Thursday 11 September 2014

Hungary at the CRC: Lack of Data, but Willingness to Further Consider Breastfeeding

On the 9th and 10th September 2014, the Committee on the Rights of the Child considered the combined third to fifth periodic reports of Hungary on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Hungary was led by the Deputy State Secretary, Ms. Tünde Fürész and it includes a desk officer of the Department of Health Policy, Ms. Gabriella Kissné Erdélyi as well as the Acting Head of Department of the General Directorate of Social Affairs and Child Protection, Gulyásné dr. Kovács Erzsébet.

On this occasion, IBFAN presented an alternative report to inform the CRC Committee on the situation of infant and young child feeding in Hungary. 

General overview of breastfeeding in Hungary 

Hungary shows a high rate of caesarean sections (30.8%) which might have a negative impact on the rate of early initiation of breastfeeding. However, the latter information is not available. Moreover, there is no available data on exclusive breastfeeding in the first 6 months for the recent years. The most recent data show a low rate of exclusive breastfeeding at the age of 6 months (±42%).

Generally, Hungary shows a poor monitoring of key breastfeeding as well as infant and young child feeding (IYCF) indicators. Furthermore, since 2002, there is neither information on courses on breastfeeding nor on others efforts to promote breastfeeding in the country. There is also a lack of information concerning the past and current activities conducted by the National Committee on Breastfeeding.

According to our IBFAN International Code Documentation Centre, only few provisions of the International Code of Marketing of Breastmilk Substitutes have been fully implemented into the national legislation. Moreover, the national Baby-Friendly Hospital Initiative (BFHI) coordinator, Dr. Cholnoky, also emphasized that baby food companies systematically violate the International Code by providing free sample and promotional materials to mothers.

In 2002, Dr. Cholnoky deplored that the BFHI was not followed by the medical professionals. At that time, the lack of knowledge about breastfeeding practices was identified as the main barrier to the widespread of the BFHI. However, the practice of ‘rooming-in’ (allowing mothers and infants to remain together) was common. Currently, out of 119 hospitals, there are 17 hospitals certified as “baby-friendly” in the country.

Hungary shows low fertility and female employment rates that are largely explained by insufficient support for parents to reconcile work and care commitments. Maternity leave lasts 24 weeks and the amount of maternity leave benefits is of 70% of the daily average gross earnings of the previous year. However, mothers working within the informal sector are not entitled to maternity leave benefits.

Data shows that in Hungary the number of pregnant women living with HIV who received antiretroviral medicaments for preventing mother-to-child transmission were of 5 in 2010 compared to 9 in 2009.

Finally, there is no information available on any emergency preparedness plan which may ensure an integrated response capable of protecting and supporting breastfeeding in case of emergencies.

Discussion on infant and young child feeding

The Committee showed particular interest in health issues and asked the Delegation to provide information about actions taken in this regard, especially to tackle deficiencies within the health system which affect children. A lack of well-trained health professional on pre-natal period was highlighted. The Committee mentioned the WHO and UNICEF recommendations related to children’s right to health as the correct path to follow.

In this framework, breastfeeding was specifically addressed and given particular attention. The Committee expressed concern in relation to the very low rate of infant early initiation of breastfeeding which is caused among others by aggressive marketing policies consisting in the distribution of free sample in maternity wards. In this regard, the Delegation clarified that every single formula given in hospital contains a clear notice affirming that breastfeeding is the best practice. Furthermore, it stressed that marketing in hospitals is prohibited.

The Committee also asked for further explanations with regard to the hospital rule preventing mothers from keeping their children with them while in hospital. The Delegation asserted instead that children must stay with mothers in hospital, unless mothers ask to put children in another room. The Delegation is therefore willing to promote further the “rooming-in” practice as well as breastfeeding. In particular, Hungary aims at introducing the so-called “kangaroo mother care” system.

The Delegation of Hungary pointed out the existence of a National Committee on Breastfeeding, whose main task is to assess the quality of hospitals as “baby-friendly”. Moreover, the Delegation repeatedly stressed their leader position in Europe in breastfeeding rates. According to the Delegation, the global average is of 4 women who exclusively breastfeed in the first 6 months out of 10 (40%). In Hungary, 36% of women exclusively breastfeed in the first six months.

The Committee solicited further the Delegation for obtaining information about work-family life balance and maternity leave in the informal sector. The Delegation answered by mentioning the Hungarian Labour Act, according to which women must be given the opportunity to breastfeed during working hours.

Finally, the Committee highlighted the high rate of C-section cases, which have an impact on early initiation breastfeeding. The Delegation acknowledged that in the period 2008-2012 the rate of induced births was indeed quite high, thereby stressing the willingness to consider the issue further.

Concluding Observations 

In its Concluding Observations, the Committee made few indirect recommendations. At the level of general measures of implementation, it urged Hungary to “adopt a comprehensive policy covering all areas of children’s rights under the Convention and ensure that its strategies and action plans are provided with necessary human, technical and financial resources for their effective implementation” (§10).

With regard to health issues, the Committee recommended that Hungary “take measures to ensure that health care facilities and practitioners, including paediatric and specialized care practitioners, are available throughout the country including in rural areas” and that the Government “take measures to provide access to education on nutrition” (§47). 

In addition, the Committee issued direct recommendations related to infant and young child feeding (§51). It recommended that Hungary “take all necessary measures to encourage exclusive breastfeeding of infants until 6 months of age and provide data on the rate of breastfeeding in its next periodic report. The Committee also recommends that the State party increase the number of baby friendly hospitals and take measures to fully implement the provisions of the International Code of Marketing of Breast-milk Substitutes”.

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