Wednesday 21 January 2015

Uruguay at the CRC: Lack of Monitoring of the Legislation Implementing the Code

On January 19th and 20th, 2015, the Committee on the Rights of the Child considered the combined third to fifth periodic report of Uruguay on the situation of the implementation of the Convention on the Rights of the Child in the country. The Uruguayan delegation was led by Mrs. Alejandra Costa, Director for Human Rights and Humanitarian Law at the Ministry of Foreign Affairs.

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

General overview of breastfeeding in Uruguay

The report outlined that although the rate of exclusive breastfeeding under 6 months is high (65%), some 4 children out of 10 are not breastfed within an hour after birth, which questions the quality of the counselling and support received by mothers in maternities. Besides, more than 7 children out of 10 are not breastfed until the age of 2 years, despite the recommendations of the World Health Organization.

Regarding protection and support of breastfeeding, IBFAN noted that the National Breastfeeding Standard (NNLM) is not fully implemented as many health workers are not trained on its content, including on the InternationalCode on Marketing of Breastmilk Substitutes and the guidelines “Buenas Practicas de Alimentacion del lactante y del nino pequeño”. In addition, there is no monitoring mechanism of the legislation implementing the International Code.

The IBFAN report also highlighted that in 2009-2010, only 35% of the maternities of the country were certified as “baby-friendly” and that the Human Milk Bank receives in-kind donations from Nestlé, which can lead to situations of conflict of interest.

Finally, the report noted that the maternity leave does not allow mothers to breastfeed exclusively for 6 months, and that mothers working in the informal sector are not covered. There are no training courses on HIV and infant feeding for health professionals and there is no national plan to protect and support breastfeeding in case of emergencies.

Discussion on infant and young child feeding

Questioned on the issue of maternal mortality, the Uruguayan delegation responded that measures are taken to ensure that all pregnant women have access to health and that early checkups are carried out. Majority of deliveries occur in institutions and the government has taken action to prevent avoidable maternal deaths within the current national action plan. The next action plan should also cover the issue of nutrition of pregnant women, which is not included in the current action plan.

On the issue of breastfeeding, the Committee first congratulated Uruguay for the implementation of the International Code of Marketing of Breastmilk Substitutes. However, it noted that the International Code is not yet fully implemented and that no monitoring mechanism is in place. It also asked for more information on the training of health professionals regarding optimal breastfeeding practices. It expressed concern about Nestlé’s donations received by Human Milk Bank and deplored the fact that only 35% of the maternities of the country are complying with the requirements of the Baby-friendly Hospital Initiative. Finally, the Committee regretted that women working in the informal sector are not allowed to maternity leave benefits and it stressed the need for Uruguay to adopt a plan to protect and support breastfeeding in case of emergencies.

The Uruguayan delegation answered that the maternity leave has been recently extended to 14 weeks and that after the third month of leave, parents can decide whether the father will take up the leave. However, the delegation admitted that informal workers are not allowed to these benefits. Regarding monitoring of the legislation implementing the International Code, the delegation explained that the government is currently working with UNICEF to develop such a monitoring mechanism. In regard to the implementation, the delegation noted that an initiative called “Good eating habits during breastfeeding” has been developed, as well as a strategy, and stressed the fact that breastfeeding rates have been improved (from 20% in the 1990s to 65% today). 

After follow-up questions from the Committee, the delegation again stressed that monitoring of the legislation implementing the Code is the main challenge for the government regarding breastfeeding. The delegation also admitted that the Human Milk Bank, which is under supervision of the Ministry of Health, has received glass jars to store the breastmilk from Nestlé and that these jars, which cannot be bought on the national market, are free from any advertisement. No funds from the industry are accepted. The delegation added that Uruguay has developed a joint network of human milk banks with Brazil in order to ensure that all children, especially underweight children, have access to breastmilk.

Concluding Observations

In its Concluding Observations, the Committee made recommendations indirectly related to infant and young child feeding, however it did not refer specifically to breastfeeding. Regarding health and health services, the Committee urged Uruguay to “strengthen its efforts to ensure access to quality health services by all children, particularly children living in the most disadvantaged and remote areas of the country”, as well as to “develop policies and programmes to address chronic malnutrition and anaemia” (§ 46).

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