68th Session of the CRC Committee: Recommendations Related to Breastfeeding

The 68^th Session of the Committee on the Rights of the Child (CRC Committee) took place in Geneva from January 12^th to 30^th, 2015. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 11 countries: Colombia, Dominican Republic, the Gambia, Iraq, Jamaica, Mauritius, Sweden, Switzerland, Tanzania, Turkmenistan and Uruguay. IBFAN submitted alternative reports on the situation of infant and young child feeding in 10 of the reviewed countries (Colombia, Dominican Republic, Gambia, Iraq, Jamaica,  Sweden, Switzerland, Tanzania, Turkmenistan and Uruguay). The reports on Colombia, the Dominican Republic and Uruguay were prepared by the IBFAN groups in the countries.  Spanish summaries of the alternative reports were prepared in order to inform Spanish-speaking members of the Committee (Colombia, Dominican Republic, Gambia, Iraq, Jamaica,  Sweden, Switzerland, Tanzania, Turkmenistan and Uruguay).

In its Concluding Observations, the CRC Committee referred specifically to breastfeeding in 6 out of the 11 countries under review (Colombia, Dominican Republic, Gambia, Jamaica, Switzerland and Turkmenistan). Sweden, Iraq, Mauritius, Tanzania and Uruguay did not receive any direct recommendation on breastfeeding, but they received recommendations on other specific health issues that are indirectly connected to breastfeeding.

General measures of implementation

The Committee recommended that most countries under review (Gambia, Iraq, Jamaica, Mauritius, Switzerland, Tanzania, Turkmenistan and Uruguay) to take all necessary steps to collect disaggregated data that should cover all areas of the Convention.

Moreover, in light of the CRC General Comment No. 16 on Stateobligations regarding the impact of the business sector on children’s rights, the Committee urged Colombia, the Gambia, Switzerland and Tanzania to examine, adapt and clearly establish its legislative framework concerning legal accountability of business enterprises and their subsidiaries operating in or managed from the State party’s territory. The Committee specifically recommended Colombia and Tanzania to require companies to undertake assessments, consultations, and full public disclosure of the environmental, health-related and human rights impacts of their business activities and their plans to address such impacts. The Committee also requested the Gambia to establish monitoring mechanisms for the investigations and redress of violations of children’s rights.

Health resources and budget

The Committee called for the allocation of adequate resources for health services (Colombia, Gambia, Tanzania), and for the development and implementation of health-related policies and programmes (Gambia and Dominican Republic). The importance of creating a monitoring mechanism for the implementation of such policies was also stressed in the recommendations to Colombia and the Dominican Republic. Specific concerns over the low percentage of the federal budget devoted to the healthcare system were expressed by the Committee in its Concluding Observations related to Iraq. The Committee urged also Tanzania to allocate sufficient human resources to the health services, in order to provide trained care at delivery, improved care for newborns and during the neonatal period, and antenatal care and services for infants and preschool children at primary health centres.

In addition, the Committee recommended Colombia, Dominican Republic, Gambia and Tanzania to implement the OHCHR Technical guidance on the application of a human rights-based approach to the implementation of policies and programmes to reduce and eliminate preventable mortality and morbidity of children under 5 years of age (hereafter: OHCHR Technical guidance on child mortality), which includes specific recommendations on breastfeeding protection (including the implementation of the International Code) and promotion.

Preventive health

The importance of preventive health has been highlighted in several recommendations.

The Committee recommended Colombia, the Dominican Republic and Tanzania to increase their efforts to reduce neonatal, child and maternal mortality. In particular, Colombia and the Dominican Republic were urged to establish an independent mechanism for investigating cases of child and maternal mortality. The Gambia was specifically asked to improve access to maternal care services by increasing the availability and accessibility to emergency obstetric and neonatal care and skilled birth attendants, while Iraq was recommended to reduce maternal mortality through improving emergency obstetric care, trained delivery care at home and services at maternal and child health clinics with trained health care providers. In addition, Jamaica was recommended to keep strengthening efforts to ensure adequate provision of prenatal and post natal care, as well as to address the increase in maternal mortality.

Children’s access to health care was addressed in 7 countries out of 11 (Colombia, Gambia, Jamaica, Switzerland, Tanzania, Turkmenistan and Uruguay). In particular, Jamaica was urged to increase the number and coverage of health care professionals and Turkmenistan was recommended to ensure a sufficient number of family doctors nurses and midwifes and to ensure that all health-care personnel responsible for health care of children is well qualified and well trained. Furthermore, Switzerland was urged to ensure that children have access to quality paediatric hospital treatment and family paediatricians throughout the Swiss territory and Tanzania was recommended to establish more child and maternal health clinics, and access to safe and trained delivery services. Additionally, Iraq was recommended to allocate all necessary human, technical, and financial resources for interventions aimed at reducing preventable and other diseases among children, particularly diarrhoea, acute respiratory infections and under nutrition.

Nutrition and safe drinking water

The Committee asked the Dominican Republic, Gambia, Tanzania and Uruguay to increase efforts to eliminate child malnutrition, highlighting the problem of poor water quality leading to neonatal and maternal deaths in the Dominican Republic and asking Gambia and Tanzania to increase access to safe drinking water and sanitation. Jamaica was specifically urged to introduce targeted interventions to prevent the undernourishment of children, including the promotion of proper infant and young child feeding practices. Besides, obesity and overweight among children were highlighted for Jamaica and Switzerland as a main reason for promoting healthy eating habits among young children and adolescents. More generally, the Committee encouraged Mauritius to improve the nutritional status of infants, children and mothers.

HIV/AIDS

The Committee addressed the issue of mother-to-child HIV transmission by requesting Colombia to strengthen its efforts to implement the Strategic Plan to eliminate HIV/AIDS mother-to-child transmission.

The Dominican Republic was recommended to ensure the sustainability of the Programme on HIV/AIDS as well as the availability of universal antiretroviral treatment, and to increase the capacity for HIV/AIDS testing of pregnant women and children at the Community Health Centres. The Committee also asked Tanzania to improve follow-up treatment for HIV/AIDS-infected mothers and their infants to ensure early diagnosis and early initiation of treatment. Mauritius and Turkmenistan were both urged to develop a roadmap to ensure the implementation of effective preventive measures, as well as to improve access and coverage of antiretroviral therapy and prophylaxis for HIV-infected pregnant women.

Breastfeeding national strategy

In its recommendations to the Gambia, the Committee stressed the importance of implementing effectively the existing national nutrition policy and called for the creation of a National Breastfeeding Committee as well as for the systematic collection of data on breastfeeding practices.

Turkmenistan was also urged to ensure systematic data collection on infant and young child feeding practices while Switzerland was recommended to develop a comprehensive national strategy on infant and young children feeding practices.

Breastfeeding protection

The Committee urged Colombia, the Dominican Republic, Gambia, Switzerland and Turkmenistan to adequately implement the International Code on Marketing of Breast-Milk Substitutes and specifically asked Jamaica to regulate the marketing of breastmilk substitutes.

With regard to maternity protection, the Gambia was recommended to provide maternity leave to all working mothers, including domestic workers, and Switzerland was required to consider extending maternity leave to minimum six months. The Committee also called Turkmenistan for ensuring that working mothers have the practical possibility to breastfeed, including by developing breastfeeding-friendly workplaces and child care centres at work. More generally, the Dominican Republic was urged to strengthen its maternity protection.

Breastfeeding promotion

Out of 11 reviewed countries, 6 were recommended to strengthen efforts to promote breastfeeding. Specifically, Colombia, the Dominican Republic and Turkmenistan were encouraged to promote breastfeeding through educational campaigns, while Jamaica was recommended to provide information and training on breastfeeding to relevant officials, particularly staff working in maternity units, and parents. The Gambia was urged to promote exclusive breastfeeding up to the age of six months. Finally, Switzerland was recommended to strengthen 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.

Breastfeeding support

Regarding support to breastfeeding through the health care system, Colombia and the Dominican Republic were urged to adequately implement the Baby-Friendly Hospital Initiative (BFHI) while Switzerland was recommended to further increase the number of hospitals certified as baby-friendly.

With respect to training on breastfeeding, 4 countries out of 11 received direct recommendations. Such recommendations included: promote breastfeeding through the training of health professionals (Colombia and Jamaica); inclusion of breastfeeding in the training of nurses (Gambia); and review and strengthening of the training of health professionals on the importance of breastfeeding (Switzerland).

Switzerland was also recommended to ensure that national recommendations on breastfeeding comply with the relevant WHO recommendations.

	Country		IBFAN report	Summary of specific recommendations on IYCF
Session 68 – January 2015	1	Colombia (4th-5th periodic report)	yes	Indirect – General measures of implementation (§ 10, 18a-c): examine and adapt its legislative framework to ensure the legal accountability of business enterprises and their subsidiaries operating in or managed from the State party´s territory […] regarding violations of children rights; require companies to undertake assessments, consultations, and full public disclosure of the  […] health-related and human rights impacts of their business activities and their plans to address such impacts; establish monitoring mechanisms for the investigation and redress of such abuses, with a view to improving accountability, transparency and the prevention of violations. Health (§ 40a-c): ensure the availability and accessibility of health services for all children [...] by allocating adequate resources and monitoring the implementation of relevant policies; establish independent mechanisms for investigating cases of child and maternal mortality and ensure legal sanctions when this happens due to health personnel negligence; increase its efforts to reduce maternal and child mortality, including by implementing the OHCHR Technical guidance on the application of a human rights-based approach to the implementation of policies and programmes to reduce and eliminate preventable mortality and morbidity of children under 5 years of age. Direct (§ 40h): strengthen efforts to promote breastfeeding through educational campaigns and training to professionals, adequately implement the International Code of Marketing of Breast-Milk Substitutes and the Child-Friendly Hospital initiative.
	2	Dominican Republic (3rd-5th periodic report)	yes	Indirect (§ 50b,c,d): strengthen efforts to reduce neonatal, child and maternal mortality and, to that aim, take into account the OHCHR Technical guidance on the application of a human rights-based approach to the implementation of policies and programmes to reduce and eliminate preventable mortality and morbidity of children under 5 years of age (A/HRC/27/31); establish independent mechanisms for investigating cases of child and maternal mortality and apply legal sanctions when this happens due to health personnel negligence; increase efforts to eliminate child malnutrition. Direct (§ 50e): enhance efforts to promote breastfeeding through educational campaigns, adequately implement the Strategic Plan on Breastfeeding (2012-2016), the International Code of Marketing of Breastmilk Substitutes and the Child-Friendly Hospital initiative, and strengthen maternity protection.
	3	Gambia (2nd-3rd periodic report)	yes	Indirect (§ 61a,b,c,d,e): ensure that sufficient resources are allocated for the health sector and are used effectively; develop and implement comprehensive policies and programmes for improving the health situation of children and facilitating a greater and equal access to quality primary health services by mothers and children in all areas of the country; take all effective measures 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; improve access to maternal care services by improving health infrastructure and increasing the availability and accessibility to emergency obstetric and neonatal care and skilled birth attendants at lower- and district-level health facilities; strengthen efforts to address malnutrition and diseases of children, including by strengthening educational programmes, campaigns to inform parents about basic child health and nutrition, hygiene and environmental sanitation and reproductive health, and by providing sufficient drugs, including RDTs, malaria pneumonia and diarrheal rehydration drugs; strengthen its efforts to increase access to safe drinking water and sanitation. Direct (§ 65): 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. The Committee also recommends that the State party establish a National Breastfeeding Committee, systematically collect data on breastfeeding practices, ensure the enforcement of the International Code of Marketing of Breastmilk Substitutes, include breastfeeding in the training of nurses, and provide maternity leave to all working mothers, including domestic workers.
	4	Iraq (2nd-4th periodic report)	yes	Indirect – General measures of implementation (§ 7d): review the system of data collection with a view to incorporating all the areas covered by the Convention. Health (§ 61a-b): 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. A particular focus is needed on displaced communities, rural areas, and the central and southern regions; 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.
	5	Jamaica (3rd-4th periodic report)	yes	Indirect: continue to strengthen efforts to ensure adequate provision of prenatal and post natal care, as well as address the increase in maternal mortality;  increase the number and coverage of health care professionals to ensure access to children of quality health care services; combat obesity among children and intensify measures to raise awareness of healthy nutrition among parents, children and the public in general and promote healthy eating habits particularly among young children and adolescents (§ 45 a, b, f) Direct (§ 45 c, d, e): introduce targeted interventions to prevent the undernourishment of children, including the promotion of proper infant and young child feeding practices; take action to improve the practice of exclusive breastfeeding for the first six months, through awareness-raising measures, including campaigns, providing information and training to relevant officials, particularly staff working in maternity units, and parents; regulate the marketing of breast-milk substitutes;
	6	Mauritius (3rd-5th periodic report)	no	Indirect – General measures of implementation (§ 12): take measures for the National Child Protection Strategy and its Action Plan to cover all areas under the Convention [...] and that it effectively implement the National Human Rights Action Plan 2012-2020, and ensure monitoring of its implementation; expeditiously improve collection of updated data and their regular availability by the Statistics Office. Health (§ 52): take measures to improve the nutritional status of infants, children and mothers. HIV/AIDS (§ 56a-b): sustain the measures in place to prevent mother-to-child transmission of HIV/AIDS and develop a roadmap to ensure the implementation of effective preventive measures; improve follow-up treatment for HIV/AIDS-infected mothers and their infants to ensure early initiation of treatment, and improve access and coverage of antiretroviral therapy and prophylaxis for HIV-infected pregnant women.
	7	Sweden (5th periodic report)	yes	Indirect – Health (§ 41): strengthen its efforts to improve the health status of children from disadvantaged and marginalised groups and allocate sufficient financial, human and technical resources to ensure their right to health without discrimination.
	8	Switzerland (2nd-4th periodic report)	yes	Direct (§ 59): 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; review and strengthen training for health professionals on the importance of exclusive breastfeeding; further increase the number of hospitals certified as baby-friendly; develop a comprehensive national strategy on infant and young children feeding practices; ensure that the International Code of Marketing of Breast-milk Substitute is strictly enforced; ensure that national recommendations on breastfeeding comply with relevant WHO recommendations; and consider extending maternity leave to minimum six months.
	9	Tanzania, United Republic of (3rd-5th periodic report)	yes	Indirect – General measures of implementation (§ 10, 16, 22): ensure the effective implementation of the existing strategies addressing children’s issues, including the provision of sufficient human, technical, and financial resources; expeditiously improve its data collection system; the data should [...] be used for the formulation, monitoring and evaluation of laws, policies, and programmes; establish clear regulations and a nation-wide legislative framework, including through the adoption of agreements between private enterprises and the State party at the local level, requiring companies domiciled or operating in the State party to adopt measures to prevent and mitigate adverse child rights impact of their operations in the country; require companies to undertake child rights assessments, consultations, and full public disclosure of the environmental, health-related and child rights impacts of their business activities and their plans to address such impacts and promote the inclusion of child rights indicators and parameters for reporting. Health (§ 54): allocate sufficient financial and human resources to health services, in particular access to trained care at delivery, improved care for new-borns and during the neonatal period, antenatal care and services for infants and preschool children at primary health centres; establish more child and maternal health clinics and access to safe and trained delivery services [...] ensuring the availability of trained health workers, the necessary equipment and medical supplies; strengthen national strategies to address the critical nutritional needs of children; improve access to safe drinking water and adequate sanitation facilities; implement the OHCHR Technical guidance on the application of a human rights-based approach to the implementation of policies and programmes to reduce and eliminate preventable mortality and morbidity of children under 5 years of age. HIV/AIDS (§ 56a-b): strengthen efforts to prevent mother-to-child HIV transmission; improve follow-up treatment for HIV/AIDS-infected mothers and their infants to ensure early initiation of treatment.
	10	Turkmenistan (2nd-4th periodic report)	yes	Direct (§ 49): enhance its efforts to promote exclusive breastfeeding practices; enact legislation implementing all the provisions of the International Code of Marketing of Breast-Milk Substitutes; raise awareness about optimal breastfeeding practices among the population; ensure systematic collection of data on infant and young child feeding; and ensure that working mothers have the practical possibility to breastfeed, including by developing breastfeeding-friendly workplaces and child care centres at work.
	11	Uruguay (3rd-5th periodic report)	yes	Indirect – General measures of implementation (§ 10, 16): take into account the results of the evaluation of its Plan of action (2010-2015) in the elaboration of the new plan (2015-2020). The Committee also recommends that the State party ensure that sufficient human, technical and financial resources are allocated for the implementation, monitoring and evaluation of the ENIA and its plan of action; expeditiously establish a comprehensive data collection system; the data should cover all areas of the Convention and should be disaggregated [...], shared among the ministries concerned and used for the formulation, monitoring and evaluation of policies, programmes and projects for the effective implementation of the Convention. Health (§ 46): strengthen its efforts to ensure access to quality health services by all children, particularly children living in the most disadvantaged and remote areas of the country, and encourages the State party to develop policies and programmes to address chronic malnutrition and anaemia.