Monday 21 October 2013

Human rights recommendations on breastfeeding by the Committee on the Rights of the Child (64th session)

The 64th session of the Committee on the Rights of the Child (CRC Committee) took place in Geneva from 16 September to 4 October 2013. The Committee reviewed the progress of the implementation of the Convention on the Rights of the Child in 7 countries: China, Kuwait, Lithuania, Luxembourg, Monaco Sao Tome and Principe and Tuvalu.
IBFAN submitted 4 alternative reports on the situation of infant and young child feeding for China, Kuwait, Lithuania and Luxembourg. The reports were written in collaboration with IBFAN groups in the countries.
We regret to see that in its concluding observations, the CRC Committee referred specifically to breastfeeding in only 2 out of the 7 countries (China and Tuvalu). In the case of Luxembourg, even if breastfeeding was largely mentioned in the discussion between the CRC Committee and the government delegation, Luxembourg did not receive any recommendation concerning breastfeeding.
Some of the recommendations on health care and on the business sector and its impact on child rights are of relevance for infant and young child feeding and are reported below.
The CRC Committee recommended China and Tuvalu to promote exclusive breastfeeding. It has also stressed the need to establish Baby-Friendly Hospitals (China) and to adopt the International Code of Marketing of Breastmilk Substitutes and resolutions (China, Tuvalu). It also urged Tuvalu to provide training to all health workers about breastfeeding.
The Committee particularly addressed the issue of children affected by contaminated formula in China and recommended the government to strengthen its legislative framework on food and health standard and ensure sanctions and remedies in cases of violation.
An Emphasis has been put on the importance of respecting the right of the child to the enjoyment of the highest standard of health (China, Lithuania, Monaco, Sao Tome and Principe). Countries have been reminded to pay attention to the 2013 General Comment 15 on the right of the child to health, which explicitly recognizes the importance of breastfeeding for the achievement of the right of the child to health. It urges States, in the effort of diminishing infant and child mortality, to devote particular attention to neonatal mortality and suggests, inter alia, to “pay particular attention to ensuring full protection and promotion of breastfeeding practices”. Moreover, “Exclusive breastfeeding for infants up to 6 months should be protected and promoted and breastfeeding should continue together with appropriate complementary foods preferably until two years of age as feasible. States’ obligations in this area are defined in the “protect, promote and support framework”, adopted unanimously by the World Health Assembly” in the Global Strategy for Infant and Young Child Feeding.
Some of the countries are recommended to provide quality training for the health care personnel (and to increase the budget for health programs in general. China is urged to improve health infrastructure as well as availability and accessibility to emergency obstetric and neonatal care, especially in rural and poor areas, in order to prevent child and maternal mortality. Sao Tome and Principe is recommended to undertake surveys in order to understand the causes of maternal mortality and to intensify its efforts to improve access to safe drinking water and sanitation. Lithuania is demanded to ensure maternal care for women who choose to deliver at home and finally, it recommended Monaco to ensure that all children, including non-nationals, enjoy the same access and quality to health services.
A great focus was placed on the need to regulate the impact of the business sector on children’s rights. The CRC Committee drew attention to the 2013 General Comment 16, which specifically calls on States “to implement and enforce internationally agreed standards concerning children’s rights, health and business including the [...] International Code of Marketing of Breast-milk Substitutes and relevant subsequent World Health Assembly resolutions”.

 Countries are recommended to ensure the implementation by companies of both international and national environment and health standards and ensure appropriate sanctions in cases of violations. Countries are also recommended to require companies to undertake assessments of the environmental health-related and human rights impact of their business activities The CRC Committee also focused on the need to prevent mother-to-child HIV/AIDS transmission by improving access to treatment, follow-up treatments and by ensuring early diagnosis, as well as early initiation of treatment.

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Wednesday 2 October 2013

Monaco at the Committee on the Rights of the Child

Monaco presented its consolidated 2nd and 3rd periodic report on the situation of the implementation of the Convention on the Rights of the Child in the country. The consolidated 4th to 6th periodic report is expected by January 2019.
IBFAN did not present any report.
Discussion on infant and young child feeding
The issue of breastfeeding has not been addressed by the CRC Committee during its dialogue with the government delegation. The delegation instead mentioned health care issues and claimed that the Government has established prevention and information programmes to ensure the healthy upbringing of children. Pregnant women receive a medical follow-up and enjoy a special regime at work.
Concluding Observations

In its Concluding Observations, the CRC Committee has made no specific recommendation on breastfeeding to the government delegation.

In par. 37 and 38 regarding health care and services, the Committee asked Monaco to pay attention to its General Comment no. 15 (2013), which insists on “the right of the child to the enjoyment of the highest attainable standard of health, and recommends that the State party undertake all necessary measures, including legislative measures, to ensure that all children, including non-nationals, enjoy the same access and quality of health services”.

Tuesday 1 October 2013

Breastfeeding and child rights in Luxembourg

Luxembourg presented its consolidated 3rd and 4th periodic report on the situation of the implementation of the Convention on the Rights of the Child in the country. The combined 5th to 6th periodic report is expected by October 2019.
IBFAN submitted an alternative report on the situation of infant and young child feeding in Luxembourg. The report highlights the fact that breastfeeding rates are insufficient. Only 6% of infants are exclusively breastfeeding during the first 6 months; this rate has indeed decreased since 2001. In 2005, the government of Luxembourg assured it will establish a national plan for promoting and protecting breastfeeding. Until now two plans have been adopted, one between 2006 and 2010 and the other between 2011 and 2015. Unfortunately, the action plan has not been backed with sufficient budget, leading to restricted implementation. More and more women stop breastfeeding their children before they reach 6 months. The report also underlines the fact that only half of the four maternity hospitals are baby-friendly, while there is a lack of information to mothers about breastfeeding from midwives and breastfeeding counselors. The report states that the implementation of the International Code of Marketing of Breastmilk Substitutes and resolutions is weak as it conforms to the EU Directive 2006/141/EC and not to the WHO Code. Concerning maternity protection at work, breastfeeding breaks are paid by the employer and women need to present a medical certificate for the whole duration of breastfeeding. This may lead certain women to feel pressured not to ask for the break or not taking them for the entire breastfeeding period, which in turn could explain the decreasing rate of exclusive breastfeeding at 6 months.
Discussion on infant and young child feeding
During the dialogue with the government delegation, CRC Committee has raised questions on breastfeeding. The Committee members pointed to the fact that exclusive breastfeeding is practiced by always fewer women. They asked whether health professionals receive training on breastfeeding, and on the impact of cesarean section on breastfeeding rates. The Committee members asked whether promotion of breastmilk substitutes is authorized in hospitals. They highlighted the fact that the promotion of infant formula in hospitals, and lack of regulation of their marketing together with a lack of support to understand the importance of exclusive breastfeeding up to 6 months, can undermine the successful breastfeeding by mothers, and recommended to Luxembourg to have strong regulations on the marketing of breastmilk substitutes coupled with a good monitoring of the Code and resolutions, as well as adequate maternity protection for working women so that mothers are really supported to breastfeed. The Committee also addressed the need to turn all four hospitals into baby-friendly.

The Luxembourg delegation reported that concerning the decreasing rate of exclusive breastfeeding, it is mainly women of low social and economical background who stop more and more breastfeeding their children after 6 months. The government of Luxembourg highlighted the fact that it is currently working in collaboration with international partners on the project to change the image of breastfeeding in order to convince mothers to continue breastfeeding their child until 6 months.
Concerning the Baby-Friendly Hospital Initiative, the delegation of Luxembourg said that one of the objectives of the national programme is to put BFHI in the national criteria for maternity units.

Concluding Observations

Although issue related to breastfeeding such as the BFHI, the marketing breastmilk substitutes, adequate budgeting of the national action plan and maternity protection were tackled during the Committee, we regret to see that no recommendations on this issue in the Concluding Observations were given to Luxembourg. 
For more information on breastfeeding in Luxembourg please see