Monday, 19 January 2015

Tanzania at the CRC: Suboptimal Breastfeeding Practices and Low Rate of Institutional Delivery

On January 15th and 16th, 2015, the Committee on the Rights of the Child considered the combined third to fifth periodic reports of the United Republic of Tanzania on the situation of the implementation of the Convention on the Rights of the Child in the country. The Tanzanian delegation was led by Mrs. Sophia Simba, Minister for Community Development, Gender and Children.

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

General overview of breastfeeding in the United Republic of Tanzania

In Tanzania, high rates of neonatal, infant, under-5 and maternal mortality coexist with a low rate of skilled attendant at birth (49%). Suboptimal breastfeeding practices are widespread: some 1 child out of 2 is neither breastfed during the first hour after delivery nor exclusively breastfed until 6 months of age. In addition, early introduction of complementary food is a recurring problem and vast majority of babies under 3 months old are fed with water, juice, porridge or other foods, increasing the risk of infections and malnutrition. There is also a cultural belief that the colostrums is dirty and should be discarded.

Although the 1992 Food and Nutrition Policy pointing out the high rate of malnutrition among children linked with inadequate breastfeeding and weaning is still in place, as well as the National Nutrition Strategy 2011/12-2015/16 and the 2004 National Strategy on Infant and Young Child Nutrition, several problems persist in the country regarding promotion and support of breastfeeding. First, information on the activities undertaken to promote breastfeeding is lacking, as well as information on specific trainings or courses on optimal breastfeeding practices aimed at health professionals. The High Level Steering Committee on Nutrition, created in 2011, in charge to coordinate multi-sectorial interventions to reduce child malnutrition and promote optimal breastfeeding. However, it has only a coordinating role and does not carry out any monitoring activity. Finally, there is no information on the existence of a specific National Breastfeeding Committee or Coordinator.

Regarding protection of breastfeeding, in 1994, Tanzania has adopted a National Regulation for Marketing of Breastmilk Substitutes and Designated Products. However, its revision has not been endorsed yet and there is very poor awareness of its content at all levels and in most sectors.

In addition, in 2010, only 37% of the hospitals in the country were certified as “baby-friendly" and maternity leave is only available every 3 years and does not cover women in the informal sector. Even though 9 women out of 10 know that HIV can be transmitted through breastfeeding, the estimated rate of mother-to-child transmission in 2013 was 15.8%. Last but not least, the country does not have any plan to protect and support breastfeeding in case of emergencies.

Discussion on infant and young child feeding

The CRC Committee first noted that in the last years, the overall budget allocated to health has decreased and that the country shows high rates of maternal, neonatal and infant mortality. It asked the delegation if there is any initiative or measure in place to address the issue of the very high maternal mortality, which has a direct impact on child survival. 

The Committee also raised specific questions on breastfeeding. It asked for further clarifications on the activities to promote breastfeeding in relation with the National Breastfeeding Week. Regarding the High Level Steering Committee on Nutrition, it asked which is its role regarding breastfeeding promotion in the country, especially within hospitals facilities.

The Tanzanian delegation answered that during the National Breastfeeding Week, awareness-raising activities such as seminars, distribution of ICT materials, workshops on importance of breastfeeding, trainers’ training on breastfeeding and HIV, information on the International Code and on optimal breastfeeding practices have been organized and a promotional campaign on exclusive breastfeeding until 6 months of age has been launched. The delegation added that the High Level Steering Committee on Nutrition is in charge to ensure that proper resources are allocated to provide good nutrition to the population including through fortification of oil, wheat and maize.

The Committee expressed further concern about the very low rate of institutional delivery and asked how, in this conditions, does the government ensure that all mothers have access to correct information about the best way to feed their child. Besides, it emphasized that almost half of the mothers do not breastfeed until 6 months and asked what measures are taken to tackle this issue. It also asked what kind of regulations of the marketing of breastmilk substitutes are in place in order to allow mothers to make the correct information, and noted that guaranteeing that mothers are enable to optimally  breastfeed leads to huge public savings and places children in the best situation to start their life.

In a follow-up question, the Committee noted that the rate of early initiation of breastfeeding is very low in the country and emphasized its crucial importance for the baby’s as well as for the mother’s health. The Committee also asked if there is any programme to help mothers in terms of lactation, noting that the rate of continued breastfeeding until 2 years is particularly low. Regarding breastfeeding protection, supposedly ensured by the implementation of the Baby-friendly Hospital Initiative, it asked if there is any regulation regarding baby foods advertisements in hospitals. On the access to emergency obstetric care, the Committee asked what is the coverage of skilled attendants at birth and if there are trainings for traditional birth attendants. Regarding the large number of young mothers, it asked if there are any family planning services in the country.

The delegation highlighted the importance of breastfeeding in the first months of life for the healthy development of brain. It explained that breastfeeding importance is raised in one of the guidelines on IMCI (Integrated Management of Child Illnesses) and also through parenting education. Promotion of breastfeeding is also done through dissemination of ICT materials in health centers, hospitals and schools. The delegation further noted that the Tanzania Food and Drugs Authority has implemented regulations on the marketing of breastmilk substitutes and is providing information through national media on the best use of breastfeeding instead of formula feeding. Besides, the Tanzania Bureau of Standards is in charge of controlling the food standards and making screens.

Concluding Observations

In its Concluding Observations, the Committee issued recommendations indirectly related to infant and young child feeding. With regard to health and health services, the Committee stated its concerns over the persistent high maternal mortality and morbidity rates, the limited access to health care services to children poverty and remote and rural areas, and the prevalence of chronic malnutrition, leading to stunting and the limited access to safe drinking water and sanitation (§ 53).
Therefore, the Committee urged Tanzania to allocate sufficient financial and human resources to health services, particularly mentioning the trained care at delivery as well as improved care for new-borns and during the neonatal period, antenatal care and services for infants and preschool children at primary health centres (§ 54a). It also requested Tanzania to “establish more child and maternal health clinics and access to safe and trained delivery [...]” (§ 54b).
Specifically addressing the issue of children nutrition, the Committee recommended Tanzania to “strengthen national strategies to address the critical nutritional needs of children, particularly among the most vulnerable groups, through targeted interventions” and to “improve access to safe drinking water and adequate sanitation facilities and ensure sustainability, availability, sufficiency and affordability to all, particularly children” (§ 53c-d).

Finally, the Committee urged the country to implement the OHCHR Technical guidance child mortality (A/HRC/27/31) (§ 54 e) which includes specific recommendations on breastfeeding protection (including the implementation of the International Code) and promotion.