Friday, 23 January 2015

Switzerland at the CRC : Lack of Political Will and Financial Means to Ensure Protection, Promotion and Support of Breastfeeding

On January 21st and 22nd, 2015, the Committee on the Rights of the Child considered the combined second to fourth periodic report of Switzerland on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Switzerland was led by Ambassador Stéphane Cueni and Mrs. Anne-Claude Demierre, State Counsellor of the canton of Fribourg.

On this occasion, IBFAN presented an alternative report to inform the CRC Committee on the situation of infant and young child feeding in Switzerland. IN addition, as a member of the Swiss NGO Child Rights Network Switzerland, IBFAN-GIFA also contributed to the joint report of the network.

General overview of breastfeeding in Switzerland

IBFAN report highlighted that Switzerland does not have a comprehensive national strategy on protection, promotion and support to infant and young child feeding in line with the Global strategy for infant and young child feeding adopted at WHA in 2002. The Swiss national strategy to promote healthy diets initiated in 2008 includes promotion of breastfeeding, and there is a national foundation tasked with breastfeeding promotion, but only a few cantons are funding small-scale breastfeeding promotion activities as part of their obesity prevention programs. Overall, political will and national planning and resources are insufficient to create a favorable environment for mothers and parents to make informed decisions and put them into practice. Although more than half of Swiss babies are born in baby-friendly hospitals, scarce international indicators reveal poor breastfeeding practices (rate of exclusive breastfeeding under 6 months: 14%, rate of early initiation of breastfeeding: 66% and no data on continued breastfeeding at 1 or 2 years). The rate of C-sections, a barrier to early initiation, is very high (33%).

In addition, protection of breastfeeding is insufficient. Indeed, the Swiss law does not cover all provisions of the International Code of Marketing of Breastmilk Substitutes and applies only to infant formula until 6 months; what is more, monitoring at national level is not independent, as the panel responsible is jointly composed of experts and members of the baby food industry. In consequence, as an example, mothers of 4 month year old babies receive gift packages at home containing samples of follow-on formula and complementary foods marketed for infants from 4 months. Parents often receive conflicting information, including from health professionals who lack appropriate independent training and are faced with potential conflicts of interest induced by financial ties between their professional associations and the baby food industry.

On a more positive note, IBFAN noted that Switzerland ratified the ILO Convention 183 on maternity protection, by revising their legislation to ensure that all working mothers are granted paid breastfeeding breaks until their child is one year of age.

Discussion on infant and young child feeding

The Committee expressed concern about the increase of obesity in children. Mentioning specifically breastfeeding, the Committee noted that even though breastfeeding is officially recommended, the efforts to promote optimal breastfeeding practices are yet not satisfactory: there is a lack of training aimed at health professionals, no national strategy on breastfeeding and only very little funds allocated to breastfeeding promotion.

Regarding obesity, the delegation explained that Switzerland has adopted a 2013-2016 Nutrition Strategy based on the 6th Swiss Nutrition report, the European White Paper and the WHA Strategy for diet, physical activity and health. A National Plan of Action has also been put in place and is coordinated by Promotion Santé Suisse in 20 cantons. On the issue of breastfeeding, the delegation answered that much attention is paid to the health of mothers and children within the above-mentioned National Nutrition Strategy and that Federal Food Safety and Veterinary Office supports and promotes breastfeeding through the Swiss Foundation for the Promotion of Breastfeeding. In the last years, two important steps have been taken in relation with breastfeeding: 1/ a new legislation on maternity protection has been implemented, which provides paid breastfeeding breaks to working mothers, and the ILO Convention 183 has been subsequently ratified; 2/ a new ordinance has been adopted in 2008, which limits the marketing of infant formula until 6 months of age.

The Committee then raised follow-up questions on the protection of breastfeeding, emphasizing the lack of implementation of the International Code and relevant subsequent WHA resolutions into the Swiss legislation and asking if there was any immediate plan to strengthen the national legislation implementing the Code and to set up an independent monitoring mechanism. In addition, the Committee asked if, considering the need for 6 months of exclusive breastfeeding, Switzerland was planning to extend the duration of the maternity leave accordingly.

The delegation could not answer on the question on breastfeeding protection and the International Code because of lack of information. On the issue of maternity leave, it explained that the government is not considering an extension of the duration of 14 weeks, which comply with European standards, but is now working on strengthening the paternity leave.

The Committee again referred to breastfeeding and asked if there was any intention to increase to rate of hospitals certified as “baby-friendly” (about 55%).

The delegation answered that some hospitals are indeed certified, but that some others have refused to enter into the process. Currently, there is no government plan to extend the number of certified health facilities. The delegation added that a canton express concern about the fact that women were being pressured to breastfeed and said that some degree of freedom should be allowed. Mothers should be able to choose to breastfeed or not. The delegation further stated that there shouldn’t be a state plan on this issue.

The Committee finally noted that breastfeeding is also crucial for emotional bonding and attachment between the mother and her child and that Switzerland should reconsider its approach related to the Baby-Friendly Hospital Initiative. Noting that nowadays, two incomes are often necessary to support a family and that most of women no longer stay at home to take care of their children, the Committee invited Switzerland to extend the maternity leave, because it is the only way to enable women to breastfeed exclusively for 6 months.

Concluding Observations

In its Concluding Observations, the Committee referred indirectly and directly to infant and young child feeding. Regarding promotion of breastfeeding, the Committee recommended Switzerland to “strengthen its efforts to promote exclusive and continued breastfeeding by providing access to materials, and raising awareness concerning the importance of breastfeeding and the risks of formula feeding” (§ 59a). Regarding support to breastfeeding, the Committee stressed the need to “review and strengthen training for health professionals on the importance of exclusive breastfeeding, and to “further increase the number of hospitals certified as baby-friendly” (§ 59b-c). Moreover, Switzerland was urged to “develop a comprehensive national strategy on infant and young children feeding practices” and to make sure that the national recommendations on breastfeeding comply with the relevant WHO recommendations (§ 59d-e). Finally, the Committe recommended to “ensure that the International Code of Marketing of Breastmilk Substitutes is strictly enforced” and to “consider extending maternity leave to minimum six months” (§ 59f-g).