reduce infant and child mortality while sub-optimal breastfeeding practices significantly increase sanitary risks for the child, including infections, diarrhoea and pneumonia, the three major killers of infants and children.[2] Colostrum, the mother’s milk during the first post-partum days, provides protective antibodies and indispensable nutrients, essentially acting as a first immunisation for newborns, strengthening their immune system and reducing the chances of death in the neonatal period. Breastmilk alone is the ideal nourishment for infants for the first six months of life, providing them all of the nutrients they need, which means that no other liquid or food is required. Furthermore, continued breastfeeding beyond six months, accompanied by adequate complementary foods, ensures growing children a good nutritional status and protects them against illnesses.[3] In addition, breastmilk is a low-cost, high quality and locally produced food and thus, ensures food security from the start of the life.[4] Therefore, the World Health Organisation (WHO) recommends exclusive breastfeeding until 6 months of age and then, complementary breastfeeding until 2 years of age or further. Despite these recommendations, approximately 1.4 million children under five die each year because they haven’t been properly breastfed, 830 000 of which could have been prevented if the infant had been breastfed within the first hour after birth.[5]

Early cessation of breastfeeding and the impact of infant formula on child health. While the crucial role of breastfeeding in fighting child mortality and morbidity is widely recognised, early cessation of breastfeeding in favour of industrial breastmilk substitutes as well as needless supplementation and poorly timed introduction of complementary foods are far too common. Currently, only 39% of the 134.6 million infants born worldwide are exclusively breastfed in the first 6 months. This leaves almost 85 million of babies whose right to health, adequate food and nutrition is compromised by early cessation of breastfeeding. Moreover, only 58% of children are still breastfed at 2 years.[6] These low breastfeeding rates are due to several combined factors related to the lack of integrated programmes at scale for the protection, promotion and support of optimal infant and young child feeding, including lack of protection from unethical marketing of breastmilk substitutes, bottles and teats, lack of promotion and support in the health care system and lack of support for breastfeeding women in their workplace.[7] As a result, numbers of babies are fed with breastmilk substitutes, what denies the child the positive effects of breastfeeding highlighted above and increases the risks of exposing the child to pathogenic organisms and substances. The harmful pathogens that may contaminate the powdered formulas can cause serious illnesses and even lead to death.[8] Lastly, the presence of bisphenol A, a chemical component of most plastic bottles and teats, may present danger for child health and therefore, increase the risks associated with artificial feeding.[9]

IBFAN’s action to reduce under-five child mortality and morbidity by advocating for breastfeeding with regard to human rights standards and principles

Breastfeeding and the baby food industry. The misconduct of baby food companies continues to be a key cause for poor breastfeeding practices, as these companies reap profits from promotion of their products which directly compete with breastfeeding. They too often undermine breastfeeding by making unethical and unfounded claims about their products and by marketing them in deceptive ways. These commercial malpractices have a negative impact on the realisation of the right of children to health and to adequate food and nutrition, and thus affect directly child mortality and morbidity rates. Indeed, studies have shown that promotion of breastmilk substitutes has a negative influence on breastfeeding rates.[10] Besides, the increasing undue influence of companies, including baby food companies, on policy-makers and key institutions constitutes a threat to the independence of public health institutions. Therefore, it risks affecting their ability to work in the public interest in a transparent and accountable way. For these reasons, IBFAN promotes the accountability of the business sector by engaging in a critical debate about the role and the human rights obligations of commercial actors. Therefore, we work towards the implementation of the Maastricht Principles on Extraterritorial Obligations of States in the area of Economic, Social and Cultural Rights[11]. In addition, IBFAN advocates for the adoption of legal safeguards against the impact of conflicts of interest within the process of policy-making at both international and national levels, for example within the framework of the WHO reform.

The International Code of Marketing of Breast-milk Substitutes. IBFAN is committed to the Global Strategy on Infant and Young Child Feeding, adopted by WHO in 2002.[12] Hence, we are assisting governments in implementation of the International Code of Marketing of Breastmilk Substitutes and its subsequent WHA resolutions to the fullest extent, and ensuring that corporations are held accountable for their International Code violations. Companies have an obligation to comply with the International Code regardless of any government action, yet monitoring by civil society shows that none of the large multinational companies live up to this obligation. A crucial contribution of IBFAN is the preparation of global monitoring reports that continuously show the extent to which the baby food industry violates the International Code. The latest 2014 report details global marketing trends by baby food manufacturers and exposes violations of the International Code and its subsequent resolutions.[13] IBFAN has also been assisting governments since 1981 with their implementation of the International Code; much of the success to date can be attributed to our efforts and those of UNICEF (and to some degree WHO). However, the level of progress in International Code implementation cannot be regarded as satisfactory. The grossly inadequate resources invested in breastfeeding and optimal infant and young child feeding, particularly in the International Code implementation and monitoring, are one of the causes.

The Convention on the Rights of the Child. Since 1989, the Convention on the Rights of the Child (CRC) has placed breastfeeding on the child rights agenda, particularly in regard to its Article 24, which enshrines the right of the child to the enjoyment of the highest attainable standard of health. The CRC Committee, in its General Comments 15 and 16, further elaborated on government and non-state actors’ obligations to ensure that the International Code is implemented and enforced, and that optimal breastfeeding practices of are adequately protected, promoted and supported by States Parties. Moreover, the CRC Committee recognises that implementation of the International Code by States Parties as a concrete measure towards the realisation of parents’ right to objective information on the advantages of breastfeeding and thus, to fulfilling the obligations of the Article 24 of the Convention.[14] It has also regularly recommended governments to adopt additional policies, programmes and initiatives to protect, promote and support breastfeeding.[15] Since 1998, IBFAN collaborates with the CRC Committee and submits alternative reports on the state of infant and young child feeding, including breastfeeding practices, in the reviewed countries. In 2013 alone, a total of 17 countries were reviewed by the Committee on the Rights of the Child (CRC Committee). IBFAN submitted alternative reports on the situation of IYCF for 13 of them: China, Kuwait, Lithuania, Luxembourg, Malta, Guinea, Niue, Armenia, Guinea Bissau, Israel, Rwanda, Slovenia and Uzbekistan.[16] In addition, IBFAN contributed to the consultation processes on the right of the child to the enjoyment of the highest attainable standard of health (Article 24),[17] that lead to the adoption of CRC General Comment 15, and on child rights and the business sector,[18] that lead to the adoption of CRC General Comment 16.

Women’s rights to reproductive health and maternity protection. Human rights for women and children were largely developed separately within the human rights framework and the complex inter-connectedness of mother and child in pregnancy, infancy and breastfeeding has not yet been adequately addressed. Breastfeeding has not been properly recognised by the international community as an essential part of human rights, including as women's sexual and reproductive right, and it is constantly undervalued and threatened because of misinformation and commercial pressures. Furthermore, the maternal practice is seen by some as being incompatible with other roles that women have, in particular their occupational role. Dominant social values, structures and institutions, which are rapidly spreading across the globe, often exploit and undervalue women's physical needs and both their productive and reproductive contributions. Many countries, industrialised and developing alike, lack adequate maternity protection in the workplace to protect breastfeeding practices. Currently, there is no comprehensive framework or convention tackling the rights, needs and capability of both mother and child during this critical period of biological, emotional, social and legal interconnectedness. For this reason, in 2014, IBFAN will advocate for women’s rights to reproductive health as well as maternity protection within the framework of the Convention on the Elimination of Discrimination against Women (CEDAW) by submitting regularly alternative reports to the CEDAW Committee and sharing CRC Committee’s Concluding Observations to promote harmonisation of work of these two treaty bodies.

Contribution to international consultation processes. IBFAN takes part in human rights bodies’ topical discussion days, providing its expertise on issues such as the rights of children of incarcerated parents,[19] and attempts to raise the profile of safe food and adequate nutrition for infants and young children, i.e. breastfeeding and optimal infant feeding practices, in relevant international and national policies in the context of Post-2015 Millennium Development Goals agenda.[20] In addition, IBFAN will take part in the upcoming 2nd International Conference on Nutrition.

[1] Bhutta et al., What works? Interventions for maternal and child undernutrition and survival, The Lancet, 2008, 371 (9610) : 417-440. http://www.who.int/nutrition/topics/Lancetseries_Undernutrition3.pdf.
[2] Arifeen S. et al., Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics, 2001, 108(4): 67. http://pediatrics.aappublications.org/content/108/4/e67.full?sid=832a7273-16cf-4a41-a87d-bda69505da92.; 

Chantry C.J. et al., Full Breastfeeding Duration and Associated Decrease in Respiratory Tract Infection in US Children. Pediatrics, 2006, 117( 2) : 425 -432. http://pediatrics.aappublications.org/content/117/2/425.full.;
Duijts L. et al., Prolonged and Exclusive Breastfeeding Reduces the Risk of Infectious Diseases in Infancy. Pediatrics, 2010, 126 (1) : 18 -25. http://pediatrics.aappublications.org/content/126/1/e18.full.
UNICEF, Pneumonia and diarrhoea : How to tackle the deadliest diseases for world’s poorest children. June 2012. http://www.unicef.org/media/files/UNICEF_P_D_complete_0604.pdf.
[3] Singh K. and Srivastava P, The effect of colostrums on infant mortality: urban rural differentials. Health and Population, 1992, 15(3&4): 94-100. http://nihfw.org/Publications/material/J294.pdf.
[4] IBFAN, Food and nutrition security from the start of the life, Submission to the E-Consultation on Hunger, Food and Nutrition Security. http://www.fao.org/fsnforum/post2015/sites/post2015/files/resources/post%202015_08%2001%202012_IBFAN%20input%20(2).pdf.
[5] Save the Children, Superfood for babies: How overcoming barriers to breastfeeding will save children’s lives, 2013. http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/SUPERFOOD%20FOR%20BABIES%20ASIA%20LOW%20RES%282%29.PDF.
[6] Childinfo / UNICEF, Child nutrition – Statistics by area : Infant and young child feeding. http://www.childinfo.org/breastfeeding_iycf.php. (accessed 7 February 2014)
[7] UNICEF / IBFAN, Challenges to Breastfeeding and State Parties’ Obligations, Oral Presentation to the CRC Committee, 21st January 2014, Geneva.
[8] FAO / WHO, Enterobacter sakazakii and other microorganisms in powdered infant formula, Meeting Report, WHO Microbiological Risk Assessment Series, 2004, 6. http://www.fao.org/docrep/007/y5502e/y5502e00.htm.
IBFAN, Infant and Young Child Feeding and Chemical Residues, 2013. http://ibfan.org/ips/IBFAN-Statement-on-Infant-and-Young-Child-Feeding-and-Chemical-Residues.pdf.
[9] Braun J.M. and Hauser R., Bisphenol A and children's health. Current Opininion in Pediatrics, 2011, 23 (2): 233-239. http://www.ncbi.nlm.nih.gov/pubmed/21293273.
Braun J.M. et al., Impact of Early-Life Bisphenol A Exposure on Behavior and Executive Function in Children. Pediatrics, 2011, 24: 873-882. http://pediatrics.aappublications.org/content/126/1/e18.full.pdf+html.
Donna S. et al., Bisphenol A and Chronic Disease Risk Factors in US Children. Pediatrics, 2013, 19: e637-e645. http://pediatrics.aappublications.org/content/early/2013/08/13/peds.2013-0106.full.pdf+html.
[10] US Government Accountability Office, Some Strategies Used to Market Infant Formula May Discourage Breastfeeding; State Contracts Should Better Protect against Misuse of WIC Name, February 2006. http://www.gao.gov/new.items/d06282.pdf.
Foss K.A. and Southwell B.G., Infant feeding and the media: the relationship betweenParents' Magazine content and breastfeeding, 1972–2000. International Breastfeeding Journal, 2006 (1): 10. http://www.internationalbreastfeedingjournal.com/content/pdf/1746-4358-1-10.pdf.
[11] Maastricht Principles on Extraterritorial Obligations of States in the area of Economic, Social and Cultural Rights. http://www.etoconsortium.org/nc/en/library/maastricht-principles/?tx_drblob_pi1[downloadUid]=23.
[12] WHO, Global Strategy for Infant and Young Child Feeding, 2002. http://whqlibdoc.who.int/publications/2003/9241562218.pdf?ua=1.
[13] ICDC, Legal Update, January 2014. http://www.ibfan-icdc.org/files/Jan_2014.pdf.
[14] UNICEF, Implementation Hanbook for the Convention on the Rights of the Child, 3rd edition, 2007 : 360. http://www.unicef.org/publications/files/Implementation_Handbook_for_the_Convention_on_the_Rights_of_the_Child_Part_2_of_3.pdf.
[15] In 2013, out of the 17 States Parties reviewed under the Convention, the CRC Committee made recommendations on the implementation of the International Code to 9 countries and recommendations on the protection, promotion and support of breastfeeding to 10 countries.
[16] These reports can be found online on IBFAN’s website: http://ibfan.org/reports-on-the-un-committee-on-the-rights-of-the-child.
[17] IBFAN, Breastfeeding and the right of the child to the enjoyment of the highest attainable standard of health. Contribution to the General Comment on the Child’s Right to Health. http://www2.ohchr.org/english/bodies/crc/docs/CallSubmissions_Art24/InternationalBabyFoodActionNetwork.pdf.
[18] IBFAN / FIAN, Submission to the General Comment on Child Rights and the Business Sector. http://www2.ohchr.org/english/bodies/crc/docs/CallSubmissionBusinessSector/IBFAN_FIAN_JointSubmission.pdf.
[19] IBFAN, Children of Incarcerated Parents: Considerations on Infant and Young Child Feeding, 2011. http://ibfan.org/upload/files/children-inc_parents_IBFAN%20subsmission.pdf.
[20] IBFAN, Food and nutrition security from the start of the life, Submission to the E-Consultation on Hunger, Food and Nutrition Security. http://www.fao.org/fsnforum/post2015/sites/post2015/files/resources/post%202015_08%2001%202012_IBFAN%20input%20(2).pdf.