Tuesday, 29 September 2015

Timor-Leste at the CRC: Low Coverage of Skilled Attendance at Birth and High Prevalence of Acute Malnutrition

On September 25, the Committee on the Rights of the Child considered the combined 2nd to 3rd periodic report of Timor-Leste 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 Timor-Leste.

General overview of breastfeeding in Timor-Leste

Timor-Leste is characterized by high rates of child stunting (50%), underweight (about 38%) and moderate or severe malnutrition (about 11%), associated with low delivery care coverage and evidences of inappropriate feeding practices. Almost 30% of babies are born without the assistance of a skilled attendant, while only 22% of mothers give birth at health facilities. Additionally, the median duration of breastfeeding had decreased from 17.7 months in 2003 to 17.5 months in 2009/10 and less than 20% of children aged 6-23 months receive timely and appropriate complementary feeding.

IBFAN further noted the absence of a National Breastfeeding Committee and the lack of national guidelines for Infant and Young Child Feeding (IYCF). Breastfeeding indicators are not regularly and systematically monitored and the new legislation implementing the International Code of Marketing of Breast-milk Substitutes (hereafter: the Code) has not yet been endorsed by the Ministry of Health and is thus not enforced.  

The lack of appropriate pre- and in-service training programmes on infant and young child feeding is also of concern, as well as the lack of standards and guidelines for mother-friendly childbirth.

The report also flagged the low number of hospitals that are certified as “Baby Friendly” (2 out of 6 hospitals, i.e. 33.3%).

IBFAN further stressed the insufficient duration of the maternity leave (12 weeks) and the absence of legal provision allocating breastfeeding breaks. Finally, it noted that no specific programmes on IYCF and HIV/AIDS have been developed.

Discussion on infant and young child feeding

In its preliminary statement, the delegation began by mentioning the implementation of the integrated community health services through the SISCa programme. The programme is implemented in 13 districts, 65 Sub-Districts, and 442 villages. The delegation also mentioned the health promotion programmes aimed at pregnant women and granting them prenatal care and counseling. Finally, the delegation underlined the launch of the National Commission on Child rights in 2014, which is mandated to promote, defend and monitor children’s enjoyment of their rights.

The CRC Committee highlighted the most important problems in the country, such as the high rates of poverty, hunger, child malnutrition, stunting and wasting as well as the huge differences between rural and urban areas in terms of enjoyment of equal services and possibilities. It noted with concern the inconsistent data collection, as ministers do not use similar indicators, and the lack of regulation to control business sector activities that could affect children and their families. More specifically, the Committee noted that about 7 out of 10 children are not breastfeed until 2 years of age and asked what is done to encourage mothers to breastfeed. It also pointed out the insufficient duration of the maternity leave as well as the absence of provision allowing working women to take breastfeeding breaks.

The delegation of Timor-Leste recognized that malnutrition constitutes a major challenge for the country. Consequently, some programmes and measures have been put in place to remedy the situation, such as the promotion of appropriate infant feeding practices (exclusive breastfeeding under 6 months, adequate introduction of complementary food for children between 6-23 months, continued breastfeeding until 2 years or beyond, appropriate feeding for infants born from HIV-infected mothers). Regarding maternity protection, the delegation explained that working women are entitled to 90 days of maternity leave and once they return to their workplace, they are allowed to take 3 hours per day to breastfeed.

In its follow-up questions, the Committee emphasized breastfeeding as being the best nutrition for infants and asked whether the Ministry of Health was planning to ratify the law implementing the International Code of Marketing of Breastmilk Substitutes. The Committee also stressed the low number of hospitals certified as “Baby-Friendly” and asked how many hospitals have currently complied with the Ten Steps to Successful Breastfeeding.

The delegation referred to the 2013 Demographic Health Survey whereby the following results were established: early initiation of breastfeeding=93%, exclusive breastfeeding at 3 months=63%, breastfeeding between 12-15 months=75% and  continued breastfeeding 20-23 months=39%. Moreover, the delegation explained that 5 hospitals and 65 different health centers were complying with the Baby-Friendly Hospital Initiative.  The delegation added that the Prime Minister decided until November 28, 2016, all families should be visited by healthcare professionals. A programme of medical training has been set up in partnership with the Cuban government in order to increase the number of doctors. In the future, each of the 200 villages should be attributed 1 doctor and 2 nurses.

Concluding Observations

The Concluding Observations have not yet been released. This article will be updated following their publication.