Friday, 23 January 2015

Iraq at the CRC: High Prevalence of Infections and Chronic Undernutrition among Children

On January 21th, 2015, the Committee on the Rights of the Child considered the combined second to fourth periodic report of Iraq on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Iraq was led by H.E. Mohammed Mahdi Ameen Al-Bayati, Minister of Human Rights.

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

General overview of breastfeeding in Iraq

The rate of early initiation of breastfeeding passed from 25.1% in 2006 to 43% in 2011. While representing a significant increase, this means that almost 6 children out of 10 are still not receiving any breastmilk during their first hour of life, even though delayed breastfeeding is proven to have a negative impact on neonatal mortality. Additionally, the rate of exclusive breastfeeding under 6 months was only 20% in 2011, and there are no recent data on its progress, while the rate of continued breastfeeding at 2 years dropped from 35.7% in 2006 to 23% in 2011. Such poor breastfeeding records show a lack of general information on optimal breastfeeding practices, from the mothers’ side as well as from the health professionals, who lack the resources and capacity to proper inform pregnant women about their nursing role. Moreover, such rates are also the result of the distribution of free infant formula to all infants, as part of Iraq’s Public Distribution System for food rations.

The draft National Strategy for Infant and Young Child Feeding was prepared in 2005 and was aimed at raising awareness on infant and child feeding problems and practices. However, it is not unknown whether this strategy has been implemented so far. The draft National Strategy provides for specific training to health professionals on HIV and infant feeding issues, and thus it is not clear whether the provision of the strategy is implemented, as well as the whole strategy itself.

Regarding protection of breastfeeding, only voluntary provisions exist in Iraq to implement the International Code of Marketing of Breastmilk Substitutes. A draft law was prepared in 2011, with the goal of transposing into law most provisions of the International Code, but to date there is no information available on its adoption and implementation. The coverage rate of the Baby-Friendly Hospital Initiative (BFHI) in the hospitals and maternities in Iraq was 59% in 2009/2010, but there are no recent data on the current number of hospitals certified as “Baby-Friendly” and on whether these institutions still respect the criteria of the BFHI.
Maternity protection is not adequate, considering that the paid maternity leave duration is only 62 days. Finally, no information is available on the provision of a strategic plan to protect and promote breastfeeding in case of emergencies.

Discussion on infant and young child feeding

The CRC Committee commended the delegation of Iraq about the progress made on immunization and on institutional deliveries, highlighting that this is a very positive result considering the difficult context Iraq is in. However, it observed that there is still a high rate of preventable infections among children, such as diarrhea, and asked for comments on that as well as on the issue of chronic undernutrition. Moreover, the CRC Committee asked what efforts are being made at the health care system level in order to reduce the number of preventable maternal deaths.

The delegation of Iraq did not provide answers on the topics that have been touched related to health, justifying this with the absence of the representative of the Ministry of Health, who could not participate to the session due to budget issues.

Concluding Observations

In its Concluding Observations, the Committee made several recommendations indirectly related to infant and young child. After expressing concerns on the high rate of under-five mortality and the high prevalence of chronic under-nutrition and maternal mortality, the Committee highlighted also that “while the armed conflict is having a devastating impact on the availability and quality of healthcare, the State party devotes a low percentage of the federal budget to its healthcare system” (§ 60).

The Committee thus recommended Iraq to “reduce maternal mortality by providing access to emergency obstetric care and ensuring access to trained delivery care at home, services at maternal and child health clinics with trained health care providers” and to “allocate all necessary human, technical and financial resources for interventions aimed at reducing preventable and other diseases, particularly diarrhoea, acute respiratory infections and under nutrition” (§ 61a-b). Finally, the Committee also recommended that Iraq to “take all necessary measures to sufficiently equip hospitals as a matter of priority” (§ 61c).