Lack of Adequate Training of Health Professionals in Kyrgyzstan (CRC)

On the 28^th of May 2014, the Committee on the Rights of the Child considered the combined 3rd and 4th periodic report of Kyrgyzstan on 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 the situation on the issue of infant and young child feeding in Kyrgyzstan.

General overview of breastfeeding in Kyrgyzstan

The report noted that in Kyrgyzstan, high rates of infant and neonatal mortality coexist with inadequate infant feeding practices, such as early weaning and early introduction of complementary food, breastmilk substitutes and other liquids. Almost 2 children out of 3 are not breastfed until the age of 6 months and only about 2 children out of 10 are breastfed until the age of 2 years. Moreover, the report pointed out the lack of adequate training of health care workers and health professionals on optimal breastfeeding practices. Besides, even though many provisions of the International Code of Marketing of Breastmilk Substitutes have now been implemented into law, there is still no independent monitoring.  

In Kyrgyzstan, there is neither information on the total amount of maternity yards in the country, nor recent data on the amount of “baby-friendly” hospitals. Besides, the report has highlighted the regional disparities regarding the knowledge on HIV/AIDS. Finally, the lack of emergency preparedness plan to ensure integrated response to protect and support infant and young child feeding in case of emergencies has been noted.

Discussion on infant and young child feeding

The Committee pointed out that a law on the marketing of breastmilk substitutes was adopted in March 2009. However, mothers are still not provided with adequate information on breastfeeding and additionally, they often received free samples of formula. The Committee also emphasized the lack of monitoring mechanism of the new law as well as the poor support to optimal breastfeeding practices, and noted that only one third of the children were exclusively breastfed until 6 months of age.

The Kyrgyz delegation responded that on the contrary, campaigns to promote breastfeeding have been launched. In 2010, an independent demographic medical survey carried out on a large section of the population by international experts found that 56% of infants were exclusively breastfed until the age of six months of age. According to the delegation, breastfeeding is well promoted in the country through many current initiatives led in collaboration with local health committees. The delegation also explained that the government is planning to promote midwifes’ activities at local level. It stated that pre- and post-diploma vocational training is widespread and that breastfeeding classes are included in the programmes. Finally, it explained that teaching and promotion material has been translated to Kyrgyz and Russian languages.

Concluding Observations

In its Concluding Observations, the Committee urged Kyrgyzstan to develop a comprehensive system for collecting disaggregated data (para 7(b). Regarding health issues, it requested the country to tackle the issues of child mortality resulting of preventable and curable diseases and to ensure children's access to adequate and sufficient food (para 48) and take all necessary measures to prevent transmission of HIV/AIDS by raising awareness of the public (para 50).

The Committee also issued direct recommendations related to breastfeeding (para 53-54). After having noted the adoption of the Law on the promotion of breastfeeding of March 2009, regulating the advertisement and promotion of infant formulas, the Committee expressed concern about the poor implementation of the Law and the reported complicity between medical personnel and baby food industries, which has led to inadequate information and free samples of baby food products provided to mothers. Therefore, the Committee recommended Kyrgyzstan to “take all necessary measures to implement its legislation promoting breastfeeding practices and ensure that all mothers receive adequate information on the benefits of their breast-milk”.  It also recommended Kyrgyzstan to “adopt the International Code for Marketing of Breast-Milk Substitutes.”

Low Breastfeeding Rates in Jordan (CRC)

On the 26^th of May 2014, the Committee on the Rights of the Child considered the combined fourth to fifth periodic reports of Jordan 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 Jordan’s situation on the issue of infant and young child feeding.

General overview of breastfeeding in Jordan

In Jordan, the rate of early initiation of breastfeeding is low (38.8%) what, compared to the very high rate of institutional delivery (almost 99%), questions the quality of the training provided to health professionals. Furthermore, almost four children out of five are not exclusively breastfed until 6 months of age, while more than 45% of the infants under 1 month of age are fed with infant formula and some 24% of the children of 4-5 months of age are weaned prematurely. These data should be assessed in close conjunction with the high stunting rate of the children under 5 years of age are stunted (8%). The country has implemented most, but not all, of the provisions of the International Code of Marketing of Breastmilk Substitutes as legally enforceable measures.

A general lack of data on “baby-friendly” hospitals also has been observed. Similarly, a lack of data on HIV/AIDS and infant feeding has been noted. This is especially concerning given that the latter infection is still stigmatized and the population does not receive adequate and comprehensive information about it.

Besides, the alternative report emphasized that not all working women are benefiting from maternity protection and many women still experience occupational segregation.

Finally, it has been highlighted that, despite a national policy and training programme on infant and young child feeding in emergencies, support to optimal breastfeeding practices in refugees’ camps is not ensured and refugee women often face difficulties to access to health care facilities.

Discussion on infant and young child feeding

The CRC Committee pointed out that the rate of exclusive breastfeeding is low and asked if there was any national campaign to encourage mothers to breastfeed for a longer period. 

The delegation of Jordan answered that Jordan has implemented a law prohibiting the marketing of breastmilk substitutes. It stated that awareness-raising campaigns to promote breastfeeding have been launched and information on the best way to incorporate breastfeeding within the family routine has been disseminated.  The delegation also explained that there is a national guidance for medical professionals on the circumstances in which powdered milk should be recommended.

In addition, the delegation also explained that Jordan has the lowest rate of HIV/AIDS in the Arab region and that the national HIV/AIDS strategy includes reintegration measures for infected persons and awareness-raising campaigns on the transmission of the virus.

Concluding Observations

In its Concluding Observations, the CRC Committee recommended Jordan to strengthen its mechanisms for data collection (para 8 (b)). Regarding health issues, it urged the country to “ensure equal access to quality health services by all children, through the adoption of measures aimed at prioritizing children in the most disadvantaged and marginalized situations, especially child refugees, and by addressing child malnutrition and infectious diseases” (para 44). The Committee also emphasized the necessity to “improve access to quality, age-appropriate HIV/AIDS, sexual and reproductive health information and services” (para 48).

However, the Committee issued no direct recommendations related to infant and young child feeding. 

Obstacles to Optimal Breastfeeding Practices in Uzbekistan (CESCR)

On the 13th of May 2014, the Committee on Economic, Social and Cultural Rights considered the 2nd periodic report of Uzbekistan on the implementation of the International Covenant on Economic, Social and Cultural Rights.

IBFAN presented an alternative report to inform the CESCR Committee on the situation on the issue of infant and young child feeding in Uzbekistan.

General overview of breastfeeding in Uzbekistan

The alternative report highlighted several obstacles to breastfeeding practices in Uzbekistan. First of all, the country has low rates of early initiation to breastfeeding (67%) and exclusive breastfeeding up to 6 months of age (26%). Furthermore, suboptimal infant feeding practices have been observed: the introduction of other liquids-especially water and other milk/formula- and of complementary food in infants’ diet occurs too early. Moreover, the health personnel appear to be not duly trained to promote and support breastfeeding. Besides, the International Code on Marketing of Breastmilk Substitutes is not implemented and the marketing of breastmilk substitutes is not regulated in the domestic legislation. Finally, the maternity leave’s duration after delivery is less than 2 months and the following parental leave is paid inadequately.

Discussion on infant and young child feeding

No specific questions were raised on infant and young child feeding by the experts. Nevertheless, during the discussion, the Uzbek delegation referred to a letter dated on 27 December 2011 from the Permanent Representative of Uzbekistan to the United Nations addressed to the Secretary-General. This letter explained that Uzbekistan hosted an international symposium entitled “National Model of Mother and Child Health-care in Uzbekistan: Healthy Mother, Healthy Child” that took place in Tashkent on 26 November 2011. During the latter symposium, according to the delegation, it has been acknowledged that the Uzbek National Model is one of the most effective strategy for achieving a good development in the area of maternal and infantile health.

CECSR Concluding Observations

In its recommendations towards Uzbekistan, the Committee notes that despite the significant decrease in maternal and child mortality, their occurrence remain relatively high. Therefore, the Committee urges the State party to strengthen its efforts to improve mother and child health, especially during pre-natal and neonatal periods (para 24).

Undue Marketing of Breastmilk Susbtitutes in Czech Republic (CESCR)

On the 9th of May 2014, the Committee on Economic, Social and Cultural Rights considered the second periodic report of the Czech Republic on how the country is implementing the provisions of the International Covenant on Economic, Social and Cultural Rights.

IBFAN presented an alternative country report to inform the CESCR Committee on the situation on the issue of infant and young child feeding.

General overview of breastfeeding

It has been noted that breastfeeding rates have been declining. Exclusive breastfeeding rate at 6 months of age are is low and have been decreasing. There are regional disparities in the breastfeeding rates, which may be due to maternal age and education. Also, it is clearly seen that systematic data on complementary feeding is missing.

Moreover, the International Code of Marketing of Breastmilk Substitutes has not been implemented at the national level. As a consequence, advertisement of infant formula and sponsorship to the health professionals by baby food industry is widespread. Government’s efforts to protect and promote breastfeeding are far from being sufficient. The support given to the National Lactation Centre is very small, and has not yet been officially acknowledged. Furthermore, training of health personnel on the protection, promotion and support of breastfeeding is insufficient. It is carried out only by the National Lactation Centre. Government’s support in this direction is missing. 

The Baby-friendly Hospital Initiative lacks a clear re-assessment mechanism, to ensure that all certified hospitals are adhering to the “Ten Steps to Successful Breastfeeding”. Professionals working in certified baby-friendly hospitals lack regular training on management and protection of breastfeeding.

Discussion on infant and young child feeding

Neither questions from experts nor any interventions from the delegation have been observed on the question of infant and young child feeding.

Instead, the discussion turned around how much of the upbringing of children was being carried out by men. Campaigns to promote burden sharing were underway, but it might take some time to change traditional ways of thinking.

CECSR Concluding Observations

In its Concluding Observations, the Committee has not made any direct or indirect recommendations on the issue of infant and young child feeding. 

Breastmilk Substitutes Undermine Breastfeeding in China (CESCR)

On the 8^th of May 2014, the Committee on Economic, Social and Cultural Rights considered the second periodic report of China as well as reports of the Special Administrative Region of Hong Kong and of the Special Administrative Region of Macao on the implementation of the International Covenant on Economic, Social and Cultural Rights.

In view of the session, IBFAN presented an alternative report on the situation of infant and young child feeding in China, prepared by IBFAN East-Asia.

General overview of breastfeeding

The report shows that in China, breastfeeding declined rapidly during the 1980s due to the promotion of breastmilk substitutes and inappropriate medical practices. With the implementation of the Baby-Friendly Hospital Initiative since 1992 and the national regulation on the marketing of breastmilk substitutes (China’s Regulation) entered in force in 1995, breastfeeding’s superiority has been recognized and mothers are encouraged and supported to breastfeed their infants. However, breastfeeding promotion in community and work place has not yet received enough attention. One of the challenges regards the popularity of formula feeding and persistence of inadequate feeding practices such as giving water to infants under 5 months. Another challenge is the ban the marketing promotion of infant formula which undermines mothers’ confidence on successful breastfeeding. It is difficult for health authorities to supervise, conduct training and reassessments of the baby-friendly health facilities in China given the great number of concerned facilities (over 60,000). Finally, it is hard to ensure mothers’ entitlement to paid maternal leave and breastfeeding facilities, especially considering the rapid evolution of lifestyle in China.

Discussion on infant and young child feeding

No specific questions were raised on the infant and young child feeding.  

Nonetheless, the experts raised questions about the separation of mothers and children in the Hong Kong Special Administrative Region, affecting thousands of children, as there was no legislation that ensured the right of a mother to live with her children. In addition, the experts also raised the issue of pre-natal sex selection because of boy preference, as well as forced abortion, even in the third trimester. The adoption of Chinese babies by overseas parents has also been addressed as a problematic issue; indeed, mostly 100 per cent of these adopted babies were girls.

In relation with maternity protection, we note that the delegation of China has stated that some 46 % of the working population is made of women.

CECSR Concluding Observations

In its Concluding Observations, the Committee recommends China to establish a clear regulatory framework for companies and to adopt appropriate legislative and administrative measures to ensure legal liability of companies (para 13). Moreover, the Committee recommends that the State take measures to eliminate multiple-discrimination faced by rural women in particular in access to health (para 16).  After expressing its concern about the situation of food security in some of the poor areas, the Committee urges the State to strengthen its efforts to protect the right to adequate food.  Indeed, the State should intensify its efforts in order to address effectively the situation of food insecurity and child malnutrition in poor rural areas.  The enforcement of the Food Safety Law is desirable to strengthen its efforts on food safety supervision and to ensure the production, processing, distribution, marketing and consumption of safe food (para 29). 

In addition, the Committee recommends China to undertake all necessary measures to improve its health care and services to guarantee the enjoyment of the right to good quality and affordable health care to all persons in China.  On the same note, a recommendation is also made to increase the budgetary allocations to the health sector and to strengthen training for health care professionals (para 33). 

Besides, the Committee emphasizes the importance of awareness-raising activities aimed at promoting understanding of the modes of transmission of HIV among the population (para 34).

Finally, the Committee urges the State party, Hong Kong, China and Macao, China to build a systematic data collection (para 61) and encourages the State party to engage all relevant actors including NGOs in the process of discussion on the implementation of the present concluding observations at national level (para 65).