Friday, 16 January 2015

The Gambia at the CRC Committee: Cultural Beliefs against Optimal Breastfeeding Practices

On January 15th, 2015, the Committee on the Rights of the Child considered the combined second and third periodic report of the Gambia on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of The Gambia was led by Ms. Fanta Bai Secka, Director of Social Welfare, Mr. Baba Samateh, Director of Social Statistics at the Gambia Bureau of Statistics, and Ms. Bafou Jeng, State Counsel at the Ministry of Justice, Child’s Rights Unit.

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

General overview of breastfeeding in the Gambia

The Gambia is characterized by high neonatal, infant, under-five and maternal mortality rates, associated to little delivery care coverage and low breastfeeding rates. Almost one baby out of two is born without the assistance of a skilled attendant and a same proportion of newborns are not breastfed within one hour from birth, while seven children out of ten are not exclusively breastfed until 6 months of age. Additionally, the most recent data on breastfeeding in the Gambia date back to 2010, showing an irregular and insufficient data collection system regarding breastfeeding. The UNICEF highlighted the existence of cultural beliefs against exclusive breastfeeding among the population, with a general traditional mindset asserting that colostrum is not good for the baby.

Although National Nutrition Policy 2010-2020 dedicates a full section to the promotion of optimal infant and child feeding practices, including a list of specific strategies, there is no clarity on their implementation. In addition, there is neither National Breastfeeding Committee and Coordinator nor information available on future plans of creating one.

On a positive note, the Gambia adopted a strong law on the marketing of breastmilk substitutes, implementing most of the International Code of Marketing of Breastmilk Substitutes. In 2008, the Baby-Friendly Hospitals Initiative criteria were respected in over 20 health care facilities, but there are no recent data on its current implementation and monitoring mechanism.

Finally, the legislation on maternity protection does not cover all women working in all sectors. There are no figures on the exact number of children under 15 living with HIV in the Gambia and no strategic action plan on infant and child feeding in emergencies.

Discussion on infant and young child feeding

The CRC Committee questioned the delegation of the Gambia on the causes of such a low profile of breastfeeding in the country, mentioning specifically that the exclusive breastfeeding rate under 6 months could and should be improved, observing that it is the most natural way of feeding children and that should be promoted also because of the emotional needs of children. The Committee asked also what measures are being taken in order to encourage women to breastfeed and whether these measures are put in place at a prenatal care level or through the media.

The Gambian delegation stated that breastfeeding was an issue in the past, and that is does not constitute an issue anymore. Continuous campaigns on the radio, on TV and in the communities are supporting breastfeeding and encouraging exclusive breastfeeding until 6 months. Additionally, the delegation affirmed that since the enactment of an act in 2010, women are entitled to 6 months of paid maternity leave, as a further proof of the efforts the government is making to promote and support breastfeeding.

The Committee then addressed the fact that the Gambia’s legislation on maternity protection does not cover all sectors, and the delegation assured that it actually does, adding that there is all the political will to promote and raise the breastfeeding rates, confirmed by a statement made by the President of the nation. Regarding HIV and breastfeeding, the Committee asked what support system is provided to the mothers living with HIV, and the delegation mentioned the existence of a system of monthly food rations including supplement milk provided to women living with HIV.

Concluding Observations

In its Concluding Observations, the Committee made both indirect and direct recommendations related with infant and young child feeding. It first recommended to ensure the allocation of sufficient resources for the health sector and to facilitate a greater and equal access to quality primary health services by mothers and children in all areas (§ 61a). Effective measures were also required to “increase the number of trained medical and other health personnel, including traditional healers”, and “facilitate cooperation between trained medical personnel and traditional healers, especially midwives” (§ 61b). The Committee also urged to improve access to maternal care services through improved health infrastructure and to increase availability and accessibility of emergency obstetric and neonatal care and skilled birth attendants at lower- and district-level health facilities (§ 61c).
With regard to nutrition, the Committee recommended the Gambia to “strengthen its efforts to address malnutrition and diseases of children, including by strengthening educational programmes, campaigns to inform parents about basic child health and nutrition [...]” (§ 61d), and to “strengthen its efforts to increase address to safe drinking water and sanitation” (§ 61e).

Finally, specifically referring to breastfeeding, the Committee urged the State party to “ensure the effective implementation of the 2010-2020 National Nutrition Policy, strengthen its awareness-raising efforts on the importance of breastfeeding and promote exclusive breastfeeding of children up to the age of six months”. It also recommended to “establish a National Breastfeeding Committee, systematically collect data on breastfeeding practices, ensure the enforcement of the International Code of Marketing of Breast-milk Substitutes, include breastfeeding in the training of nurses, and provide maternity leave to all working mothers, including domestic workers” (§ 65).