Friday, 13 June 2014

Recommendations related to breastfeeding by the 66th Committee on the Rights of the Child

The 66th Session of the Committee on the Rights of the Child (CRC Committee) took place in Geneva from 26 May to 13 June 2014. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 5 countries: India, Indonesia, Jordan, Kyrgyzstan and Saint Lucia. IBFAN submitted alternative reports on the situation of infant and young child feeding for each of the reviewed countries. The reports on India and Indonesia were written in collaboration with IBFAN groups in the countries. In its Concluding Observations, the CRC Committee referred specifically to breastfeeding in only 3 out of the 5 countries (India, Indonesia and Kyrgyzstan). Jordan and Saint Lucia did not receive any direct recommendation on breastfeeding, although they received recommendations on various topics indirectly related to breastfeeding.
General measures of implementation
The Committee has put an emphasis on the improvement of the data collection system in all of the 5 countries under review (India, Indonesia, Jordan and Kyrgyzstan), stressing the importance of collecting disaggregated data for the formulation, evaluation and monitoring of policies, programmes and projects for the effective implementation of the Convention.
The Committee also called for the development of a national plan for action in India and Saint Lucia, and insisted on the necessity to include time-bound and measurable goals and targets to effectively monitor progress in the implementation of child’s rights at national level (Saint Lucia).
Health resources and budget
The Committee also called for strengthening of resources allocated to health by urging Indonesia to substantially increase its allocations in the area of health to adequate levels and by recommending India to ensure that appropriate resources be allocated to health sector in order to improve the health situation of children, in particular to respond to high rates of acute respiratory infections, malnutrition and diarrhoea.
Besides, the Committee urged India to provide all professionals working with children, including health workers, with adequate and systematic training in children’s rights.
Preventive health
The importance of preventive health care has been highlighted in several recommendations.
Indonesia has been requested to ensure provision of postnatal care for all women with the focus of reducing preventable and other diseases, particularly diarrhoea, acute respiratory infections and undernutrition, and to promote good infant and young child feeding practices. It has also been requested to strengthen and expand access to preventive health for all pregnant women and children, and to take all necessary efforts to reduce maternal mortality.
Kyrgyzstan has been asked to take measures to prevent deaths of children as a result of preventable and curable diseases.
Saint Lucia has been recommended to ensure adequate provision of postnatal care, as well as address the issues of low birth weight, increasing infant mortality rate, and obesity among children through awareness-raising efforts, and to continue dissemination of health information and the promotion of health education regarding basic child health to all segments of society.
Malnutrition
While India has been urged to ensure effective implementation of its National Security Food Act (2013) which contains provisions aiming at combating children’s undernourishment, Jordan has been asked to address child malnutrition and infectious diseases and Kyrgyzstan has been recommended to ensure that no child in the country is undernourished and that all children have access to adequate and sufficient food.
HIV/AIDS
The Committee has issued specific recommendations on the prevention of mother-to-child HIV/AIDS transmission (India, Indonesia) as well as a recommendation on antiretroviral therapy and prophylaxis for HIV-infected pregnant women and children (India).
In addition, general recommendations on the prevention of HIV/AIDS transmission by raising awareness of the public have been issued (Jordan, Kyrgyzstan).
Breastfeeding protection
Full implementation of the International Code on Marketing of Breastmilk Substitutes has proven to be an effective intervention to protect breastfeeding and to ensure that mothers are provided with adequate information on the best way to feed their infants and young children. Therefore, the Committee has insisted on the need for Indonesia and Kyrgyzstan to adopt the Code, and has requested India to ensure effective implementation of, and compliance with, the Code, as well as establish a monitoring and reporting system to identify Code violations and implement stringent measures against identified violators.
More generally, in the light of the CRC General Comment No. 16 on State obligations regarding the impact of the business sector on children’s rights, India has been requested to establish a clear regulatory framework for the industries to ensure that their activities do not negatively affect human rights, especially in relation to children’s rights. Yet, it is of serious concern that despite the systematic infringements of the Code committed by baby food companies in India, the Committee urged the country to implement more partnerships with the private sector with focus on health. According to IBFAN-GIFA, this call for an increase in number and thus importance of health projects and programmes modeled as “public-private partnerships”, is likely to lead to risks of conflicts of interest in both policy-making sphere as well as in programme implementation and, most importantly, may undermine the existing legally binding instruments and threaten development of clear and comprehensive regulatory framework.  Therefore, the recommendations of the Committee regarding the role of the private sector can be seen as conflicting.
Breastfeeding promotion
The Committee expressed concern over the insufficient rates of exclusive breastfeeding in India and Indonesia, and the poor implementation of the law on the promotion of breastfeeding in Kyrgyzstan, leading to inadequate information as well as free samples of baby food products provided to mothers.
Therefore, India has been specifically requested to promote exclusive breastfeeding practices, including the promotion of breastfeeding from birth, complementary feeding strategies with or without provision of food supplements as well as micronutrient interventions for mothers. Meanwhile, Indonesia has been urged to strengthen the promotion of breastfeeding, including by establishing a specific programme on the topic. Finally, Kyrgyzstan has been recommended to implement its legislation on the promotion of breastfeeding practices and ensure that mothers receive adequate information on the benefits of their breastmilk.
Breastfeeding support

However, no specific recommendation on breastfeeding support (e.g. inclusion of knowledge on optimal breastfeeding practices in health curricula) has been issued by the Committee following its 66th session.
Table 1. CRC Committee - Session 66 / 2014 -Summary of Concluding Observations on IYCF

Country
IBFAN report
Summary of specific recommendations on IYCF
7
India
(3rd-4th periodic report)
yes
Indirect – General measures of implementation (para 14 (a); 20; 26; 30 (a)): prioritize the development of the National Plan of Action to implement the 2013 National Policy for Children; expeditiously improve its data collection system; provide all professionals working for and with children with adequate and systematic training in children’s rights. This includes in particular […] health workers […]; establish a clear regulatory framework for the industries operating in the State party to ensure that their activities do not negatively affect human rights or endanger […] other standards, especially those relating to children’s rights. Health (para 63; 64; 68): strengthen its efforts to address […] the existing disparities in access to and quality of health services, including by establishing partnerships with the private sector […]; ensure that appropriate resources be allocated to the health sector, with particular attention to specific maternal and child health care policies, programmes and schemes to improve the health situation of children, in particular to respond to high rates of acute respiratory infections, malnutrition and diarrhoea; ensure the effective implementation of the National Food Security Act.
Direct (para 54): enhance efforts to promote exclusive breastfeeding practices, including the promotion of breastfeeding from birth, complementary feeding strategies with or without provision of food supplements as well as micronutrient interventions for mothers; ensure the effective implementation of, and compliance with, the International Code of Marketing of Breast-milk Substitutes, and establishment of a monitoring and reporting system to identify violations of the Code, as well as of stringent measures in all situations of violations of the Code. Violations include the promotion and distribution of samples and promotional materials by the private sector institutions involved in the Infant Formula marketing and distribution.
8
Indonesia
(3rd-4th periodic report)
yes
Indirect – General measures of implementation (para 7): continue to upgrade its system of data collection to cover all areas of the Convention; ensure that all data and indicators are used for the formulation, monitoring and evaluation of policies, programmes and projects for the effective implementation of the Convention. Health (para 48; 52): increase its health budget and expand access to primary health-care services across all provinces; ensure the provision of primary health-care services for all pregnant women, including […]  postnatal care, and children, focusing on interventions to reduce preventable and other diseases, particularly diarrhoea, acute respiratory infections and undernutrition, as well as promote good infant and young child feeding practices; strengthen and expand access to preventive health care […] for all pregnant women and children, particularly infants and children under the age of 5; take all necessary efforts, including emergency obstetric care, to reduce maternal mortality; sustain the measures in place to prevent mother-to-child transmission of HIV/AIDS as well as provide for counselling and improve follow-up treatment for HIV/AIDS-infected mothers and their infants.
Direct (para 54): strengthen the promotion of breastfeeding, including by establishing a programme to promote and enable all mothers to successfully breastfeed exclusively for the first six months of the infant’s life; adopt the International Code of Marketing of Breast Milk Substitutes.
9
Jordan
(4th-5th periodic report)
no
Indirect – General measures of implementation (para 8 (b)): strengthen its mechanisms for data collection by establishing a central database on children and ensure that data are collected on all areas of the Convention and disaggregated. Health (para 44; 48): ensure equal access to quality health services by all children […] by addressing child malnutrition and infectious disease; improve access to quality, age-appropriate HIV/AIDS, sexual and reproductive health information and services.
10
Kyrgyzstan
(3rd-4th periodic report)
yes
Indirect – General measures of implementation (para 7 (b)): develop a comprehensive system for collecting disaggregated data to cover all those under the age of 18 years. Health (para 48; 50): take measures to prevent deaths of children as a result of preventable and curable diseases, by educating parents and providing easy access to early medical intervention; take measures to ensure that no child in the country is undernourished and that all children have access to adequate and sufficient nutritious food; take all necessary measures to prevent transmission of HIV/AIDS by raising awareness of the public.
Direct (para 54): 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;  adopt the International Code for Marketing of Breast-Milk Substitutes.
11
Saint Lucia
(2nd-4th periodic report)
no
Indirect – General measures of implementation (para 11; 13; 17): develop and implement a comprehensive national plan of action for the full implementation of the Convention; to establish the Central Database Registry […] ensuring a comprehensive and integrated data collection system on children. Health (para 43(a) and (b)): ensure adequate provision of prenatal and post natal care, as well as address the increasing number of children born with low birth weight, the increasing infant mortality rate, and obesity among children, through awareness-raising efforts, and the reasons for these trends; dissemination of health information and the promotion of health education regarding basic child health to all segments of society.