Thursday, 13 February 2014

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


The 65th 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.