Croatia at the CRC: Job Insecurity for Working Mothers and Low Rate of Exclusive Breastfeeding

On the 15th September 2014, the Committee on the Rights of the Child considered the combined Third and Fourth Periodic Report of the Republic of Croatia on the situation of the implementation of the Convention on the Rights of the Child in the country. The delegation of Croatia was led by the Assistant Minister for Social Policy, Strategy and Youth, Ministry of Social Policy and Youth, Mr. Hrvoje Sararić and includes the Senior Expert Advisor, Service for Children and Family, Ministry of Social Policy and Youth, Ms. Sabina Morosini Turčinović.

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

General overview of breastfeeding in Croatia

Information related to breastfeeding is not part of the national data collection survey. Such data are instead based on reports prepared by individual institutions or researchers.

In Croatia breastfeeding is generally considered the appropriate and desirable way to feed a newborn baby. Indeed, the rate of early initiation of breastfeeding is high (98%-99% in 2008-2009 and 91%-94% in 2011). However, there is a lack of awareness of the benefits of exclusive breastfeeding and the risks associated to formula feeding. This leads to premature cessation of breastfeeding. Indeed, the rate of exclusive breastfeeding at 6 months is very low (14.8%). Finally, Croatia lacks also of human milk banks, as there are none in the country.

In 2006 a National Breastfeeding Committee (NBC) was established by the Ministry of Health. In 2007 the National Program for Breastfeeding Protection and Promotion was completed by the NBC. However, such Program has not been implemented yet.

The Ordinance on Baby Foods for Infants and Young Children and Processed Cereal-Based Foods for Infants and Young Children (OJ 74/08) transposes the International Code of Marketing of Breastmilk Substitutes for the first time into a national legal measure. However, an appropriate monitoring system is missing.

It is worthwhile to mention that numerous courses on breastfeeding are available for health professionals in Croatia, albeit on a voluntary basis. However, the knowledge, attitudes and practices of most health professionals are still deficient.

The Baby-Friendly Hospital Initiative (BFHI) was successfully revived by UNICEF Croatia in 2006. As a consequence, 30 out of 31 maternity facilities are currently designated as ‘Baby-Friendly’. However, there has been a rapid drop in ‘Baby-Friendly’ standards following the BFHI designation.

Croatian job market (in both private and public sectors) discriminates against women. In particular, contracts are often terminated when the woman becomes pregnant or gives birth. By contrast, different kinds of maternity leave are available. Moreover, during the first 12 months after the child’s birth, mothers who are breastfeeding are entitled to two hours absence from work.

Plans of action and accompanying materials need to be prepared and finalised by the NBC and the Ministry of Health in order to be capable of coping with future emergencies.

Discussion on infant and young child feeding

The Committee specifically addressed the issue of breastfeeding. It welcomed the increase of mothers who choose to breastfeed (95%). However, it expressed concern with regard to baby food companies’ marketing and advertising concerning formulas and breastmilk substitutes.

The Delegation of Croatia pointed out the adoption in 2012 of a specific program aiming at promoting breastfeeding as the best practice and encouraging women to breastfeed. It also stressed the existence of a Committee for the Promotion and Protection of Breastfeeding.

Croatia expressed satisfaction with regard to the results brought by such a Program, especially in relation to breastfeeding in the first 3 months of life. Indeed, according to the Delegation, in the 3-year period of implementation of such Program, exclusive breastfeeding have increased dramatically. 95% of women exclusively breastfeed during the first days, whilst this rate decreases with time going by. In particular, 40% of women exclusively breastfeed after six months.

By addressing a specific concern of the Committee, the Delegation clarified that children can stay day and night with mothers who breastfeed while in hospitals.

The Delegation highlighted then the existence of a group for support led by nurses which gathers women and advised them in relation to breastfeeding. Furthermore, 8 counselling teams exist, which are well-recognised also outside the country.

It was acknowledged that until 2007, women in hospitals used to receive the so-called “happy baby” package, which contained advertisement for baby formulas. However, in 2007, a guideline was adopted prohibiting this package as well as other kind of advertisement in hospitals. Nonetheless, in the knowledge of the Delegation, this kind of advertisement is currently made in pharmacies, shopping malls and other places. Croatia declared its willingness to persist with the above-mentioned Program and continue to encourage breastfeeding. It also asserted that aggressive advertising will be prohibited, even outside the hospital system.

Furthermore, the Committee asked more generally for further information with regard to children’s rights and the business sector. Mr. Sararić, the Head of the Delegation, acknowledged that a balance between personal and working life is difficult in Croatia. However, the Croatian Government is endeavouring to better tackle this issue through the National Family Policy which is still under progress. Relevant measures need to be identified yet. In particular, Mr. Sararić mentioned the necessity to raise awareness about the strong need of family-working life balance within the business sector.

Concluding Observations

In its Concluding Observations, the Committee made several indirect recommendations. With regard to the general measures of implementation, it urged Croatia to “expedite the adoption of the new National Strategy for Protection and Promotion of the Rights of the Child for 2014-2020 and ensure that it includes concrete goals and measures” (§9) and “to expeditiously improve its data collection system” (§15).

Regarding health issues, the Committee recommended that Croatia “strengthen its efforts to ensure that all children enjoy equal access to health services” as well as “allocate adequate human resources to maintain the quality of health care”.

Additionally, the Committee issued direct recommendations related to infant and young child feeding (§ 49). It requested Croatia to “take action to improve the practice of exclusive breastfeeding, through awareness-raising measures, the provision of information and training to relevant officials, particularly staff working in maternity units, and parents”. It also recommends that the Government “take all the necessary legislative and structural measures, including monitoring, to control the marketing of breast-milk substitutes”.

Morocco at the CRC: Important Decline of the Exclusive Breastfeeding Rate

On the 3rd September 2014, on the occasion of the review of Morocco’s combined third and fourth periodic reports on the situation of the implementation of the Convention on the Rights of the Child in the country, IBFAN presented an alternative report to inform the Committee on the Rights of the Child about the situation of infant and young child feeding in the Kingdom.

General overview of breastfeeding in Morocco

The report highlighted the decline of exclusive breastfeeding of 23.3% between 1992 and 2011 (51% in 1992 and 27.8% in 2011). In 2005, the Ministry of Health has even declared that the decline of breastfeeding constitutes a concern of public health. An overall lack of knowledge about optimal breastfeeding practices has also been pointed out; indeed, more than 2 infants out of 3 are not breastfed within one hour after delivery, while the rate of predominant breastfeeding under 6 months of age is higher (45.5%) than the rate of exclusive breastfeeding, notwithstanding that predominant breastfeeding has been associated with an increased risk of diarrhoea. The addition of sugar in infants’ meals has also been highlighted as problematic. Finally, regional disparities have addressed: in rural areas, mothers are more likely to breastfeed, while in urban areas, breastfeeding rates are lower and bottle-feeding is more common.

In Morocco, only few provisions of the International Code on the Marketing of Breastmilk Substitutes have been implemented into law, despite the prohibition of the distribution of free baby food samples since 1992. Furthermore, some 43% of the hospitals and maternities of the country are certified as “baby-friendly” (43 out of 112). In addition, the report reflected the concern raised by the initiative “Rising to the Challenge” (convened by WHO, UNICEF and UNFPA in collaboration with other partners) about the lack of commitment of medical and paramedical institutions in raising awareness of the health professionals on the public health approaches and on the Ministry of Health primary health care guidelines in a sustainable manner and with a good standard of quality.

Finally, the report pointed out some others concerns related to infant and young children feeding: the absence of maternity leave for women working in the informal sector, the lack of knowledge on different ways of mother-to-child transmission of HIV as well as the lack of information on the current status of the 2008 pilot programme “Prevention of mother-to-child transmission of HIV”, and the absence of information on any emergency preparedness plan to ensure integrated response to protect and support breastfeeding in case of emergencies.

Discussion on infant and young child feeding

The Committee expressed concerns about the fact that only 43 hospitals out of 112 are certified as "baby-friendly" as well as about the fast decrease of the exclusive breastfeeding rate in the country. The Committee emphasized the emotional attachment between mothers and their child thrived through nursing and asked what are the measures set up by the government in order to support young mothers to breastfeed. In addition, the Committee highlighted the fact that in Morocco, only few provisions of the Code have been implemented into national legislation.

The Moroccan Delegation first stated that there are persisting differences between rural and urban areas in terms of access to reproductive health services. The government has therefore developed an action plan to improve health care provision in remote areas through hospitals and mobile health care services. The aim is to reach the ratio of 95% of skilled attendant present at birth. In terms of reproductive health, the government has implemented a national strategy and a booklet on this issue has been published in collaboration with the WHO. Regarding breastfeeding, the Delegation indicated that the 2011-2019 national strategy on nutrition focuses among other things on strengthening the nutrition of infants. In addition, the Delegation mentioned the existence of the national plan to encourage breastfeeding. It further stated that a bill aimed at encouraging breastfeeding has been prepared in the framework of the 2012-2016 national plan of action for child health. 

The Committee further asked what is done against companies that advertise their products in hospitals and if there is a national law implementing the Code and protecting breastfeeding against aggressive marketing of breastmilk substitutes.

The Delegation answered that breastfeeding is promoted within health facilities throughout the country.

Concluding Observations

In its Concluding Observations, the Committee made several indirect recommendations. With regard to the general measures of implementation, it urged Morocco “to take all necessary measures to address those recommendations that have not been implemented or not sufficiently implemented and, in particular, those related to data collection” (§7). It also asked Morocco to “ensure that the Integrated Policy on Children encompasses child protection and covers all areas under the Convention and all children” (§13).

Additionally, the Committee draws Morocco’s attention to “its general comment No. 16 (2013) on State obligations regarding the impact of the business sector on children’s rights and especially recommends that the State party examine and adapt its legislative framework concerning legal accountability of business enterprises and their subsidiaries operating in or managed from the State party´s territory” (§23(a)).

With regard to health issues, the Committee recommended that Morocco “ensure that sufficient resources are allocated for the health sector and effectively used, and 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”. It also called the Government to “take more effective measures to address maternal and infant mortality and the nutritional status of young children” (§55 (a)(b)).

However, the Committee did not issued any direct recommendation related to breastfeeding.

Venezuela at the CRC: Strong Legislation but Lack of Data

On the 1^st and 2^nd September 2014, the Committee on the Rights of the Child considered the combined third to fifth periodic reports of Venezuela on the situation of the implementation of the Convention on the Rights of the Child in the country. The Delegation of Venezuela, led by the Minister of Popular Power for Women and Gender Equality (Ministerio del Poder Popular para la Salud, MPPS), Ms. Andreina Tarazón, was constituted of 31 members, including the General Director of the Health Committee of the Ministry of Popular Power for Education, Ms. Asia Yadira Acosta.

IBFAN presented an alternative report to inform the CRC Committee on the situation of infant and young child feeding in Venezuela.

General overview of breastfeeding in Venezuela

The report highlighted a significant deficit in data collection on infant and young child feeding (IYCF). The available data on IYCF are from 2008 and show that more than 70% of children are not exclusively breastfed until 6 months of age while almost 13% are predominantly breastfed until 6 months of age, although it is considered as an inadequate practice. Some 75% of the children are introduced to complementary food before the recommended age of 6 months. In addition, when bottle feeding, the dilution of the powder milk or formula has shown to be inadequate in more than 70% of cases.

Nonetheless, the Government of Venezuela has shown its will to encourage breastfeeding. Firstly, one of the goals set in the “Plan de la Patria Socialista de la Nación 2013-2019” is to increase exclusive breastfeeding by 70%. Secondly, breastfeeding is promoted as a priority by the MPPS and is referred to in the Organic Law on Children and Adolescents Protection (Ley Orgánica para la Protección de Niños y Adolescentes, LOPNA). Thirdly, the International Code of Marketing of Breastmilk Substitutes, as well as the Baby-Friendly Hospital Initiative (BFHI), were formally implemented into national legislation through two ministerial decisions in 2004. However, in 2010, only 17 out of 204 hospitals were certified as ‘baby-friendly’ and violations of the Code can still be detected, such as the use of health claims, promotion of ‘baby competitions’, corporate sponsoring of  medical events.

Regarding training of health professionals, courses on breastfeeding are organized jointly by the Childcare and Paediatricians Venezuelan Society and the UNICEF. Besides, a course on breastfeeding counselling is organized at national level; since its launch, more than 3,000 accredited breastfeeding counsellors have been trained. Finally, the GALACM-UCV breastfeeding support group also gives training courses on breastfeeding. Nevertheless, in 2009, it is of concern that about 35% of surveyed mothers did not receive information on breastfeeding during pregnancy.

In Venezuela, mothers are entitled to a maternity leave that has been increased from 12 to 20 weeks in 2012. Yet, IBFAN report calls for the extension of the maternity leave up to 40 weeks of corrected age for mothers with premature babies.

Regarding IYCF and VIH/AIDS, a programme on the prevention of vertical transmission is carried out in order to ensure the supply of infant formula during the first year of life for children of HIV-positive mothers. Finally, the national legislation states that breastfeeding should be protected in case of emergencies.

Discussion on infant and young child feeding

The Delegation of Venezuela affirmed that a humanist approach is taken in the field of reproductive health and that the government guarantee the provisions of medical services in this field through the programme Barrio Adentro. A specific programme entitled Misión niño Jesús aimed at pregnant women has been implemented.  In addition, the Delegation stated that the government provides support to improve the nutrition of mothers and children, especially by timely supplementation. Finally, it highlighted that 8 human milk banks have been implemented in  the country.

Concluding Observations

In its Concluding Observations, the Committee made several indirect recommendations. With regard to general measures of implementation, it urged Venezuela “to finalize the design of the National Plan of Action for Children and Adolescents (2015-2019)” (§11) as well as “to expeditiously complete and implement its data collection system” (§20).

As far as health issues are concerned, it recommended that Venezuela “collect disaggregated data on children’s health related issues, in particular on child mortality, including under five mortality, maternal mortality, vaccination coverage, nutrition and breastfeeding; allocate adequate human, technical and financial resources to the national public health system; building on data related to the causes, design a strategy to reduce child and maternal mortality, which includes the implementation of the two existing protocols on maternal and neonatal mortality and continue its efforts to reduce malnutrition and increase vaccination coverage” (§53 (a)-(d)). Furthermore, The Committee also addressed the issue of HIV/AIDS mother-to child transmission by requesting the government to “collect disaggregated data on HIV/AIDS related issues, in particular on [...] number of cases of mother-to-child transmissions, [...] and number of children and pregnant women under treatment” and “ensure that all HIV/AIDS positive pregnant women receive adequate treatment” (§61(a),(c)).

The Committee also issued direct recommendations related to infant and young child feeding (§53(e)). It recommended that Venezuela “increase its efforts to promote breastfeeding by developing a comprehensive programme of action to promote exclusive breastfeeding, including training for staff in hospital maternity wards, closely monitor the implementation of the International Code of Marketing of Breast-milk Substitutes and develop awareness raising campaigns”.

Lack of Breastfeeding Promotion, Protection and Support in Saint Lucia (CRC)

On the 6^th of June 2014, the Committee on the Rights of the Child considered the combined second to fourth periodic reports of Saint Lucia on the situation of the implementation of the Convention on the Rights of the Child (CRC) in the country.

IBFAN presented an alternative report to inform the CRC Committee on Saint Lucia's situation on the issue of infant and young child feeding.

General overview of breastfeeding in Saint Lucia

The alternative report highlighted the lack of tracking of key breastfeeding indicators as well as the absence of infant and young child policies and programmes at national level. It has shown that some 20% of caregivers do not know how to prevent diarrhoea, reported to be the one of the main causes of infant and child mortality in the country, while breastfeeding has proven to be one of the most effective intervention to prevent accute diarrhoea. 

Regarding the implementation of the International Code of Marketing of Breastmilk Substitutes, a recent report issued by IBFAN’s International Code Documentation Centre showed that only some provisions of the Code have been implemented on a voluntary basis.

IBFAN's report also raised concerns about the fact that in 2011, UNICEF recorded that no single hospital registered as “baby-friendly” in the country. Finally, the lack of information available on the prevention of HIV/AIDS mother-to-child transmission and on an emergency preparedness plan to ensure integrated response to protect and support breastfeeding in case of emergencies have been emphasized.

Concluding Observations

In its Concluding Observations, regarding the general implementation of the Convention, the Committee urged Saint Lucia to strengthen its efforts to develop and implement a comprehensive national plan of action  […], including specific time-bound and measurable goals and targets to effectively monitor progress in the implementation of child’s rights throughout the country (para 11). The Committee also recalled its previous recommendation about the implementation of a comprehensive and integrated data collection system on children, covering the entire period of childhood up to the age of 18 (para 17).

Regarding health issues, the Committee requested Saint Lucia to continue to strengthen efforts to ensure adequate provision of prenatal and post natal care, as well as address the increasing number of children born with low birth weight, the increasing infant mortality rate, and obesity among children, through awareness-raising efforts, and the reasons for these trends, and to continue the dissemination of health information and the promotion of health education regarding basic child health to all segments of society (para 43).

However, the Committee issued no direct recommendations related to infant and young child feeding. 

Communiqué de Presse : IBFAN-GIFA avance trois bonnes raisons pour soutenir la révision de l’art. 6O al. 2 de l'OLT 1 concernant les pauses allaitement

La Suisse s’est engagée à ratifier la Convention 183 de l’Organisation internationale du Travail (OIT) sur la protection de la maternité. Afin de pouvoir ratifier cette convention, le SECO a proposé une révision de l’art. 60 al. 2 de l’Ordonnance 1 relative à la loi sur le travail (OLT 1) pour se mettre en conformité avec la Convention 183 de l’OIT au sujet des pauses allaitement. Nonobstant, la Fédération des entreprises romandes (FER) ainsi que l’Union Suisse des Arts et Métiers (USAM), organisation faîtière des PME suisses, s’opposent au nouveau projet de loi (Le Courrier, 20 janvier 2014, page 6 ; Le Matin, 23 janvier 2014 ; Courrier de la FER au SECO, 10 janvier 2014). Elles exigent notamment des pauses allaitement plus courtes que celles prévues dans le projet de loi et sont opposés à l’abolition de la différence entre allaitement dans l'entreprise ou à l'extérieur, qui permettrait aux femmes concernées de quitter leur travail plus tôt afin de pouvoir allaiter leur enfant. 

L'Association Genevoise pour l'Alimentation Infantile (GIFA), membre du réseau International Baby Food Action Network (IBFAN) et dont l'expertise en matière d'allaitement est reconnue au niveau international, régional et national, est favorable à la ratification de la convention OIT 183 par la Suisse. Dans cette perspective, elle soutient pleinement la révision de l’art. 60 al. 2 OLT 1 proposée par le SECO pour les 3 raisons suivantes :

1. Les employeurs ont intérêt à rémunérer des pauses allaitement adéquates. De nombreuses études montrent que l’instauration de pauses allaitement adéquates rémunérées réduit l’absentéisme des mères (dont les bébés sont moins souvent et moins longtemps malades), rendent les travailleuses plus fidèles et loyales envers leur employeur (dont elles apprécient le « geste » et s’en souviennent pendant de nombreuses années), augmentent leur productivité, diminuent leurs départs et le tournus au travail, et donnent une image moderne et plus avenante de l’entreprise. Par ailleurs, de telles pauses représentent une charge modeste pour l’entreprise.
2. Des pauses suffisamment longues sont importantes du point de vue physiologique. Le processus de l’allaitement ne saurait être chronométré. Chaque expérience d'allaitement est différente. Il est scientifiquement prouvé que les bébés tètent en moyenne entre 8 et 12 fois par 24 heures les 12 premiers mois, que le lait maternel s’adapte aux besoins de l’enfant et que la fréquence et la durée des tétées varient significativement d’une mère/bébé à l’autre. La longueur des pauses allaitement proposées par le SECO est donc totalement justifiée, et pourrait même être rallongée. La Fondation Suisse pour la Promotion de l’Allaitement Maternel propose d’ailleurs de prolonger de 10 min la durée d'une pause allaitement afin de permettre aux mères de se rendre sur le lieu où elles vont tirer leur lait ou allaiter leur bébé, et pour éventuellement pouvoir se changer (voir prise de position sur www.allaiter.ch).
3. Le nombre et la durée des pauses d'allaitement devraient être adaptés aux besoins particuliers, selon la recommandation 191 de l'OIT qui précise que les pauses quotidiennes d'allaitement devraient pouvoir être prises en une seule fois sous la forme d'une réduction globale de la durée du travail, au début ou à la fin de la journée de travail, pour autant que cela soit réalisable et en accord avec l'employeur et la femme concernée. La recommandation OIT prône également la création de structures pour l'allaitement des enfants dans des conditions d'hygiène adéquates sur le lieu de travail ou à proximité.

Par sa ratification de la Convention des droits de l'enfant (CDE) et la Convention sur l'élimination de toutes les formes de discrimination à l'égard des femmes (CEDAW), la Suisse s'est engagée légalement à adopter des mesures spécifiques nécessaires pour soutenir les femmes et leurs nourrissons au travail, en accord avec la Convention 183 de l'OIT sur la protection de la maternité. Les employeurs, tout comme les citoyens, doivent soutenir ces mesures essentielles pour la santé publique ainsi que pour le bien-être des enfants et des familles.

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A l'intention du lecteur: IBFAN-GIFA est partenaire du Département des Affaires régionales, de l'Economie et de la santé de l'Etat de Genève (DARES) pour le volet promotion de l'allaitement, dans le cadre de la stratégie cantonale de prévention de l'obésité. GIFA est également financé par la Ville et le Canton de Genève dans le cadre d'un projet de protection promotion et soutien de l'allaitement maternel en Afrique 2014-2015. Autres documents utiles: 

- Allaitement au travail: Comment protéger et soutenir vos employées au mieux, GIFA

- Lettre ouverte de GIFA à Liliane Maury-Pasquier, du 8 août 2013 

- En collaboration avec HUG Contrepoids, Fourchette Verte, Service Santé de l'Enfance et de la Jeunesse: campagne et brochures Miam la Vie