Honduras at the CRC: Lack of Funding for the Implementation of National Policies and Insufficient Maternity Leave

On May 20 and 21, 2015, the Committee on the Rights of the Child considered the combined fourth and fifth periodic report of Honduras on the situation of the implementation of the Convention on the Rights of the Child in the country.

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

General overview of breastfeeding in Honduras

IBFAN pointed out the decline in the rate of early initiation of breastfeeding within one hour after birth between 2005-2006 (79%) and 2011-2012 (64%) which appears to be even higher in rural areas (70% in 2011-2012) according to the survey ENDESA 2011 - 2012. IBFAN also noted with great concern that the rate of early initiation of breastfeeding is lower among children born with delivery assistance by health professionals. In addition, in 2011-212 almost 7 children out of 10 were not exclusively breastfed until 6 months of age, while half of them were bottle-fed. 

IBFAN further highlighted the absence of funding allocated to the implementation of national policies and plans on breastfeeding and infant nutrition by the National Breastfeeding Committee (CONALMA). For example, due to the lack of funding, all the activities designed in the National Breastfeeding and Complementary Feeding Plan 2009-2013 could not be implemented. As a result of such poor funding of national policies and plans, there is a deficiency in the training of health professionals on optimal breastfeeding practices which leads to a lack of skilled counseling on infant and young child feeding. 

Only few provisions of the International Code of Marketing of Breastmilk Substitutes are implemented and there is a lack of knowledge on the Code among health personnel resulting regular Code violations. 

Regarding maternity protection, the report stressed that the maternity leave (12 weeks, of which 6 weeks after delivery) does not allow mothers to breastfeed exclusively for 6 months. There is no paternity leave entitlement and many workplaces are lacking nursing areas and childcare facilities. Finally, IBFAN emphasized the absence of any preparedness plan to ensure the protection and support of breastfeeding in emergencies. 

Discussion on infant and young child feeding

The discussion between the Committee and the delegation has been very much focused on the issue of the violence against children and the condition of by migrant children. The issue of the prohibition of abortion has also been raised by several members of the Committee 

However, the Committee raised concerns about the high rates of teenage pregnancies in the country, and asked what is done to prevent them. It also emphasized the high rates of malnutrition in the country. More specifically, the Committee asked the delegation about the measures taken to protect and promote breastfeeding.

Regarding adolescent pregnancies, the delegation explained the First Lady recently launched a prevention campaign and that a multisectoral approach is followed by the government. For example, there are clinics specifically aimed at adolescents, where they can go without their parents. The delegation also specified that no women who require treatment are turned away even in the case they have had an abortion. The delegation stressed that since 2010, a guidance on how to teach sexual education to adolescent is in place, but it admitted that the government needs to step up its efforts in this area.

Regarding breastfeeding, the delegation mentioned the 2013 law on breastfeeding protection, promotion and support and specifically referred to the articles 10 (on the constitution of the CONALMA), and 19 to 31 (on the regulation of the marketing of breastmilk substitutes).

Concluding observations

In its Concluding Observations, the Committee made several indirect recommendations to Honduras in relation with infant and young child feeding. However, it did not refer specifically to breastfeeding.

The Committee first urged Honduras to provide the adequate resources for the effective functioning of data collecting systems, by including disaggregated data and high quality and timely information (§16a-c).

After welcoming the decline of infant and under-5 mortality and the adoption of the Breastfeeding Law, the Committee expressed its concerns on the “delay of adopting a primary health-care strategy and the limitations imposed on the Expanded Programme of Immunization” (§60). In this regard, the Committee recommended Honduras to adopt of a primary-health care strategy (§61a) and the adequate allocation of human, technical and financial resources to the immunization programme (§61b). The Committee also stressed the need to improve the coverage and the quality of health services, particularly in rural and indigenous areas (§61c). Regarding HIV/AIDS, the Committee highlighted the importance sustain measures to prevent mother-to-child transmission (§67b) and to improve the follow-up treatment for infected mothers and their children (§67c).

Lastly, regarding nutrition, the Committee highlighted the high level of chronic malnutrition, which affects twice as many children in rural as in urban areas (§68) and thus recommended the State party to strengthen its efforts to reduce the rated of chronic malnutrition (§69c).

Netherlands at the CRC: Inadequate Official Information on Breastfeeding and Absence of a National Programme

On May 27th, 2015, the Committee on the Rights of the Child considered the fourth periodic report of Netherlands on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Netherlands was led by Mrs. Angelique Berg, Director General for Public Health, Ministry of Health, Welfare and Sports (Netherlands), H.E. Mrs. R. Bourne-Gumbs, Minister of Education, Culture, Youth and Sports (Sint Maarten), H.E. Mrs. Rutmilda Larmonie Cecilia, Minister of Social Development, Labor and Welfare (Curaçao) and H.E. Mr. Pauldrick F.T. Croes, Minister of Social Affairs, Youth and Labor (Aruba).

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

General overview of breastfeeding in Netherlands

Generally, there is a lack of regular and systematic collection of data on infant and young child feeding practices in the country and the few data available do not monitor the official WHO/UNICEF indicators (e.g. the rate of early initiation of breastfeeding within one hour after birth is not monitored). Data reveal that some 20% of the newborns received infant formulae within 24 hours after birth, due to a lack of adequate guidance provided by birth attendants. Besides, the country does not organize specific capacity building courses on HIV/AIDS and infant feeding aimed at health professionals.

It is of concern that despite the WHO recommendation to introduce complementary foods from 6 months onwards, official institutions such as the Netherlands Nutrition Centre and the Dutch Youth Health Centre advice to introduce complementary foods at 4 months. Besides, there is currently no Breastfeeding Masterplan in place and the National Prevention Plan does not include breastfeeding. The monitoring role of the National Breastfeeding Council should also be clarified.

In addition, no breastfeeding promotion campaign is being conducted in the country and the International Code of Marketing of Breastmilk Substitutes is not fully implemented while one third of hospitals and maternities are not certified as “baby-friendly”.

The duration of paternity leave duration (2 days plus 3 unpaid) is also too short to ensure that fathers are able to support mothers in establishing exclusive breastfeeding. Finally, there are no specific guidelines or policies regarding breastfeeding support or protection in case of emergency.

Discussion on infant and young child feeding

Responding to the State report, the Committee expressed concern about the mention of breastfeeding being “women’s own choice” which seems to leave new mothers alone with the decision of breastfeeding their baby rather than providing them with adequate information and support in this regard.

The Committee also expressed concerned about the Dutch official recommendations to introduce complementary feeding at 4 months rather than at 6 months as recommended by the World Health Organization. It also pointed out the lack of implementation of theInternational Code of Marketing of Breastmilk Substitutes. It specifically asked for further explanations on the measures taken bto prevent undue marketing of breastmilk substitutes and to ensure exclusive breastfeeding until 6 months of age. The Committee also asked questions on the measures to address the epidemic of obesity in the country.

The delegation affirmed that in Netherlands, misleading marketing is prohibited by the Commodities Act. It also highlighted that some 80% of mothers start breastfeeding right after the birth, while 47% still breastfeed after 3 months and 38% exclusive breastfeed until 6 months. Regarding breastfeeding promotion, the government indicated that it provides mothers with full information on the importance of breastfeeding through the Netherlands Nutrition Centre.

The representative of Sint Maarten underlined that obesity constitutes a huge challenge in the island. Therefore, programmes are implemented in collaboration with the Ministry of Health and Education to promote physical education, weight monitoring and a healthy eating in public schools. In relation with breastfeeding, the delegation declared that promotion of optimal breastfeeding practices such as exclusive and continued breastfeeding is done through the dissemination of information brochures among mothers.

In addition, the delegation stated that in Aruba there is currently a national plan to protect and promote breastfeeding as well as the implementation of Baby-Friendly Hospital Initiative. The mission of the Pro Lechi Mama Aruba Foundation, created in 2002, is to empower women to breastfeed through educational activities and practical support. It also provides information on breastfeeding to health care providers. According to the delegation, these measures have positively influenced breastfeeding rates in the island (e.g. the rate of exclusive breastfeeding raised from 3.1% in 2002 to 13.4% in 2010).

Finally the delegation of Curacao explained that there is also a foundation in charge for promoting optimal breastfeeding practices on the island and that breastfeeding is promoted within free baby well clinics in which children are followed up until 5 years of age. The Curacao delegation added that mothers are allowed to breastfeed at their workplace and that incarcerated women are allowed to keep their child with them until they reach the age of 6 months.

Concluding observations

In its Concluding Observations, the Committee did not specifically address breastfeeding, but it made recommendations indirectly related to infant and young child feeding.

The Committee first noted the lack of a central system that regularly collects data; therefore, it recommended Netherlands to improve its data collection system, including qualitative and quantitative indicators in all areas of the Convention (§16-17). 

The Committee also made recommendations on the importance of respecting child rights in relation to the business sector, highlighting the importance of establishing and implementing regulations to ensure the compliance of the business sector with international and human rights, particularly with regard to children rights (§23). Thus, referring to its General Comment No 16 (2013) on State obligations regarding the impact of the business sector on children’s rights, the Committee recommended Netherlands to establish a clear and regulatory framework for the industries to ensure that their activities do not affect negatively children rights (§23a), ensure the effective monitoring of implementation of international and environmental and health standards and implement an appropriate sanctioning system and remedy mechanism (§23b). 

Regarding health, the Committee expressed concerns about the high rates of infant mortality (§42a) and the limited access to health care services for children with low economic or social status (§42c). Consequently, the Committee urged Netherlands to take measures to prevent infant mortality by providing effective and quality neonatal and other care services for infants in the whole country (§43a) and to ensure that all children have free access to basic health care services (§43c-d). 

Lastly, with regard to nutrition, the Committee noted the significant numbers of child obesity and overweight (§42b) and therefore recommended Netherlands to “provide access to nutrition education and sufficiently nutritious food to all children in the State party in order to promote healthy eating habits” (§43b).

Mexico at the CRC: Steep Decline of Breastfeeding Practices

On May 19 and 20, 2015, the Committee on the Rights of the Child considered the combined fourth and fifth periodic report of Mexico on the situation of the implementation of the Convention on the Rights of the Child in the country. 

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

General overview of breastfeeding in Mexico

In its alternative report, IBFAN insisted on the high rates of child overweight and obesity as well as on the lack of drinking water and the widespread sale of soft drinks in schools. In 2006, child obesity rose to 36.9% while deaths caused by diabetes progressively increased. 

The report also emphasized the high infant mortality rate (7 per 1, 000 live births for 2012-2013) that even reaches 23.89 per 1,000 live births in remote regions like Chiapas. 

In such a context, it is of concern that breastfeeding rates are low. The 2012 National Health and Nutrition Survey showed that the median duration of breastfeeding was of 10 months only. It also reveals a steep decline of exclusive breastfeeding rates between 2006 and 2012. Regarding the enforcement of the International Code of Marketing of Breastmilk Substitutes, IBFAN report flagged the lack of monitoring and sanctioning mechanism, leading to Code violations within the National Health System. 

IBFAN also denounced the adverse impacts of national nutrition programmes. For example, the programme “Prospera”, Mexico’s largest programme of food assistance, includes distribution of a ready-to-use food supplement, contravening the international recommendations on infant and young child feeding. The Programme Cruzada Contra el Hambre is led in partnership with corporations that violate the International Code and the distribution of Tarjetas Sin Hambre allows poor families to access to a list of 15 subsidized products that includes unhealthy foods such as instant sugar-added coffee (Nescafé Dolca), instant oat cereal Powder milk (Nestlé’s Nido and others) and instant chocolate powder.

IBFAN also noted the Mexico did not ratify the ILO Convention 183 (2000) on Maternity Protection and needs to extend maternity protection to the growing number of women working in the informal sector. 

Finally, IBFAN stressed the need to adopt and implement the Operational Guidance on Infant and Young Child Feeding in Emergencies in order to protect breastfeeding during disasters.

Discussion on infant and young child feeding

The CRC Committee expressed concerns about the high rate of child mortality in indigenous areas. It also raised the issues of child obesity and teenage pregnancies. 

More specifically, the CRC Committee noted the decline of breastfeeding rates and the fact that many mothers receive promotional gifts from baby food companies within hospitals and maternities. It highlighted the lack of enforcement of regulations related to the marketing of breastmilk substitutes and asked which actions are by the government in this regard

The Mexican delegation answered that the mortality rate is currently following a downward trend in Mexico, and that many policies and programmes have been implemented in this regard. The government also mentioned their programmes “Prospera” and “Cruzada Contra el Hambre”, noting that they cover large portions of indigenous regions. For example, some 25% of the beneficiaries of the Prospera programme are from indigenous communities. In addition, the delegation noted that more than 700,000 families have beneficied of the programme “Tarjetas Sin Hambre”. 

In relation with infant and young child feeding, the delegation responded that as part of a national strategy for breastfeeding a new programme on breastfeeding promotion has been launched. It also affirmed that the Ten Steps to Successful Breastfeeding of the Baby-Friendly Initiative are being implemented throughout the country and that several human milk banks have been set up. 

Regarding obesity, the delegation mentioned the national comprehensive strategy for tackling overweight and obesity, which is based on 3 pillars: 1) taxes 2) legal reform and 3) promotion of physical activity. Likewise, a special tax on sugary drink has been implemented as part of this strategy. In relation with the legal reform, the delegation mentioned the integration of a constitutional article prohibiting the sale of sugary drinks in schools, as well as federal legal provisions limiting the advertisement of unhealthy foods on TV during programmes aimed at children and in cinemas. It affirmed that the government carries out awareness-raising activities such as campaigns to measuring waist and promote physical activity and it made reference to the national council on NCDs. The delegation also mentioned the implementation of water fountain in every school as part of the legal undertaken.

Finally, regarding maternal mortality, the delegation noted that several campaigns aiming at tackling teenage pregnancies have been launched. As a result, a drop of 15% of such pregnancies is expected. It also affirmed that teenage mothers are allowed to deliver in any health service of the country.

Concluding observations 

In its Concluding Observations, the Committee issued both indirect and direct recommendations related to infant and young child feeding to Mexico. 

Addressing specifically infant and young child feeding, the Committee expressed concerns the decline of exclusive breastfeeding (§47d) and recommended Mexico to strengthen the efforts to “promote breastfeeding through educational campaigns and training to professionals” and “adequately implement the International Code of Marketing of Breast-Milk Substitutes and the Child-Friendly Hospital Initiative”(§48d).

Highlighting the persistent child chronic malnutrition in rural and indigenous areas (§47c) and the increasing of overweight and obesity among children (§47e), the Committee also recommended Mexico to draft a national strategy on nutrition that would ensure food security, especially in rural and indigenous areas (§48c), as well as to continue raising awareness on the impact of processed food including and strengthen the regulations restricting the advertising and marketing of junk, salty, sugary and fatty foods and their availability for children (§48e).

Regarding, health services, the Committee stressed the need to ensure the availability and accessibility of quality health services, in particular rural and indigenous children, including by allocation adequate resources (§48a). 

The Committee also expressed concerns over the high child and maternal mortality rates (§47b), recommending the State party to strengthen and reduce maternal and child mortality, including by implementing the OHCHR Technical Guidance on child mortality (A/HRC/27/31).

Finally, regarding environmental health, the Committee expressed concern about the insufficient measures taken by Mexico to address air, water, soil and electromagnetic pollution, which gravely impact on children and maternal health. It thus recommended the State party to assess theses impacts on children and maternal health as a basis to design a well-resourced strategy to remedy the situation, prohibit the import and use of pesticides or chemicals that are banned or restricted for use in exporting countries and examine and adapt its legislative framework to ensure the legal accountability of business enterprises involved in activities having a negative impact on the environment in the light of its General Comment No 16 (2013) on State obligations regarding the impact of the business sector on children’s rights (§51-52a-c).

[Note: Click here to access to a discussion paper prepared by IBFAN Mexico which provides an interpretation of what should be an "adequate" implementation of the International Code of Marketing of Breast-milk Substitutes.]

Ghana at the CRC: Concerns about the Decline of Exclusive Breastfeeding and the High Rate of Neotoal Mortality

On May 21 and 22, 2015, the Committee on the Rights of the Child considered the combined third to fifth periodic report of Ghana on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Ghana was led by Hon.Nana Oye Lithur, Minister of Gender, Children and Social Protection, and Ms. Laadi Ayamba, Chair person, Parliamentary Select Committee.

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

General overview of breastfeeding in Ghana

IBFAN report highlighted the declining trend in breastfeeding rates, particularly the exclusive breastfeeding rate under 6 months (63% in 2008 to 45.7% in 2011) and early initiation of breastfeeding (52% in 2008 to 45.9% in 2011). This situation is closely connected with the inadequate funding to implement the policies and actions plans on Child Health and Nutrition.

In Ghana, the InternationalCode of Marketing of Breastmilk Substitutes is fully implemented through the BreastfeedingPromotion Regulation 2000 (BPR 2000). However, the Committee in charge of monitoring its implementation was found inactive due to the lack of commitment from the Food and Drugs Authority which results in systematic violations.

In  addition, despite the pre- and in-service training programs aimed at health workers and courses provided by the Ghana Health Service with the support of UNICEF, WHO and other partners, the need for more trained counsellors in health facilities was underlined.

The report finally flagged the short duration of the maternity leave which does not cover women working in the informal sector. Finally, the lack of emergency preparedness plan with specific guidelines to ensure protection and support of breastfeeding in emergencies was pointed out.

Discussion on infant and young child feeding

During its discussion with Ghana, the CRC Committee addressed specifically the issue of breastfeeding. It expressed concerned about the high neonatal mortality rate and the decline of exclusive breastfeeding due to the insufficient monitoring on the implementation of the BPR 2000 and the subsequent violations of the International Code. It asked which measures will be taken to this particular issue and asked for more information on breastfeeding promotion to mothers as well as on the implementation of an adequate monitoring and sanction mechanism to enforce the BPR 2000.

First of all, the delegation admitted the lack of financial resources allocated to health. Regarding neonatal mortality, the delegation stated that a new Sub-Committee composed of government representatives, medical staff, technicians and community health workers has been established in 2012. It aims to design and launch a national action plan for the period 2014 to 2018.   In addition, a national meeting on neonatal mortality will be held in July 2015, bringing together all relevant partners at national level, including community health workers.

In relation to the persistent high maternal mortality rates, the delegation highlighted the implementation of a policy on free antenatal and delivery care for all women. As a result, the latest demographical and health survey showed that 97% of pregnant women receive antenatal care and 74% of births are attended by a skilled health professional. Besides, specific trainings are delivered so that midwives are enabled to deliver services at community level, especially in the most remote areas, and physicians as well as technicians are enabled to deal with perinatal conditions such as post-partum hemorrhage. The government recently started a pilot project to provide women delivering at home (30% of pregnant women), a tablet of misoprostol to prevent hemorrhages. The delegation also explained that pregnant teenage girls are granted with free access to antenatal care, although they still sometimes face discrimination on the ground.

Besides, the delegation admitted that the rate of exclusive breastfeeding under 6 months declined between 2008 and 2011. To remedy this situation, the government took measure to increase awareness of health workers through specific trainings. The government also stressed its commitment to strengthen the implementation of the Baby-Friendly Hospital Initiative as well as to enforce the BPR 2000, resulting in the slow rise of the rate of exclusive breastfeeding.

Finally, the delegation declared that misleading advertisements have been reduced since the entering into force of the BPR 200. However, it admitted that baby food manufacturers are still trying to influence health professionals through sponsorship of seminars and conferences.

Concluding observations

In its Concluding Observations, the Committee referred directly and indirectly to infant and young child feeding. 

The Committee first recommended Ghana to improve its data collection system (§16). Then, referring to its General Comment No 16 (2013) on State obligations regarding the impact of the business sector on children’s rights, the Committee urged the State party to establish clear regulations and a nation-wide legislative framework requiring companies operating in the State party to adopt measures to prevent and mitigate their adverse child impact of their operations in the country (§20a) and 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 (§20b).

Regarding health, the Committee expressed concerns about the insufficient funding allocated to health, the low number of qualified and experienced health provider staff as well as an inequitable provision of health services (§49 a-b). Therefore, it called for the allocation of sufficient financial and human resources, particularly to child health and nutrition, providing effecting access to trained and qualified health care (§50a). 

The Committee also highlighted the continuous high maternal and neonatal mortality rates in the State (§49f), stressing AIDS as one of the causes of child mortality (§53c). Thus, it recommended Ghana to reduce mortality rates by improving parental care (§50c) and by providing access to antiretroviral therapy and followed-up treatment for HIV/AIDS infected mothers and their children (§54b, d). It also urged the State party to finalize the National Newborn Strategy and Action Plan (§50b), to improve prenatal care, to prevent communicable diseases (§50c), to implement the OHCHR Technical guidance on child mortality (A/HRC/27/31) (§50h) and to expedite the approval of the National Nutritional policy (§50f). 

Regarding breastfeeding, the Committee expressed specific concerns about the decline of breastfeeding rates between 2008 and 2011 and the inadequate monitoring of the BPR 2000 (§49d). It thus recommended Ghana to “continue the promotion of exclusive breastfeeding for six months with appropriate introduction of infant and diet thereafter, aimed at reducing neonatal as under-five mortality” (§50d) and strengthen the monitoring of implementation of the BPR by implementing a deterrent sanctioning system and ensuring that the Food and Drug Authority is committed to enforce the BPR (§50e).

Ethiopia at the CRC: Very Low Rate of Skilled Attendance at Birth Compromises Neonatal and Maternal Health as well as Early Initiation of Breastfeeding

On May 22th, 2015, the Committee on the Rights of the Child considered the combined third to fifth periodic report of Ethiopia on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Ethiopia was led by H.E. Mrs. Zenebu Tadesse Woldetsadik, Head of delegation and Ministry of the Minister of Women, Children and Youth Affairs and H.E.Mr. Almaw Mengist Ambaye, State Minister of the Ministry of the Women, Children and Youth Affairs.   

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

General overview of breastfeeding in Ethiopia

Ethiopia presents high maternal and infant mortality rates and very low rates of skilled attendance at birth (10%). In such a context, IBFAN is particularly concerned about the low rates of exclusive breastfeeding within one hour after birth (51%). In addition, data show that exclusive breastfeeding is interrupted much too early (median duration of exclusive breastfeeding: 2.3 months).

IBFAN is also worried by the lack of systematic monitoring of breastfeeding indicators and the absence of information available on the results of the national policies and strategies related to infant and young child feeding, such as the National Nutrition Programme2013-2015 and the National Strategy for Child Survival.

In Ethiopia, only few provisions of the International Code of Marketing of Breastmilk Substitutes have been implemented and there is no information available on the National Breastfeeding Committee and on its activities. Besides, the Baby-Friendly Hospital Initiative is poorly implemented throughout the country, while the maternity leave is too short to enable working mothers to breastfeed exclusively up to 6 months. In addition, nursing mothers are not entitled to breastfeeding breaks.

 Finally, it is of concern that the 2013 Policy and Strategy on Disaster Risk Management does include measures to protect and support breastfeeding in emergencies, despite the fact that this topic is addressed in the 2004 National Nutrition Strategy for Infant and Young Child Feeding.

Discussion on infant and young child feeding

The CRC Committee highlighted that the breastfeeding rates are low in the country and pointed out the short median duration of breastfeeding. In addition, the Committee expressed concern about the partial implementation of the International Code and the lack of medical assistance during childbirth.

The Ethiopian delegation stated that the reduction of child mortality it is a top priority for the government and that new programmes focused on newborn health have been recently developed. The delegation also affirmed that increased financial support has been allocated to child health and that 30,000 health care workers have received specific training on newborn care.

In relation to nutrition, the delegation explained that the National Malnutrion Task Force is working in collaboration with the Breastfeeding Committee to coordinate all measures related to the 2004 National Nutrition Strategy for Infant and Young Child Feeding. The measures taken have led a reduction of the rates of stunting, underweight and child mortality under 5 years.

Regarding breastfeeding, the delegation highlighted that 52% of infants are exclusively breastfed until 6 months of age, while 98% are ever breastfed. The delegation explained that there are cultural beliefs that compromise the practice of exclusive breastfeeding (e.g. the belief that infants need to receive water). Therefore, the government implemented campaigns and activities to promote breastfeeding among mothers. Finally, the delegation noted that information on the International Code is delivered to health professionals during their pre- and in-service training.

Concluding observations

In its Concluding Observations, the Committee referred indirectly and directly to infant and young child feeding. 

After having welcomed the reduction of maternal, infant and under-five mortality rates, and the extension of immunization coverage and breastfeeding, the Committee expressed concerns about the very low per capita spending on basic health. It also deeply regretted the persistence of regional disparities in the provision of health services, and that malnutrition, infant, under-five and maternal mortality rates remain high (§55). Therefore, the Committee recommended Ethiopia to increase the annual expenditure per capita on health and eliminate disparities in the provision of health services as well as prenatal and postnatal care and immunization coverage (§56a). Moreover, Ethiopia was urged to implement the OHCHR Technical Guidance on child mortality (A/HRC/27/31), paying particular attention to rural and remote areas (§56b). Finally the Committee stressed the need to develop and implement policies to improve health infrastructures, and intensify training programmes for all health professionals, including the pastoralist health extension workers (§56d). 

With regard to the HIV/AIDS pandemic, the Committee urged Ethiopia to consider taking measures in order to eliminate geographical disparities regarding HIV and access to treatment, by enhancing free access to neonatal care and prevention of mother-to-child transmission (§58a). It also called for the improvement of the access to quality, age-appropriate HIV/AIDS, sexual and reproductive health services (§58d).

The Committee also made direct reference to breastfeeding, calling on Ethiopia to effectively address malnutrition in terms of stunting, wasting and low weight, particularly in rural and remote areas and develop public awareness programmes on food diversity consumption of nutritious food and on the benefits of breastfeeding in collaboration with the WHO and the UNICEF (§56c).