Thursday, 15 October 2015

Recommendations related to breastfeeding by the 70th Committee on the Rights of the Child

The 70th Session of the Committee on the Rights of the Child (CRC Committee) took place in Geneva from September 14 to October 2, 2015. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 7 countries: Bangladesh, Brazil, Chile, Kazakhstan, Poland, Timor-Leste and United Arab Emirates. IBFAN submitted alternative reports on the situation of infant and young child feeding in 3 of the reviewed countries (Bangladesh, Brazil and Timor-Leste). All reports were prepared by the IBFAN groups in the countries. Spanish and French summaries of the alternative reports were prepared in order to inform Spanish- and French-speaking members of the Committee (see http://ibfan.org/reports-on-the-un-committee-on-the-rights-of-the-child).
In its Concluding Observations, the CRC Committee referred specifically to breastfeeding for 3 of the 7 countries under review (Brazil, Timor-Leste and United Arab Emirates). Bangladesh did not receive direct recommendation on breastfeeding, but was urged to implement the Technical Guidance on child mortality (A/HRC/27/31) which refers directly to breastfeeding and calls specifically for implementation and monitoring of the International Code of Marketing of Breastmilk Substitutes.
General measures of implementation
The Committee has put an emphasis on the improvement of the data collection mechanism in Bangladesh, particularly the implementation of the project to collect data in the nine districts. However, it remains concerned about the lack of disaggregated data. Likewise, the CRC Committee noticed in Brazil the insufficient data on health as well as children in street situations, children with disabilities and indigenous children. Regarding Timor-Leste, the Committee noticed that no national central database on children has been developed. Therefore, it stressed the importance of collecting disaggregated data for effective evaluation of the implementation of the Convention and the analysis on the situation of all children. Finally, it recommended the three states to collect disaggregated data that should cover all areas of the Convention and share it among the ministries.
Then, the Committee addressed the issue of the impact of the business sector on children’s rights, expressing concern about the activities of the mining and construction sector in Brazil, as well as agribusiness, food corporations, contamination of water resources and food, unhealthy diet due to misleading advertisement and environmental contamination. The lack of regulatory framework for social and environmental responsibility of business corporations and industries was an issue also raised by the Committee. In light of the CRC General Comment No. 16 on State obligations regarding the impact of the business sector on children’s rights, the Committee urged Brazil to establish a regulatory framework for the impact of the business sector on children’s rights in order to ensure effective implementation by companies of international and national environment and health standards and appropriate sanctions or remedies when violations occur. It also asked Brazil 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.
Regarding environmental health, the Committee expressed concerns about the negative effects of polluted air, water and soil in Brazil, as well as food contamination on children’s health, in particular the excessive use of agrochemicals, the contamination of water resources and the decrease availability of drinking water and its deterioration in quality. Thus, the state party was urged to ensure that existing laws and regulations concerning the use of agrochemicals are enforced, improve water supply infrastructure and access to safe drinking water, end illegal mining activities and conduct a comprehensive assessment of the effects of polluted air, water and soil on children’s health.
Additionally, United Arab Emirates was recommended to assess the negative consequences of oil consumption on children’s rights and address the situation with adequate measures to reduce air pollution and lead poisoning.
Health resources and budget
The Committee called for strengthening of resources allocated to health by urging Bangladesh to substantially increase budget allocations to all social sectors, particularly on health services in all regions and upazilas to eliminate regional disparities in the provision of health services.
The Committee urged Brazil to conduct a comprehensive assessment of the budget needs of children, addressing disparities through the application of indicators related to social sectors as well as the allocation of adequate human, technical and financial resources to the Indigenous National Supervision System (SISVAN) in order to ensure that children affected by malnutrition receive adequate food and safe drinking water. It also highlighted the need to define specific budgetary lines for children living in marginalized urban areas, including favelas and rural areas in the North and Northeast of the state.
Concerning Timor-Leste, the Committee recommended the state to ensure adequate financial and human resources, in particular with respect to the provision of neonatal, prenatal and post natal care, especially in rural areas. It also urged the state party to establish a budgeting process, which includes child rights perspective and specifies clear allocations to children in the relevant sectors, in order to address the lack of data on the proportion of budgetary allocations for the implementation of children’s rights as well as a mechanism to monitor and evaluate the adequacy and equitability of the distribution of resources allocated to the implementation of the Convention.
Preventive health
The importance of preventive health has been highlighted in several recommendations.
In its recommendations to Bangladesh, the Committee explained the need to implement the OHCHR Technical guidance on child mortality (A/HRC/27/31), which includes specific recommendations on breastfeeding protection (including the implementation of the International Code of Breastmilk Substitutes) and promotion. Likewise, it recommended the state party to develop and implement policies to improve health infrastructure and intensify training programmes for all health professionals, in order to address the issue of regional disparities in the provision of health services and the low percentage of women delivering with a support of skilled attendant.
Brazil has been urged by the Committee to increase investment in existing programmes aimed at improving the reach and quality of health services with a view to ensuring access to quality health services for indigenous children, Afro-Brazilian children, and children living in rural areas as well as for children living in marginalized urban areas. The Committee further highlighted the decrease in child mortality. Nevertheless, the Committee is still concerned about indigenous children, particularly the Guarani, who do not have adequate access to medical services and sanitation in overcrowded settlements. Thus, it asked Brazil to provide the Special Secretariat for Indigenous Health with adequate human, technical and financial resources to guarantee access to quality health services for all indigenous women and children and strengthen its efforts to ensure that Family Health Support Units are accessible for indigenous children.
Then the Committee congratulates Timor-Leste for its commitment to provide access to primary health care free to all nationals of the state party and the decrease in the under-five mortality rates. Nevertheless, the insufficient number of skilled health care professionals, poor health standards and insufficient formal health services in all parts of the states concern the Committee as they are factors influencing the still high infant and under 5 child mortality levels and very high maternal mortality rate. Therefore, the Committee called Timor-Leste to increase the quantity and coverage of health care professional and midwives for child birth to ensure access to children to of quality health services and expand the community birth preparedness initiative to increase the number of deliveries at health care facilities.
Malnutrition and safe drinking water
Regarding Bangladesh, the Committee asked the state party to pay specific attention to anaemia and malnutrition, particularly in rural and remotes areas, as well as in slums. The Committee specifically recommended Brazil to ensure that children affected by malnutrition receive adequate food and safe drinking as indigenous children, particularly the Guarani, continue to be subjected to contaminated water and food.
As there are high levels of obesity among children in Brazil and their vulnerability to unregulated advertising promoting unhealthy food, the CRC Committee requested Brazil to take all necessary measures to address obesity by promoting healthy lifestyles and raising awareness of healthy nutrition. Moreover, the Committee recommended the state party to establish a regulatory framework for advertisement with a view to protecting children from misleading advertising.     
Regarding Timor-Leste, the Committee expressed concern over the persistent high levels of malnutrition, micronutrient deficiencies, and stunting rates, the high number of children not fully immunized and the insufficient access to safe drinking water, basic sanitation and. In consequence, the Committee called for strengthened efforts and increase resources to ensure that homes, schools and public facilities have adequate WASH facilities, in particular in rural areas, as well as continuation of interventions to prevent stunting, wasting and undernourishment. It also recommended the state party to raise awareness of nutrition issues and promote overall nutrition education, including through the revised National Nutrition Strategy. Finally, regarding safe drinking water the Committee called Timor-Leste to improve the access to clean water facilities by strengthening government coordination, developing an action plan and providing the Department of Water Supply of the Ministry of Public Works with adequate staff and budget, in particular for rural communities.

HIV/AIDS
The Committee addressed the issue of mother-to-child HIV transmission by requesting Bangladesh to promote the measures in place to prevent it and develop a roadmap, and to improve the follow-up treatment for HIV/AIDS infected mothers and their infants in order to ensure early diagnosis and early initiation of treatment. Besides, it also called for improvement of access and coverage of antiretroviral therapy and prophylaxis for HIV-infected pregnant women, and access to quality, age-appropriate HIV/AIDS, sexual and reproductive health services.

Breastfeeding national strategy
Timor-Leste was commended for its plans to implement the Health Sector Strategic Plan, as well as various strategies relating to immunization, nutrition and child and adolescent health. However it highlighted the low levels of exclusive breastfeeding and recommended the state party to approve and implement the Timor-Leste Breastfeeding Policy.
Breastfeeding protection
The Committee noted with appreciation that Bangladesh adopted a new law on banning of marketing of breastmilk substitutes in 2013.
The Committee further recommended Brazil to strengthen the monitoring of existing marketing regulations relating to breastmilk substitutes as the Committee is alarmed by the widespread marketing of formula for infants and inadequacies in monitoring compliance with legislation on marketing of breastmilk substitutes.
Timor-Leste was urged to approve and implement the Code of Marketing of Breastmilk Substitutes, Breastmilk Supplements and related Products as well as increase the number of health centres supporting these practices while United Arab Emirates was requested to regulate the marketing on unhealthy food, especially when such marketing is focused on children and regulate their availability in schools and other places.
Finally, Timor-Leste was encouraged to increase the current maternity leave from three months to six months
Breastfeeding promotion
The Committee urged Brazil to improve the practice of exclusive breastfeeding for the first six months, through awareness-raising measures including campaigns, information and training for relevant officials, particularly staff working in maternity units and parents, while Timor-Leste was called to continue targeted interventions to prevent stunting, wasting and undernourishment, including the promotion of infant and young child feeding practices.
Finally, United Arab Emirates was called to continue to promote positive breastfeeding practices while refraining from imposing obligations on mothers whose free choice to breastfeed or not should always be respected. 
Breastfeeding support

As mentioned above, Brazil was urged to provide information and training for relevant officials, particularly staff working in maternity units and parents, in order to improve the practice of exclusive breastfeeding for the first six months, while Timor-Leste was called to improve training and access to healthcare professional and midwives for child birth, to continue ensuring adequate financial and human resources with respect to neonatal, prenatal and postnatal case, especially in rural areas, and to increase the number of health centres supporting Timor Leste Breastfeeding Policy and Code of Marketing. 
Table 1. CRC Committee - Session 70/2015 – Summary of Concluding Observations on IYCF


Country
IBFAN report
Summary of specific recommendations on IYCF
Session 70 – September - October 2015
1
Bangladesh
(5th periodic report)
yes
Indirect – General measures of implementation (§13a,15,55a-c): Substantially increase budget allocations to all social sectors, in particular, education, health and child protection, including earmarked resources for children in disadvantaged or vulnerable situations who may require affirmative social measures […]; the data should cover all areas of the Convention and should be disaggregated, among others, by age, sex, disability, geographic location, ethnic origin and socioeconomic background in order to facilitate analysis on the situation of all children, particularly those in situations of vulnerability […] ; allocate sufficient financial and human resources to health services in all regions and upazilas to eliminate regional disparities in the provision of health services […]; implement and apply the OHCHR Technical guidance on child mortality (A/HRC/27/31); develop and implement policies to improve health infrastructures, and intensify training programmes for all health professionals. HIV/AIDS (§63a-d): promote 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 […] ; improve access and coverage of antiretroviral therapy and prophylaxis for HIV-infected pregnant women; improve access to quality, age-appropriate HIV/AIDS, sexual and reproductive health services. Nutrition  (§55b) […] pay specific attention to anemia and malnutrition, in particular in rural and remote areas, as well as in slums.
2
Brazil
(2nd-4th periodic report)
yes
Indirect – General measures of implementation (§12b, 12d,14): in the light of its general comment No. 5 (2003) on General measures of implementation, the Committee urges the State party to improve its data collection system […]; conduct a comprehensive assessment of the budget needs of children and increase the budget allocated to social sectors […]; define specific budgetary lines for indigenous children, children living in marginalized urban areas, including favelas, and rural areas in the North and Northeast of the State party, as well as children with disabilities […]. Children’s rights and the business sector (§22 a-c) : establish a regulatory framework for the impact of the business sector on children´s rights, particularly the mining and construction sector, agribusinesses, food enterprises, and large-scale sporting/entertainment events […] to ensure that their activities do not negatively affect human rights or endanger environmental and other standards […]; ensure effective implementation by companies of international and national environment and health standards, effective monitoring of implementation of these standards, and appropriate sanctions and/or remedies when violations occur; 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. Health and Health Services (§54, 56a-c): increase investment in existing programmes aimed at improving the reach and quality of health services with a view to ensuring access to quality health services for indigenous children, Afro-Brazilian children, children living in rural areas as well as for children living in marginalized urban areas; provide the Special Secretariat for Indigenous Health (SESAI) with adequate human, technical and financial resources to guarantee access to quality health services for all indigenous women and children, including those living in informal settlements; strengthen its efforts to ensure that Family Health Support Units (NASF) are accessible for indigenous children; allocate adequate human, technical and financial resources to the Indigenous Nutritional Supervision System (SISVAN) in order to ensure that children affected by malnutrition receive adequate food and safe drinking water. Nutrition (§58): […] take all necessary measures to address obesity among children, including by promoting healthy lifestyles and raising awareness of healthy nutrition […] establish a regulatory framework for advertisement, with a view to protecting children from misleading advertising.  HIV/AIDS (§62a) : improve access to quality, age-appropriate HIV/AIDS, sexual and reproductive health services. Environmental Health (§66a-e): ensure that existing laws and regulations concerning the use of agrochemicals are strictly enforced […]  expedite the evaluation of agrochemicals by allocating the necessary human, technical and financial resources to the Agência Nacional de Vigilância Sanitária (Anvisa) and expeditiously ban agrochemicals that have been widely banned in other countries; improve water supply infrastructure and guarantee access to safe drinking water […]; expeditiously end illegal mining activities, particularly in the Tapajós-Xingu area, and design and implement measures to mitigate the negative effects of these activities[…]; undertake awareness-raising programmes for communities living in affected areas to minimize the risks of being exposed to contaminated water and food and for users of such agrochemicals; conduct a comprehensive assessment of the effects of polluted air, water and soil on children’s health and use it as a basis for developing and implementing a strategy to remedy the situation and monitor the levels of air, water and soil pollutants as well as pesticide residues in the food chain.
Direct68): […] improve the practice of exclusive breastfeeding for the first six months, through awareness-raising measures including campaigns, information and training for relevant officials, particularly staff working in maternity units, and parents […] strengthen the monitoring of existing marketing regulations relating to breast milk substitutes.
3
Timor-Leste
(2nd-3rd periodic report)
yes
Indirect - General measures of implementation (§ 14a, 14c, 17): establish a budgeting process, which includes child rights perspective and specifies clear allocations to children in the relevant sectors […]; establish mechanisms to monitor and evaluate the efficacy, adequacy and equitability of the distribution of resources allocated to the implementation of the Convention; […] expeditiously improve its data collection systemThe data should cover all areas of the Convention and be disaggregated by age, sex, disability, geographic location, ethnic origin and socioeconomic background […]. Health and Health Services (§47a, 47e-g) continue to strengthen efforts to ensure adequate financial and human resources, in particular with respect to the provision of neonatal, prenatal and post natal care, especially in rural areas; strengthen efforts and increase resources to ensure that homes, schools, and other public facilities have adequate WASH facilities, in particular in rural areas […] ; improve access to clean water facilities by strengthening government coordination […]
Nutrition (§47c): continue targeted interventions to prevent the stunting, wasting and undernourishment of children […] continue to raise awareness of nutrition issues, as well as promote overall nutrition education, including through the revised National Nutrition Strategy;

Direct (§47b, 47c, 47d, 47h): improve training and access to healthcare professional and midwives for child birth, and expand the community birth preparedness initiative to increase the number of deliveries at health care facilities; […] the promotion of proper infant and young child feeding practices […]; increase the quantity and coverage of health care professionals to ensure access to children of quality health care services, including immunizations in all districts […]; approve and implement the Timor Leste Breastfeeding Policy and the Code of Marketing of Breastmilk Substitutes, Breastmilk Supplements and Related Products, increase the number of health centres supporting these practices, and increase the current maternity leave from three months to six months to support appropriate infant feeding.